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Zhang A, Fan N, Zhang X, Guo H, Zhou Y, Zeng L, Lin Y, Jiang X. Endoscopic retrograde appendicitis therapy. Therap Adv Gastroenterol 2024; 17:17562848241275314. [PMID: 39372040 PMCID: PMC11450793 DOI: 10.1177/17562848241275314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/26/2024] [Indexed: 10/08/2024] Open
Abstract
Endoscopic retrograde appendicitis therapy (ERAT) is a novel and minimally invasive technological alternative for the management of acute or chronic appendicitis. Through endoscopic appendiceal intubation, obstructions such as appendiceal feces and parasites within the appendiceal lumen can be effectively eliminated, leading to patient recovery. Additionally, in cases where the orifices are swollen or complicated appendicitis is present, a stent may be inserted following appendiceal flushing. Due to the utilization of endoscopy for accessing the orifices of the appendix in order to alleviate appendiceal obstruction, patients were able to avoid undergoing appendectomy and experienced a reduced likelihood of recurrence when compared to antibiotic therapy. Additionally, the ERAT provided alternative options for individuals with appendicitis and comorbidities. Recent advancements in techniques, such as the "mother-baby" endoscopic system and the use of microbubble contrast agents, have expanded the range of indications and the eligible patient populations. The objective of this review is to present a comprehensive overview of the development, procedural aspects, therapeutic principles, treatment efficacy, therapeutic applications, and potential complications associated with ERAT.
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Affiliation(s)
- Anding Zhang
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
| | - Na Fan
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
| | - Xinhui Zhang
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
| | - Hongwei Guo
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
| | - Ying Zhou
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
| | - Lingchao Zeng
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
| | - Yan Lin
- Department of Pediatrics, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
| | - Xun Jiang
- Department of Pediatrics, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), No. 1 Xinsi Road, Xi’an, Shaanxi 710038, China
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Feng SJ, Zhou YF, Yang JF, Shen HZ, Cui GX, Zhang XF. Is appendoscope a new option for the treatment of acute appendicitis? World J Gastroenterol 2024; 30:3386-3392. [PMID: 39091716 PMCID: PMC11290393 DOI: 10.3748/wjg.v30.i28.3386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/11/2024] [Accepted: 07/01/2024] [Indexed: 07/24/2024] Open
Abstract
Acute appendicitis is a common surgical emergency. It is commonly caused by obstruction of the appendiceal lumen due to fecaliths, tumors, or lymphoid hyperplasia. For over a century, appendectomy has been the primary treatment for acute appendicitis. Abraham Groves performed the first open appendectomy in 1883. In 1983, Kurt Semm completed the first laparoscopic appendectomy, heralding a new era in appendectomy. However, appendectomy is associated with certain complications and a rate of negative appendectomies. Studies have suggested controversy over the impact of appendectomy on the development of inflammatory bowel disease and Parkinson's disease, but an increasing number of studies indicate a possible positive correlation between appendectomy and colorectal cancer, gallstones, and cardiovascular disease. With the recognition that the appendix is not a vestigial organ and the advancement of endoscopic te-chnology, Liu proposed the endoscopic retrograde appendicitis therapy. It is an effective minimally invasive alternative for treating uncomplicated acute appendicitis. Our team has developed an appendoscope with a disposable digital imaging system operated through the biopsy channel of a colonoscope and successfully applied it in the treatment of appendicitis. This article provides an overview of the progress in endoscopic treatment for acute appendicitis and offers a new perspective on the future direction of appendiceal disease treatment.
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Affiliation(s)
- Shu-Jiong Feng
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
| | - Yi-Feng Zhou
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
| | - Jian-Feng Yang
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
| | - Hong-Zhang Shen
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
| | - Guang-Xing Cui
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
| | - Xiao-Feng Zhang
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
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Duan C, Li Y, Ma J, Song Y, Zhou L. The Impact of Laparoscopic Appendectomy and Open Appendectomy on B7-H3-Mediated Intrinsic Immune Response in Children with Acute Suppurative Appendicitis. J Inflamm Res 2024; 17:1577-1587. [PMID: 38495342 PMCID: PMC10941988 DOI: 10.2147/jir.s446199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/01/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose Surgery impairs immune function and increases postoperative complications. B7H3, a co-stimulatory molecule, plays a crucial role in immune regulation. The present study examined the impact of B7H3 on the postoperative immune response in children with acute suppurative appendicitis (ASA) by comparing preoperative and postoperative B7H3 levels in laparoscopic surgery (LA) and open appendectomy (OA). Patients and Methods 198 pediatric ASA patients were enrolled. The researcher group performed LA, while the control group performed OA. Perioperative time, recovery time of gastrointestinal function, time to pass gas, length of incision, and length of hospitalization were compared in the perioperative period. Additionally, an ELISA assay was conducted to examine the levels of inflammatory factors and B7H3 and CD28. Short-term postoperative complications were also evaluated. Results Compared with the control group, the research group had a short operative time, gastrointestinal function recovery time, gas time, and hospitalization time. The short-term complication rate was significantly lower in the research group. More importantly, B7H3 and CD28 were insignificantly different preoperatively, but they were all reduced postoperatively. Moreover, the reduction was more pronounced in the research group. The same results were noted in inflammatory factors and immune markers, which were non-significant different preoperatively and were typically reduced postoperatively, particularly in the research group. Finally, postoperative B7H3 was positively correlated with both inflammatory factors and immune cell levels. Conclusion B7H3 was reduced in both postoperative periods, and the reduction was more pronounced in the LA group. B7H3 may be involved in postoperative recovery by modulating postoperative inflammation and immune responses.
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Affiliation(s)
- Chunsheng Duan
- Department of Pediatric Surgery, Xingtai People’s Hospital, Xingtai, Hebei, 054000, People’s Republic of China
| | - Yuan Li
- Department of Pediatric Surgery, Xingtai People’s Hospital, Xingtai, Hebei, 054000, People’s Republic of China
| | - Jiansu Ma
- Department of Pediatric Surgery, Xingtai People’s Hospital, Xingtai, Hebei, 054000, People’s Republic of China
| | - Yanglin Song
- Department of Pediatric Surgery, Xingtai People’s Hospital, Xingtai, Hebei, 054000, People’s Republic of China
| | - Lixia Zhou
- Department of Pediatric Surgery, Xingtai People’s Hospital, Xingtai, Hebei, 054000, People’s Republic of China
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