Title: Endoscopic Retrograde Appendicitis Therapy Versus Laparoscopic Appendectomy
Versus Open Appendectomy for Acute Appendicitis: A Pilot Study
Version: 3 Date: 16 Nov 2021
Reviewer's report:
The Authors performed an interesting prospective, open-label, randomized controlled study
aiming to compare Endoscopic retrograde appendicitis therapy (ERAT) with Laparoscopic
Appendectomy (LA) and Open Appendectomy (OA), and to evaluate the feasibility and safety
of ERAT in treating acute uncomplicated appendicitis.
Their efforts should be recognized as there is a substantial lack of prospective studies about
treating uncomplicated acute appendicitis with ERAT.
However, there are some considerations to do:
1) The evidence that LA is the gold standard of care for acute appendicitis is reported in the most
updated international guidelines published in the literature (Di Saverio S et al. Diagnosis and
treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg
Surg. 2020 Apr 15;15(1):27.) and comparing ERAT with OA is not useful in my opinion; it may
be useful to compare ERAT with Non-Operative-Management (NOM) with antibiotics because
there are more recent and high-level evidence that demonstrated that antibiotic therapy could
represent a feasible treatment option for image-proven uncomplicated appendicitis.
2) The small sample size of the group of patients treated with ERAT that it does not allow to
draw conclusions on the efficacy and feasibility of the endoscopic treatment versus surgery.
3) It is obvious that the more rapid re-oral intake and the less pain after treatment are better in
the endoscopically treated group: therefore, I suggest to remove these two secondary outcomes
from the manuscript.
4) The second colonscopy in patients treated with ERAT to retrieve the stent is included in the
overall cost? This point is not clear into the manuscript.
5) The report of the two tumors found during ERAT, the diagnosis and their treatment is not
useful for this prospective pilot study: I suggest to remove it.
6) Lastly, the right reference number one is: Lancet. 2015 Sep 26; 386(10000):1278-1287.
Title: Endoscopic Retrograde Appendicitis Therapy Versus Laparoscopic Appendectomy
Versus Open Appendectomy for Acute Appendicitis: A Pilot Study
Version: 3 Date: 16 Nov 2021
Reviewer's report:
The Authors performed an interesting prospective, open-label, randomized controlled study
aiming to compare Endoscopic retrograde appendicitis therapy (ERAT) with Laparoscopic
Appendectomy (LA) and Open Appendectomy (OA), and to evaluate the feasibility and safety
of ERAT in treating acute uncomplicated appendicitis.
Their efforts should be recognized as there is a substantial lack of prospective studies about
treating uncomplicated acute appendicitis with ERAT.
However, there are some considerations to do:
1) The evidence that LA is the gold standard of care for acute appendicitis is reported in the most
updated international guidelines published in the literature (Di Saverio S et al. Diagnosis and
treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg
Surg. 2020 Apr 15;15(1):27.) and comparing ERAT with OA is not useful in my opinion; it may
be useful to compare ERAT with Non-Operative-Management (NOM) with antibiotics because
there are more recent and high-level evidence that demonstrated that antibiotic therapy could
represent a feasible treatment option for image-proven uncomplicated appendicitis.
2) The small sample size of the group of patients treated with ERAT that it does not allow to
draw conclusions on the efficacy and feasibility of the endoscopic treatment versus surgery.
3) It is obvious that the more rapid re-oral intake and the less pain after treatment are better in
the endoscopically treated group: therefore, I suggest to remove these two secondary outcomes
from the manuscript.
4) The second colonscopy in patients treated with ERAT to retrieve the stent is included in the
overall cost? This point is not clear into the manuscript.
5) The report of the two tumors found during ERAT, the diagnosis and their treatment is not
useful for this prospective pilot study: I suggest to remove it.
6) Lastly, the right reference number one is: Lancet. 2015 Sep 26; 386(10000):1278-1287.
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: 16 Nov 2021
Reviewer's report:
The Authors performed an interesting prospective, open-label, randomized controlled study
aiming to compare Endoscopic retrograde appendicitis therapy (ERAT) with Laparoscopic
Appendectomy (LA) and Open Appendectomy (OA), and to evaluate the feasibility and safety
of ERAT in treating acute uncomplicated appendicitis.
Their efforts should be recognized as there is a substantial lack of prospective studies about
treating uncomplicated acute appendicitis with ERAT.
However, there are some considerations to do:
1) The evidence that LA is the gold standard of care for acute appendicitis is reported in the most
updated international guidelines published in the literature (Di Saverio S et al. Diagnosis and
treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg
Surg. 2020 Apr 15;15(1):27.) and comparing ERAT with OA is not useful in my opinion; it may
be useful to compare ERAT with Non-Operative-Management (NOM) with antibiotics because
there are more recent and high-level evidence that demonstrated that antibiotic therapy could
represent a feasible treatment option for image-proven uncomplicated appendicitis.
2) The small sample size of the group of patients treated with ERAT that it does not allow to
draw conclusions on the efficacy and feasibility of the endoscopic treatment versus surgery.
3) It is obvious that the more rapid re-oral intake and the less pain after treatment are better in
the endoscopically treated group: therefore, I suggest to remove these two secondary outcomes
from the manuscript.
4) The second colonscopy in patients treated with ERAT to retrieve the stent is included in the
overall cost? This point is not clear into the manuscript.
5) The report of the two tumors found during ERAT, the diagnosis and their treatment is not
useful for this prospective pilot study: I suggest to remove it.
6) Lastly, the right reference number one is: Lancet. 2015 Sep 26; 386(10000):1278-1287.
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