Title: Endoscopic Retrograde Appendicitis Therapy Versus Laparoscopic Appendectomy
Versus Open Appendectomy for Acute Appendicitis: A Pilot Study
Version: 3 Date: 30 Nov 2021
Reviewer:  Taras Nechay
Reviewer's report:
This is a well-designed and conducted study with a sufficient follow-up period (22 months). The
idea of a non-surgical treatment for appendicitis is tempting. The total effect of ERAT is almost
80%, which is high and can be compared with the success rate of a conservative approach to
the treatment of appendicitis.
But I have a few questions and comments.
Modern theories of the pathogenesis of acute appendicitis question the obstruction of its lumen
as an etiological factor and regard it as a consequence of the onset of inflammation (Bhangu A,
Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of
pathogenesis, diagnosis, and management. Lancet. 2015 Sep 26; 386 (10000): 1278-1287. doi:
10.1016 / S0140-6736 (15) 00275-5)
The conformity assessment for ERAT shows applicability at 20% (99 out of 514, although 258
declined themselves). In 12% of patients, the procedure was ineffective. In this case, the patients
were operated on. Another 20% developed a relapse. What is the real proportion of patients with
acute appendicitis in whom this method can be used? Does it outperform antibiotic treatment?
The main ethical issue.
Preparation for colonoscopy is essential for successful cannulation. For abdominal pain, you give
the patients laxatives (PEG) and 2 liters of water, and then observe repeated bowel movements.
How ethical is it? How many hours does this preparation take? Is there any pain relief given
to patients?
Title: Endoscopic Retrograde Appendicitis Therapy Versus Laparoscopic Appendectomy
Versus Open Appendectomy for Acute Appendicitis: A Pilot Study
Version: 3 Date: 30 Nov 2021
Reviewer:  Taras Nechay
Reviewer's report:
This is a well-designed and conducted study with a sufficient follow-up period (22 months). The
idea of a non-surgical treatment for appendicitis is tempting. The total effect of ERAT is almost
80%, which is high and can be compared with the success rate of a conservative approach to
the treatment of appendicitis.
But I have a few questions and comments.
Modern theories of the pathogenesis of acute appendicitis question the obstruction of its lumen
as an etiological factor and regard it as a consequence of the onset of inflammation (Bhangu A,
Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of
pathogenesis, diagnosis, and management. Lancet. 2015 Sep 26; 386 (10000): 1278-1287. doi:
10.1016 / S0140-6736 (15) 00275-5)
The conformity assessment for ERAT shows applicability at 20% (99 out of 514, although 258
declined themselves). In 12% of patients, the procedure was ineffective. In this case, the patients
were operated on. Another 20% developed a relapse. What is the real proportion of patients with
acute appendicitis in whom this method can be used? Does it outperform antibiotic treatment?
The main ethical issue.
Preparation for colonoscopy is essential for successful cannulation. For abdominal pain, you give
the patients laxatives (PEG) and 2 liters of water, and then observe repeated bowel movements.
How ethical is it? How many hours does this preparation take? Is there any pain relief given
to patients?
Please review this paper.
user
Title: Endoscopic Retrograde Appendicitis Therapy Versus Laparoscopic Appendectomy
Versus Open Appendectomy for Acute Appendicitis: A Pilot Study
Version: 3 Date: 30 Nov 2021
Reviewer:  Taras Nechay
Reviewer's report:
This is a well-designed and conducted study with a sufficient follow-up period (22 months). The
idea of a non-surgical treatment for appendicitis is tempting. The total effect of ERAT is almost
80%, which is high and can be compared with the success rate of a conservative approach to
the treatment of appendicitis.
But I have a few questions and comments.
Modern theories of the pathogenesis of acute appendicitis question the obstruction of its lumen
as an etiological factor and regard it as a consequence of the onset of inflammation (Bhangu A,
Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of
pathogenesis, diagnosis, and management. Lancet. 2015 Sep 26; 386 (10000): 1278-1287. doi:
10.1016 / S0140-6736 (15) 00275-5)
The conformity assessment for ERAT shows applicability at 20% (99 out of 514, although 258
declined themselves). In 12% of patients, the procedure was ineffective. In this case, the patients
were operated on. Another 20% developed a relapse. What is the real proportion of patients with
acute appendicitis in whom this method can be used? Does it outperform antibiotic treatment?
The main ethical issue.
Preparation for colonoscopy is essential for successful cannulation. For abdominal pain, you give
the patients laxatives (PEG) and 2 liters of water, and then observe repeated bowel movements.
How ethical is it? How many hours does this preparation take? Is there any pain relief given
to patients?
assistant