Endoscopic retrograde appendicitis therapy (ERAT) is effective but carries a 16.1% risk of recurrence within a year.

• Technical success was 100%, with a 92.4% clinical improvement rate in 435 patients.
• Key predictors of recurrence include age over 60 (OR=2.981), previous appendicitis, and the presence of appendicoliths.

Surgeons should prioritize ERAT for low-risk patients and utilize a recurrence risk tool for high-risk profiles, focusing on experienced operators to enhance outcomes.

• Stenting can lower recurrence risk, especially in complex cases.