Diagnosis And Treatment Of Acute And Chronic Inflammation Of The Appendix By Endoscopic Retrograde Appendicitis Therapy

Background and Objective The current treatment of acute and chronic appendicitis is mainly based on surgical resection or conservative treatment of internal medicine,which has lasted for 200 years.Endoscopic Retrograde Appendicitis Therapy(ERAT)is a new technology for the treatment of acute appendicitis.Inspired by endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of acute suppurative cholangitis,professor Bingrong Liu proposed the feasibility and effectiveness of endoscopic treatment for acute appendicitis in 2012 and later on carried out a multi-center study to promote it.In this study,patients with appendicitis received ERAT in our hospital were collected and analyzed to explore the diagnostic value of ERAT for acute and chronic inflammation of the appendix.Methods The research is divided into three parts.The first part is for patients with atypical acute appendicitis.From January 2015 to December 2016,in Jiangsu Province Hospital,41 patients suspected of acute appendicitis were divided into the test group and the control group.The patients in the test group were treated with ERAT,and the control group was treated with antibiotics.The number of days of abdominal pain relief and the final surgical resection rate were compared between the two groups.SPSS19.0 software was used for statistical analysis of the results.P<0.05 had statistical difference.The second part mainly discusses the value of ERAT in the diagnosis and treatment of chronic appendicitis.The data of 42 patients with suspected chronic appendicitis who underwent ERAT in our hospital from January 2015 to May 2017 were collected,and a retrospective follow-up study was conducted to compare the sensitivity,specificity,positive pretest value(PPV),negative predictive value(NPV)and accuracy of ERAT,CT and barium enema(BE)for the diagnosis of chronic appendicitis.Final efficacy of ERAT would also be evaluated.The third part mainly discusses the value of ERAT in the treatment of periappendiceal abscess.From September 2015 to May 2017,8 cases of periappendiceal abscess in our hospital were diagnosed by abdominal ultrasound or CT examination,showing mass or exudate at right lower quadrant or around the appendix.Fenestration of ileocecal uplift mucosa was found to fluctuate significantly and to secrete with pus by the stent.All the patients after the treatment were observed with clinical conditions,reviewed by the abdominal ultrasound and followed up.Results 1.Of the 17 patients in the test group,16 were diagnosed as acute appendicitis.After ERAT,2 cases were resected by surgical resection and the resection rate was 12.5%(2/16);24 cases in the control group had 10 cases of surgical excision after antibiotic treatment,of which 1 cases had appendix perforation and the resection rate was 41.7%(10/24).The relieving time of abdominal pain and surgical resection rate of the test group was significantly lower than that of the control group and the difference was statistically significant(=3.889,P < 0.05).2.Among all patients,32 agreed for CT,and we compared the outcomes of ERAT with those of CT in terms of sensitivity(100% vs.53.3%),PPV(93.8% vs.88.9%),and accuracy(93.8% vs.50.0%).Remaining 10 patients also underwent BE,and we compared the outcomes of ERAT with those of BE in terms of sensitivity(100% vs.80%),PPV(100% vs.100%),and accuracy(100% vs.80%).3.Colonoscopy revealed obvious hyperemia and swelling of the open appendix in all 8 patients.The contrast medium was found concentrated and indiffusible around the appendiceal cavity.Postoperative abdominal pain and abdominal tenderness were relieved obviously.The white blood cells fell to normal level after operation in 6 cases,and the right lower abdominal pain were relieved in 5 cases.Seven patients' palpable masses were disappeared by ultrasound examination a month later and one case recurred two months later.Conclusion ERAT sets the diagnosis and treatment as a whole,relieving the symptoms of the patients quickly and obviously reducing the surgical excision rate of acute appendicitis.It has a high therapeutic value for acute appendicitis and periappendiceal abscess and a high diagnostic value for chronic appendicitis.