{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T09:24:06Z","timestamp":1774430646658,"version":"3.50.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the efficacy of endoscopic retrograde appendicitis therapy (ERAT) in the treatment of pediatric suppurative appendicitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective cohort study, children undergoing ERAT for acute appendicitis between January 2019 to March 2025 were categorized according to disease severity into suppurative or simple appendicitis groups. Data encompassing baseline characteristics, preoperative profiles, procedural outcomes, and follow-up were collected and subjected to intergroup comparison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study included 61 children (31 suppurative, 30 simple). Two patients in the suppurative group were excluded from the follow-up analysis due to missing data at the one-week time point. Preoperative fever, vomiting, appendicoliths, and inflammatory markers were significantly more common in the suppurative group (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). The mean operative time was significantly longer in the suppurative group (105.5\u2009\u00b1\u200934.1 vs. 86.3\u2009\u00b1\u200934.4\u2005min,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). While ERAT achieved a 100% success rate in simple appendicitis, the success rate was significantly lower in the suppurative group (74.2% vs. 100%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), with appendiceal perforation being the primary complication (12.9%, 4\/31). Treatment failure led to appendectomy in 6 patients (20.7%) with suppurative appendicitis. Among initially successful cases, the suppurative group had a significantly prolonged recovery, including longer time to pain relief and hospital stay (both\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). At 6-month follow-up, the recurrence rate was numerically higher in the suppurative group (21.7% vs. 10.0%), although the difference was not statistically significant (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.117). Parental satisfaction scores trended lower and pain scores higher in the suppurative group during follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For suppurative appendicitis, particularly with a thin-walled appendix or large fecalith, ERAT is not recommended due to low success rates and perforation risk; laparoscopic appendectomy remains the standard. ERAT is a safe, effective organ-preserving option only for carefully selected patients with simple appendicitis or select non-necrotizing fecalith impaction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1729439","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T06:52:40Z","timestamp":1774421560000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of endoscopic retrograde appendicitis therapy in children with suppurative vs. simple appendicitis: a retrospective cohort study"],"prefix":"10.3389","volume":"14","author":[{"given":"Ning","family":"Xue","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Children\u2019s Hospital Affiliated to Shandong University (Jinan Children\u2019s Hospital)","place":["Jinan, Shandong, China"]},{"name":"Shandong Provincial Clinical Research Center for Children\u2019s Health and Disease","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xu-Xia","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Children\u2019s Hospital Affiliated to Shandong University (Jinan Children\u2019s Hospital)","place":["Jinan, Shandong, China"]},{"name":"Shandong Provincial Clinical Research Center for Children\u2019s Health and Disease","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun-Jie","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Children\u2019s Hospital Affiliated to Shandong University (Jinan Children\u2019s Hospital)","place":["Jinan, Shandong, China"]},{"name":"Shandong Provincial Clinical Research Center for Children\u2019s Health and Disease","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Children\u2019s Hospital Affiliated to Shandong University (Jinan Children\u2019s Hospital)","place":["Jinan, Shandong, China"]},{"name":"Shandong Provincial Clinical Research Center for Children\u2019s Health and Disease","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun-Ping","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Children\u2019s Hospital Affiliated to Shandong University (Jinan Children\u2019s Hospital)","place":["Jinan, Shandong, China"]},{"name":"Shandong Provincial Clinical Research Center for Children\u2019s Health and Disease","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"B1","first-page":"405","article-title":"Abraham GROVES of Fergus: the first elective appendectomy?","volume":"4","author":"Harris","year":"1961","journal-title":"Can J Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1007\/s00384-024-04793-7","article-title":"Acute appendicitis and its treatment: a historical overview","volume":"40","author":"Selvaggi","year":"2025","journal-title":"Int J Colorectal Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1055\/s-2007-1021466","article-title":"Endoscopic appendectomy","volume":"15","author":"Semm","year":"1983","journal-title":"Endoscopy"},{"key":"B4","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s12893-019-0505-9","article-title":"Laparoscopic appendectomy versus open appendectomy for suspected appendicitis during pregnancy: a systematic review and updated meta-analysis","volume":"19","author":"Lee","year":"2019","journal-title":"BMC Surg"},{"key":"B5","first-page":"244","article-title":"Laparoscopic appendectomy versus open appendectomy for acute appendicitis: a prospective comparative study","volume":"14","author":"Kumar","year":"2016","journal-title":"Kathmandu Univ Med J (KUMJ)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1007\/s00464-002-8868-9","article-title":"Pediatric laparoscopic appendectomy for acute