BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)offers an appendix-pre-serving approach;however,visual and specificity challenges persist.Conversely,endoscopic direct appendicitis therapy(EDAT)provides dire...BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)offers an appendix-pre-serving approach;however,visual and specificity challenges persist.Conversely,endoscopic direct appendicitis therapy(EDAT)provides direct visual observation with diagnostic and therapeutic capabilities.AIM To assess the efficacy and feasibility of EDAT and compare them with those of ERAT in uncomplicated appendicitis.METHODS In this retrospective cohort study,patients diagnosed with uncomplicated appendicitis and treated with ERAT or EDAT between January 2021 and November 2024 were reviewed.The primary outcome was intervention success.Secondary outcomes were guidewire use,stent placement,hospitalization duration,recurrence,and endoscopic direct-view features.Outcomes were compared between groups via appropriate statistical tests.RESULTS Of 170 patients,136 underwent EDAT and 34 ERAT.EDAT showed higher intervention success than ERAT(99.3%vs 82.4%,P<0.001),with less guidewire assistance and fewer stent placements(both P<0.001).Hospital stay was shorter with EDAT(P=0.039).The overall cumulative recurrence rates at 1 year were 10%in EDAT and 24%in ERAT;in the appendicolith subgroup,the recurrence rates were 5%and 14%in EDAT and ERAT,respectively.Findings were consistent in the propensity score-matched(PSM)cohort.CONCLUSION EDAT was demonstrated to be a more effective and feasible approach than ERAT,with a lower overall cumulative recurrence risk and within the appendicolith subgroup.Consistent results after PSM further supported the robustness of these findings.展开更多
BACKGROUND Acute appendicitis is one of the most common emergency abdominal disease,and recent studies have evaluated conservative treatment using antibiotics for uncomplicated appendicitis.Although the efficacy of co...BACKGROUND Acute appendicitis is one of the most common emergency abdominal disease,and recent studies have evaluated conservative treatment using antibiotics for uncomplicated appendicitis.Although the efficacy of conservative treatment for uncomplicated appendicitis is known,its efficacy for complicated appendicitis remains unknown,so are risk factors for the conservative treatment of appendi-citis.In our institution,conservative treatment has long been the first choice for most appendicitis cases,except for perforation.Therefore,this novel study inves-tigated the outcomes of conservative treatment for uncomplicated and compli-cated acute appendicitis and the risk factors associated with conservative treat-ment.treatment.The significant and independent predictors of resistance to conservative treatment were body temperature≥37.3℃,appendicolith and Douglas sinus fluid visible on computed tomography(CT).The rate of resistance to conservative treatment was 66.7%(6/9)for patients with the above three factors,22.9%(8/35)for patients with two factors(appendicolith and body temperature≥37.3℃),16.7%(2/12)for patients with two factors(Douglas sinus fluid and appendicolith)and 11.1%(1/9)for patients with two factors(Douglas sinus fluid and body temperature≥37.3℃).CONCLUSION A temperature≥37.3℃,appendicolith and Douglas sinus fluid on CT might be clinical risk factors of resistance to conservative treatment for acute appendicitis.展开更多
Increasing evidence suggests that non-operative management(NOM)with antibiotics could serve as a safe alternative to surgery for the treatment of uncomplicated acute appendicitis(AA).However,accurately differentiating...Increasing evidence suggests that non-operative management(NOM)with antibiotics could serve as a safe alternative to surgery for the treatment of uncomplicated acute appendicitis(AA).However,accurately differentiating between uncomplicated and complicated AA remains challenging.Our aim was to develop and validate machine-learning-based diagnostic models to differentiate uncomplicated from complicated AA.This was a multicenter cohort trial conducted from January 2021 and December 2022 across five tertiary hospitals.Three distinct diagnostic models were created,namely,the clinical-parameter-based model,the CT-radiomicsbased model,and the clinical-radiomics-fused model.These models were developed using a comprehensive set of eight machinelearning algorithms,which included logistic regression(LR),support vector machine(SVM),random forest(RF),decision tree(DT),gradient boosting(GB),K-nearest neighbors(KNN),Gaussian Naïve Bayes(GNB),and multi-layer perceptron(MLP).The performance and accuracy of these diverse models were compared.All models exhibited excellent diagnostic performance in the training cohort,achieving a maximal AUC of 1.00.For the clinical-parameter model,the GB classifier yielded the optimal AUC of 0.77(95%confidence interval[CI]:0.64-0.90)in the testing cohort,while the LR classifier yielded the optimal AUC of 0.76(95%CI:0.66-0.86)in the validation cohort.For the CT-radiomics-based model,GB classifier achieved the best AUC of 0.74(95%CI:0.60-0.88)in the testing cohort,and SVM yielded an optimal AUC of 0.63(95%CI:0.51-0.75)in the validation cohort.For the clinical-radiomics-fused model,RF classifier yielded an optimal AUC of 0.84(95%CI:0.74-0.95)in the testing cohort and 0.76(95%CI:0.67-0.86)in the validation cohort.An openaccess,user-friendly online tool was developed for clinical application.This multicenter study suggests that the clinical-radiomicsfused model,constructed using RF algorithm,effectively differentiated between complicated and uncomplicated AA.展开更多
基金Supported by Guangdong Province Clinical Teaching Base Teaching Reform Research Project,No.2021JD086.
