Appendicitis Can Be Treated Without Open Surgery: Endoscopic Direct‑Vision Appendicitis Therapy (EDAT) Offers a Solution

Appendicitis is one of the common acute abdominal conditions in clinical practice. Common triggers include fecalith obstruction, lymphoid follicle hyperplasia, parasitic infection and so forth. The traditional view holds that the appendix is a useless organ. Nevertheless, modern medical research has proven that the appendix is a vital component of the human immune system. It stores gut probiotics and modulates immune responses, and is especially critical for immune development in children and adolescents.

Appendicitis does not always require surgical removal. For some patients, recovery can be achieved merely by relieving obstruction and controlling inflammation. The Department of Gastroenterology at Taikang Xianlin Drum Tower Hospital, Affiliated to Nanjing University Medical School, has recently adopted a new technique — Endoscopic Direct‑Vision Appendicitis Therapy (EDAT) — making appendix‑preserving and precise treatment achievable.

Director Zhang Yiyang of Gastroenterology during the procedure

Why Is Appendix Removal Not the Only Option?

For the past century, surgical appendectomy has been the mainstream treatment for appendicitis, including open appendectomy and laparoscopic appendectomy. However, both approaches have notable limitations:

Trauma: Open surgery requires a 5‑8 cm incision in the right lower quadrant, which may interfere with daily life and work during recovery. Though laparoscopic surgery is minimally invasive, it still involves 2‑3 small abdominal punctures, carrying certain postoperative risks of pain and infection.

Risk of overtreatment: Not every case of appendicitis calls for appendix removal. Some patients with early‑stage simple appendicitis recover with conservative management including anti‑infection therapy, fasting and fluid resuscitation. For appendicitis caused by fecalith obstruction, timely removal of fecaliths and decompression can fully restore appendiceal function without resection.

Post‑operative complications: Conventional surgery may lead to complications such as intestinal adhesion, intestinal obstruction, surgical‑site infection and intra‑abdominal abscess. Intestinal adhesion is relatively common, which in severe cases may trigger recurrent abdominal pain, intestinal obstruction and even re‑operation.

Endoscopic Direct‑Vision Appendicitis Therapy: Suitable Patient Populations

The core principle of EDAT is decompression rather than resection. It features minimal invasiveness, high precision, appendix preservation and rapid recovery. Under intravenous anesthesia, a colonoscope is advanced through the anus to the ileocecal region where the appendiceal orifice is located. Physicians can directly visualize obstructed segments, inflammatory severity and potential appendiceal neoplasms. Instruments are deployed to extract or drain obstructing substances such as fecaliths and pus. When necessary, stents are placed at the appendiceal orifice to maintain luminal patency and facilitate inflammation resolution.

Still, EDAT is not suitable for all appendicitis patients. It is primarily indicated for: simple appendicitis, suppurative appendicitis, appendicitis in children and adolescents (whose immune system is still developing; preserving the appendix benefits long‑term health), patients who decline or cannot tolerate conventional surgery (e.g. elderly patients, obese individuals, those with severe intra‑abdominal adhesions or surgical contraindications), as well as female patients (especially women of child‑bearing age, to avoid pelvic disturbance from open surgery).

Important note: Surgical resection remains the mainstay for patients with appendiceal perforation, gangrene or large intra‑abdominal abscess. Patients with suspected appendicitis should seek early medical consultation so clinicians can evaluate conditions and select optimal therapies.

Real‑world Clinical Practice: Individualized Regimens from the Gastroenterology Department

Fecalith visualized inside appendiceal lumen under endoscopy

Twelve‑year‑old Xiao Ming presented with sudden right‑lower‑quadrant pain, fever and nausea. He was diagnosed with acute simple appendicitis due to luminal obstruction by a fecalith. Given his young age and his family’s wish to preserve his appendix, EDAT was performed. The fecalith was successfully extracted endoscopically and the appendiceal lumen was unblocked. Xiao Ming was able to get out of bed the same day and discharged on post‑operative day 3 with no surgical scars. At one‑year follow‑up, his appendix functioned normally without recurrence.

Thirty‑five‑year‑old Ms. Li suffered recurrent dull right‑lower‑quadrant pain and repeated diagnoses of chronic appendicitis despite conservative treatment. Examinations revealed stenosis at her appendiceal orifice causing recurrent fecalith accumulation and inflammation. EDAT was carried out with stent placement to dilate the stricture. Her abdominal pain resolved completely after intervention. No relapse was observed during six‑month follow‑up, and appendiceal function returned to normal.

The Department of Gastroenterology at Taikang Xianlin Drum Tower Hospital tailors treatment plans according to each patient’s condition, age and physical status. People experiencing suspicious appendicitis symptoms such as abdominal pain, fever or nausea are advised to visit gastroenterology or emergency departments promptly to prevent disease progression.

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