Randomised controlled trialindependent cross-checkabstract checked★ key study I-ORG-126 in-depth review
Removing the appendix to keep ulcerative colitis calm
Appendicectomy plus standard medical therapy versus standard medical therapy alone for maintenance of remission in ulcerative colitis (ACCURE): a pragmatic, open-label, international, randomised trial.
Overview
ACCURE Study Group. Lancet Gastroenterol Hepatol 2025 · PMID 40228513 · DOI 10.1016/S2468-1253(25)00026-3
In people with ulcerative colitis, removing the appendix reduced relapses within a year from 56% to 36%.
Does the study support the specific claim? Partly · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Test appendicectomy as a treatment for UC
- How was the study done?
Randomised trial
- How many people, animals or samples were studied?
197 adults with UC
- What was actually found?
Fewer relapses after appendicectomy
- How large was the observed effect?
RR 0.65 (0.47-0.89)
- What do the results mean in everyday life?
The appendix plays a role in gut immunity; removing it can help in UC
- What are the study's limitations?
Open-label, short follow-up
- What does it say about Elawady's specific claim?
Supports 'not vestigial'; opposes 'removal is harmful'
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Not about healthy people
Scientific in-depth review
1. Full reference
- Authors
- ACCURE Study Group
- Journal
- Lancet Gastroenterol Hepatol
- Year
- 2025
- Identifier
- PMID 40228513 DOI 10.1016/S2468-1253(25)00026-3
- Verification
- verified – PubMed efetch 2026-10-26; Crossref works API 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Funded by Fonds Nuts-Ohra and NIHR EME (non-commercial).
2. Research question
Does laparoscopic appendicectomy plus standard therapy maintain remission in ulcerative colitis better than standard therapy alone?
3. Study design and population
- Study design
- Randomised controlled trial – Pragmatic open-label international randomised superiority trial (ACCURE)
- Population
Adults with UC in remission but treated for relapse within the preceding 12 months
- Country
Netherlands, Ireland, UK (22 centres)
- Period
2012-2022
- Sample size
201 randomised; 197 analysed (99 vs 98)
- Inclusion and exclusion criteria
UC in remission, recent relapse
4. Methods and endpoints
- Exposure / intervention
Appendicectomy plus maintenance therapy
- Comparator
Maintenance therapy alone
- Endpoints
Relapse within 1 year
- Statistical methods
Relative risk, ITT
5. Actual results
- Results
1-year relapse 36/99 (36%) vs 55/98 (56%), RR 0.65 (95% CI 0.47-0.89; p = 0.005). Adverse events 11% vs 10%; serious adverse events 2% vs 0; two incidental low-grade appendiceal mucinous neoplasms.
- Absolute risks
Relapse 36% vs 56%; NNT about 5.
- Authors' conclusion
Appendicectomy is superior to standard medical therapy alone in maintaining remission in UC.
6. Strengths
- Randomised
- Objective relapse definition with masked committee
7. Weaknesses
- Open-label
- 1-year outcome
- Selected UC patients
8. Risk of bias
- Orienting tool
- RoB 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Unmasked patients and physicians; partially masked outcome assessment.
9. Assessment of the statistical interpretation
RR and CI reproduced from counts (stats/C-ORG-04_05_06_assoc.py).
10. Relevance to the specific claim
Experimental evidence that the appendix takes part in immune-mediated colonic inflammation - but removing it helped patients with UC.
11. Independent contrary findings
n/a
12. Transferability to Germany and Europe
European trial.
13. Overall methodological judgement
Supports that the appendix is immunologically active (not inert), but contradicts the archive's implication that its removal is harmful: in UC, removal was beneficial.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | indirect |
| Reproducibility | not replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Long-term effects; mechanism.