文摘BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)offers an appendix-pre-serving approach;however,visual and specificity challenges persist.Conversely,endoscopic direct appendicitis therapy(EDAT)provides direct visual observation with diagnostic and therapeutic capabilities.AIM To assess the efficacy and feasibility of EDAT and compare them with those of ERAT in uncomplicated appendicitis.METHODS In this retrospective cohort study,patients diagnosed with uncomplicated appendicitis and treated with ERAT or EDAT between January 2021 and November 2024 were reviewed.The primary outcome was intervention success.Secondary outcomes were guidewire use,stent placement,hospitalization duration,recurrence,and endoscopic direct-view features.Outcomes were compared between groups via appropriate statistical tests.RESULTS Of 170 patients,136 underwent EDAT and 34 ERAT.EDAT showed higher intervention success than ERAT(99.3%vs 82.4%,P<0.001),with less guidewire assistance and fewer stent placements(both P<0.001).Hospital stay was shorter with EDAT(P=0.039).The overall cumulative recurrence rates at 1 year were 10%in EDAT and 24%in ERAT;in the appendicolith subgroup,the recurrence rates were 5%and 14%in EDAT and ERAT,respectively.Findings were consistent in the propensity score-matched(PSM)cohort.CONCLUSION EDAT was demonstrated to be a more effective and feasible approach than ERAT,with a lower overall cumulative recurrence risk and within the appendicolith subgroup.Consistent results after PSM further supported the robustness of these findings.
文摘BACKGROUND Acute appendicitis is one of the most common emergency abdominal disease,and recent studies have evaluated conservative treatment using antibiotics for uncomplicated appendicitis.Although the efficacy of conservative treatment for uncomplicated appendicitis is known,its efficacy for complicated appendicitis remains unknown,so are risk factors for the conservative treatment of appendi-citis.In our institution,conservative treatment has long been the first choice for most appendicitis cases,except for perforation.Therefore,this novel study inves-tigated the outcomes of conservative treatment for uncomplicated and compli-cated acute appendicitis and the risk factors associated with conservative treat-ment.treatment.The significant and independent predictors of resistance to conservative treatment were body temperature≥37.3℃,appendicolith and Douglas sinus fluid visible on computed tomography(CT).The rate of resistance to conservative treatment was 66.7%(6/9)for patients with the above three factors,22.9%(8/35)for patients with two factors(appendicolith and body temperature≥37.3℃),16.7%(2/12)for patients with two factors(Douglas sinus fluid and appendicolith)and 11.1%(1/9)for patients with two factors(Douglas sinus fluid and body temperature≥37.3℃).CONCLUSION A temperature≥37.3℃,appendicolith and Douglas sinus fluid on CT might be clinical risk factors of resistance to conservative treatment for acute appendicitis.
基金funded by the Natural Science Foundation of China for Youth[grant number 82103593]Program of Three Talents and One Team[grant number 4143524].
文摘Increasing evidence suggests that non-operative management(NOM)with antibiotics could serve as a safe alternative to surgery for the treatment of uncomplicated acute appendicitis(AA).However,accurately differentiating between uncomplicated and complicated AA remains challenging.Our aim was to develop and validate machine-learning-based diagnostic models to differentiate uncomplicated from complicated AA.This was a multicenter cohort trial conducted from January 2021 and December 2022 across five tertiary hospitals.Three distinct diagnostic models were created,namely,the clinical-parameter-based model,the CT-radiomicsbased model,and the clinical-radiomics-fused model.These models were developed using a comprehensive set of eight machinelearning algorithms,which included logistic regression(LR),support vector machine(SVM),random forest(RF),decision tree(DT),gradient boosting(GB),K-nearest neighbors(KNN),Gaussian Naïve Bayes(GNB),and multi-layer perceptron(MLP).The performance and accuracy of these diverse models were compared.All models exhibited excellent diagnostic performance in the training cohort,achieving a maximal AUC of 1.00.For the clinical-parameter model,the GB classifier yielded the optimal AUC of 0.77(95%confidence interval[CI]:0.64-0.90)in the testing cohort,while the LR classifier yielded the optimal AUC of 0.76(95%CI:0.66-0.86)in the validation cohort.For the CT-radiomics-based model,GB classifier achieved the best AUC of 0.74(95%CI:0.60-0.88)in the testing cohort,and SVM yielded an optimal AUC of 0.63(95%CI:0.51-0.75)in the validation cohort.For the clinical-radiomics-fused model,RF classifier yielded an optimal AUC of 0.84(95%CI:0.74-0.95)in the testing cohort and 0.76(95%CI:0.67-0.86)in the validation cohort.An openaccess,user-friendly online tool was developed for clinical application.This multicenter study suggests that the clinical-radiomicsfused model,constructed using RF algorithm,effectively differentiated between complicated and uncomplicated AA.
