Acute appendicitis is one of the most common reason for acute abdominal pain. The main treatment method of acute appendicitis is appendectomy. With the progress of immunology, the crucial and pivotal status of intestinal mucosal immunity and intestinal flora in protecting body against pathogens emerges. Moreover, these immunologists proposed that appendix plays a vital role in intestinal mucosal immunity. