ACCURE Trial (Appendectomy and UC): Lancet Gastro Hepato, March 2026

The ACCURE randomised clinical trial investigated whether laparoscopic appendicectomy could improve disease outcomes in ulcerative colitis (UC) when added to standard medical therapy. The rationale for this approach stems from evidence suggesting that the appendix may play an immunomodulatory role in UC, influencing intestinal inflammation and disease relapse.

In this multicentre international randomised trial conducted across the Netherlands, Ireland, and the UK, patients with established UC in remission but with a relapse within the previous year were assigned to either:

Appendicectomy plus maintenance medical therapy, or

Medical therapy alone.

After 12 months of follow-up, the appendicectomy group demonstrated significantly better outcomes:

Relapse rate: 36% after appendicectomy vs 56% with medical therapy alone.

Relative risk reduction: about 35% lower relapse risk.

Patients undergoing appendicectomy were also less likely to require escalation to biologic therapy and had improved quality-of-life measures.

The procedure was generally safe, with only a small number of postoperative complications and no deaths reported.

Key Clinical Message

This landmark study provides the first randomised evidence that appendicectomy can reduce relapse rates in ulcerative colitis when added to standard therapy. It suggests that the appendix may contribute to UC pathogenesis and that appendicectomy could become an adjunctive therapeutic strategy, particularly in patients with recurrent disease despite conventional therapy.