AIM: To compare perioperative outcomes and short-term safety of endoscopic retrograde appendicitis therapy (ERAT) assisted by a single-use small-caliber digital cholangioscope (digital cholangioscope) and laparoscopic appendectomy (LA) in patients with acute uncomplicated appendicitis. This study utilized a direct-vision technique in which a digital cholangioscope was advanced over a guidewire through the colonoscope working channel into the appendiceal lumen, enabling intraluminal evaluation and intervention under direct visualization.

METHODS: A total of 60 patients with acute uncomplicated appendicitis treated at Hangzhou Ninth Hospital between January 2023 and December 2024 were retrospectively included and allocated, based on the actual treatment received, to an ERAT group (n = 32) or an LA group (n = 28). In the ERAT group, a digital cholangioscope was advanced over a guidewire through the colonoscope working channel into the appendiceal lumen, and intraluminal evaluation and treatment were performed under direct vision. Perioperative outcomes, inflammatory and pain-related parameters within 48 h postoperatively, and in-hospital complications were compared between the groups. Continuous perioperative outcomes were analyzed using multivariable linear regression, adjusted for prespecified covariates, whereas in-hospital complications were compared using a two-sided Fisher’s exact test.

RESULTS: Compared with the LA group, the ERAT group demonstrated shorter operative time, reduced intraoperative blood loss, shorter postoperative bed rest, and a shorter length of hospital stay (all p < 0.001). Total in-hospital costs were significantly higher in the ERAT group than in the LA group (p < 0.001). At 48 hours postoperatively, levels of inflammatory markers (interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α], C-reactive protein [CRP], and procalcitonin [PCT]) and pain-related mediators (dopamine [DA], substance P [SP], 5-hydroxytryptamine [5-HT], and prostaglandin E2 [PGE₂]) were significantly lower in the ERAT group than in the LA group (all p < 0.05). A lower crude in-hospital complication rate was observed in the ERAT group than in the LA group (two-sided Fisher’s exact p < 0.05).

CONCLUSIONS: In this single-center retrospective cohort study of patients with acute uncomplicated appendicitis, digital cholangioscope-assisted ERAT was associated with improved perioperative recovery and reduced short-term inflammatory and pain responses compared with LA, without evidence of an increased in-hospital complication rate. These findings suggest that ERAT may represent a feasible appendiceal-preserving minimally invasive treatment option. However, given the retrospective, non-randomized design, the results should be interpreted cautiously as associative rather than causal.