appendicitis","volume":"18","author":"Vernon","year":"2004","journal-title":"Surg Endosc"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2299","DOI":"10.1001\/jama.2021.20502","article-title":"Diagnosis and management of acute appendicitis in adults: a review","volume":"326","author":"Moris","year":"2021","journal-title":"JAMA"},{"key":"B8","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1007\/s00423-023-02935-z","article-title":"Varying negative appendectomy rates after laparoscopic appendectomy: a systematic review and meta-analysis","volume":"408","author":"Henriksen","year":"2023","journal-title":"Langenbecks Arch Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.smim.2018.02.005","article-title":"The immunological functions of the appendix: an example of redundancy?","volume":"36","author":"Girard-Madoux","year":"2018","journal-title":"Semin Immunol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"102090","DOI":"10.1016\/j.clinre.2023.102090","article-title":"Association between prior appendectomy and the risk and course of Crohn's Disease: a systematic review and meta-analysis","volume":"47","author":"Zhang","year":"2023","journal-title":"Clin Res Hepatol Gastroenterol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1111\/jgh.16108","article-title":"Risk of colorectal cancer after appendectomy: a systematic review and meta-analysis","volume":"38","author":"Liu","year":"2023","journal-title":"J Gastroenterol Hepatol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1016\/j.gie.2012.05.029","article-title":"Endoscopic retrograde appendicitis therapy: a pilot minimally invasive technique (with videos)","volume":"76","author":"Liu","year":"2012","journal-title":"Gastrointest Endosc"},{"key":"B13","doi-asserted-by":"publisher","first-page":"102241","DOI":"10.1016\/j.clinre.2023.102241","article-title":"Clinical efficacy and safety of endoscopic retrograde appendicitis treatment for acute appendicitis: a systematic review and meta-analysis","volume":"47","author":"Xu","year":"2023","journal-title":"Clin Res Hepatol Gastroenterol"},{"key":"B14","first-page":"342","article-title":"The endoscopic retrograde appendicitis therapy for acute appendicitis in children: a systematic review and meta-analysis","volume":"29","author":"Liu","year":"2023","journal-title":"Altern Ther Health Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2929","DOI":"10.14309\/ajg.0000000000003428","article-title":"Safety and efficacy of endoscopic retrograde appendicitis therapy for pediatric patients: a single-center retrospective study in Chinese children","volume":"120","author":"Tu","year":"2025","journal-title":"Am J Gastroenterol"},{"key":"B16","first-page":"569","article-title":"Colonoscopic diagnosis and treatment of acute appendicitis","volume":"7","author":"Said","year":"1995","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1016\/j.gie.2006.06.001","article-title":"Successful colonoscopic drainage of appendiceal pus in acute appendicitis","volume":"64","author":"Liu","year":"2006","journal-title":"Gastrointest Endosc"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2480","DOI":"10.1007\/s00464-021-08533-8","article-title":"Endoscopic retrograde appendicitis therapy for management of acute appendicitis","volume":"36","author":"Ding","year":"2022","journal-title":"Surg Endosc"},{"key":"B19","doi-asserted-by":"publisher","first-page":"17562848241275314","DOI":"10.1177\/17562848241275314","article-title":"Endoscopic retrograde appendicitis therapy","volume":"17","author":"Zhang","year":"2024","journal-title":"Therap Adv Gastroenterol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1007\/s00464-014-3750-0","article-title":"Endoscopic retrograde appendicitis therapy (ERAT): a multicenter retrospective study in China","volume":"29","author":"Liu","year":"2015","journal-title":"Surg Endosc"},{"key":"B21","first-page":"25","article-title":"Acute appendicitis: efficient diagnosis and management","volume":"98","author":"Snyder","year":"2018","journal-title":"Am Fam Physician"},{"key":"B22","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1007\/s00383-022-05284-y","article-title":"Non-operative management of acute appendicitis in children","volume":"39","author":"Jumah","year":"2023","journal-title":"Pediatr Surg Int"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1667","DOI":"10.14309\/ajg.0000000000003219","article-title":"Visual endoscopic retrograde appendicitis therapy vs antibiotic therapy for treatment of uncomplicated acute appendicitis","volume":"120","author":"Dai","year":"2024","journal-title":"Am J Gastroenterol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"636","DOI":"10.3760\/cma.j.cn112140-20240408-00249","article-title":"Therapeutic effectiveness of modified endoscopic retrograde appendicitis therapy for acute appendicitis of different severities in children","volume":"62","author":"Zhang","year":"2024","journal-title":"Zhonghua Er Ke Za Zhi"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/SLA.0000000000005576","article-title":"Endoscopic retrograde appendicitis therapy: is it really a need of the hour?","volume":"277","author":"Khan","year":"2023","journal-title":"Ann Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1055\/a-1737-6381","article-title":"Endoscopic retrograde appendicitis therapy versus laparoscopic appendectomy for uncomplicated acute appendicitis","volume":"54","author":"Yang","year":"2022","journal-title":"Endoscopy"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1729439\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T06:52:42Z","timestamp":1774421562000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1729439\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,25]]},"references-count":26,"alternative-id":["10.3389\/fped.2026.1729439"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1729439","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,25]]},"article-number":"1729439"}}