Background and study aim: Endoscopic Retrograde Appendicitis Therapy (ERAT) is an endoscopic procedure for management of patients with acute appendicitis (AA). In addition to being minimally invasive, it has added advantage of preservation of appendix and simultaneous inspection of colon. We performed a systematic review and meta-analysis on ERAT in patients with AA. Patients and methods: We conducted a comprehensive search of multiple electronic databases (from inception through Jan 2022) to identify the studies reporting ERAT in AA. The primary outcome was to evaluate the overall clinical and technical success of ERAT. The secondary outcome was to study the total and individual adverse events. The meta-analysis was performed using Der Simonian and Laird random effect model. Results 7 studies reporting on 298 patients were included. Majority of the patient population were males (55.3%), with mean age of 31±12.39 years. The pooled technical success rate was 99.36% (95% CI 97.61-100, I2=0) and the pooled clinical success rate was 99.29% (95% CI 97.48-100, I2=0). The pooled adverse event rate was 0.19 % (95% CI 0-1.55, I2=0). The most common adverse event was perforation with 0.19 % (95% CI 0-1.55, I2=0). Recurrence rate was 6.01 % (95% CI 2.9-9.93, I2=20.10). Average length of procedure was 41.1±7.16 min. Low heterogeneity was noted in in our meta-analysis. Conclusion: ERAT is a safe procedure with high clinical and technical success in patients with acute appendicitis. Further randomized controlled trials should be performed to assess utility of ERAT in acute appendicitis as compared to laparoscopic appendectomy.

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BackgroundPulmonary hypertension (PH/PAH) can have many possible causes in childhood. The aim of the COMPERA registry is the characterization of patients of all ages with PH/PAH and their treatment patterns.MethodsSince June 2013, paediatric patients can be included in the COMPERA registry (ClinTrials.gov: NCT01347216) which has originally been established for adult patients with pulmonary hypertension in 2007.ResultsUntil 2015, 78 patients <18 years (47 Pat <6 years) with pulmonary hypertension were enrolled, of whom 65.4% had PAH due to congenital heart disease (PAH-CHD), 25.6% had idiopathic PAH (iPAH), 3 had persistent PH of the newborn, 2 had PH associated with interstitial lung disease, and two had other PH. The patients were 6.1±6.0 years old, 52.6% girls; NYHA functional class I/II in 55.0%, and III in 42.3%. Mean disease duration after diagnosis was 37.7±55.8 months. Right heart catheterization data were available for 82.1% of the patients. Mean pulmonary artery pressure was 42.8±19.4 mmHg, right atrial pressure was 8.0±8.8 mmHg, cardiac index was 3.6±1.2 l/min/m2. Monotherapy was received by 65.4% of the patients whereas 33.4% of the patients had combination therapy. Phosphodiesterase-5 inhibitors (PDE5I) were administered to 76.9% of the patients, 35.9% of the patients received endothelin receptor antagonists and 3.8% received prostacyclins. About 24% of patients received anticoagulation therapy.ConclusionThe most common form of PH in this study cohort is PAH-CHD, followed by iPAH. Treatment options for children primarily comprise PDE5I. Only a small number of paediatric patients receive anticoagulation therapy.

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