BACKGROUND
The aim of this study was to assess the effectiveness of appendicectomy as a treatment for ulcerative colitis, in particular, if distribution of disease could predict response.

METHODS
This was a single centre retrospective study undertaken at Waikato Hospital, a tertiary centre in Hamilton, New Zealand. Patient data for the study was collected from gastroenterologists from Waikato hospital. All patients included in the data had undergone appendicectomy electively for treatment of ulcerative colitis. Patients who had an appendicectomy for other indications were excluded. Primary end point was clinical response determined by the clinicians’ global assessment of severity at 12 months post appendicectomy. Secondary endpoints were endoscopic response at first follow-up and subsequent endoscopies and requirement for escalation of medical therapy or colectomy.

RESULTS
Thirty-three patients underwent appendicectomy between February 2010 and March 2023. 67% of patients were female. The average age of patients at appendicectomy was 40 years old. 52% of patients had prior biologic exposure.
Of all patients in the study, 58% had clinical response at 12 months follow up. Of patients with isolated rectosigmoid disease, 73% of patients had clinical response at 12 months follow-up; versus clinical response in only 50% of patients with disease proximal to the splenic flexure. Of patients who did not demonstrate clinical response at 12 months, 43% had prior biologic exposure.
51% of patients had endoscopic improvement on their first endoscopic assessment. Subsequent endoscopic evaluations revealed that 48% of patients had endoscopic improvement on their most recent colonoscopy at a median of 49 months post appendicectomy.
Five patients required colectomy following appendicectomy and four patients required escalation to biologic therapy. 30% of patients had active inflammation of the appendix. 50% of these patients responded clinically to appendicectomy at 12 months follow up.

CONCLUSION
This retrospective data suggest appendicectomy is effective as a treatment option for patients with ulcerative colitis with 58% achieving clinical response at 12 months. In patients with rectosigmoid disease the clinical response was higher at 12 months follow up compared with patients with extensive disease, suggesting this group of patients may benefit more from appendicectomy. Endoscopic improvement was seen in almost 50% of patients at their most recent endoscopic assessment suggesting there is a sustained response to therapy. 27% required escalation of therapy post appendicectomy. Previous or current biologic therapy did not predict response to appendicectomy. This study supplements the data from previous studies suggesting appendicectomy should be considered as an effective therapy for ulcerative colitis.

Graeme Dickson

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