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Direct Visualization ERAT Versus Laparoscopic Appendectomy in Adults With Acute Uncomplicated Appendicitis
Sponsor: Changhai Hospital
Summary
This study compares two ways of treating acute uncomplicated appendicitis, which is a mild form of appendicitis. In the Direct Visualization ERAT group, participants will receive Endoscopic Retrograde Appendicitis Therapy (ERAT). This is a minimally invasive, non-surgical treatment that uses a flexible endoscope passed through the colon to reach the appendix, clear the blockage, and drain the infection. In the Surgery group, participants will undergo Laparoscopic Appendectomy (LA), which is the current standard surgical treatment to remove the appendix. The purpose of this study is to determine whether ERAT is as safe and effective as standard surgery for treating uncomplicated appendicitis. Before treatment, each participant will have a CT scan of the lower abdomen with contrast to confirm uncomplicated appendicitis and to rule out any signs of more serious infection. Participants will then be randomly assigned to either the ERAT group or the surgery group, and they will be informed of which treatment they will receive. Regardless of the group, all participants will receive the same supportive care, including pain relief, close monitoring, and a single dose of antibiotics before treatment. After the procedure, participants will stay in the hospital for at least 24 hours for observation. Follow-up will include an outpatient visit at 2 weeks, and telephone follow-ups at 1 month, 3 months, 6 months, and 1 year to monitor recovery and ensure that appendicitis does not recur.
Official title: Direct Visualization Endoscopic Retrograde Appendicitis Therapy (ERAT) Versus Laparoscopic Appendectomy (LA) for Acute Uncomplicated Appendicitis in Adults (E-APPEND): An Open-Label, Multicenter, Randomized Controlled Non-Inferiority Trial
Key Details
Gender
All
Age Range
18 Years - Any
Study Type
INTERVENTIONAL
Enrollment
376
Start Date
2025-11
Completion Date
2027-11
Last Updated
2025-11-17
Healthy Volunteers
No
Conditions
Interventions
Direct Visualization Endoscopic Retrograde Appendicitis Therapy
Direct visualization ERAT will be performed by experienced endoscopists (≥ 30 prior ERAT cases) under conscious sedation or general anesthesia as needed. A colonoscope with a transparent cap will be advanced to the cecum to expose the appendiceal orifice, and a direct visualization appendicoscope will be introduced through the working channel. The appendiceal lumen will be inspected and irrigated with saline to clear pus and debris, with negative pressure applied for aspiration. Small appendicoliths will be flushed out, while larger ones will be removed using a retrieval basket, stone extractor, or laser lithotripsy. When narrowing or heavy purulence is present, a stent will be inserted for drainage. After confirming adequate drainage, the scope will be withdrawn. If ERAT fails, conversion to laparoscopic or open appendectomy will be performed.
Laparoscopic appendectomy
Laparoscopic appendectomy will be performed under general anesthesia by surgeons with experience in \> 20 procedures, according to standard clinical practice. The resected appendix will be examined for gross features and sent for histopathological confirmation of acute uncomplicated appendicitis. If laparoscopic appendectomy is unsuccessful, conversion to open appendectomy will be performed.
Locations (14)
Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University
Chongqing, Chingqing, China
Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University
Guangzhou, Guangdong, China
Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University
Shenzhen, Guangdong, China
Department of Gastroenterology, The First Affiliated Hospital of Henan University,
Kaifeng, Henan, China
Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University
Zhengzhou, Henan, China
Department of Gastrointestinal Surgery, Hunan Provincial People's Hospital
Changsha, Hunan, China
Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University
Changsha, Hunan, China
Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University
Suzhou, Jiangsu, China
Department of Gastroenterology, The First Affiliated Hospital of Nanchang University
Nanchang, Jiangxi, China
Department of Gastroenterology, Jilin City People's Hospital
Jilin, Jilin, China
Department of Gastroenterology, Linyi People's Hospital
Linyi, Shandong, China
Department of Gastrointestinal Surgery, Fourth West China Hospital, Sichuan University
Chengdu, Sichuan, China
Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine
Hangzhou, China
Department of Gastroenterology, Changhai Hospital, Naval Medical University
Shanghai, China