Endoscopic Retrograde Appendicitis Therapy: A Narrative Review of Current Evidence and Challenges for European Implementation

Endoscopic retrograde appendicitis therapy (ERAT) is a minimally invasive, appendix-preserving approach to acute uncomplicated appendicitis.This narrative review critically evaluates the ERAT technique, patient selection, clinical outcomes, and challenges associated with potential implementation in European healthcare systems.Published randomised trials, observational studies, systematic reviews, and metaanalyses were reviewed alongside relevant international guidelines and literature on surgical outcomes and endoscopic capacity.ERAT has demonstrated technical success rates exceeding 95% in selected patients; however, technical feasibility does not necessarily translate into durable clinical success.Reported recurrence rates include 14.5% over three years in a randomised trial and 24% at one year in a comparative observational study.A recent meta-analysis found lower treatment success (odds ratio (OR) 0.15, 95% confidence interval (CI) 0.04-0.57)and higher recurrence (OR 7.68, 95% CI 2.32-25.46)after ERAT compared with laparoscopic appendectomy.Furthermore, preservation of the appendix precludes routine histopathological examination, raising concerns about potentially undetected appendiceal neoplasms.The available evidence is heterogeneous, predominantly originates from specialised Asian centres, and provides limited information on long-term outcomes and applicability to European healthcare systems.Implementation would require specialised endoscopic expertise, equipment, and procedural capacity.ERAT should therefore currently be regarded as an investigational treatment rather than an established alternative to laparoscopic appendectomy.Further prospective multicentre studies are needed to evaluate long-term recurrence-free survival, subsequent appendectomy, oncological safety, cost-effectiveness, and feasibility across different healthcare settings.