Efficacy and safety of endoscopic transcecal appendectomy: a systematic review and meta-analysis

BACKGROUND: Appendiceal orifice polyps are rare with prevalence of 0.08%. Surgical approach is the standard approach. Endoscopic transcecal appendectomy (ETA) has several potential advantages when compared to surgery and an alternative to non-surgical candidates. In this study, we review the efficacy and safety of ETA for the management of appendiceal lesions. METHODS: A systematic literature search was conducted across MEDLINE/PubMed, Embase, Scopus, Web of Science, and Cochrane databases. Three studies were included. The primary outcome was the efficacy of ETA in achieving technical success and en-bloc resection. Risk of bias was assessed using Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Series. A single arm meta-analysis was performed. RESULTS: A total of three studies were included. A total of 45 patients were included. The mean age was 61.8±14.22 years. Tubular adenoma was the most common pathology, with 12 adenomas. The technical success rate was 100% [95% confidence interval (CI): 92-100%]. The en-bloc resection had a success rate of 97% (95% CI: 90-100%). No bleeding events were observed with rates of 0.0% (95% CI: 0.00-0.05). Perforation was observed in 2 of 45 patients with rates of 3.0% (95% CI: 0.0-9.0%). CONCLUSIONS: This meta-analysis shows that ETA is a promising, minimally invasive technique for appendiceal polyps. It demonstrated high technical success rates in the included series. It also showed promising safety profile with minimal complications reported.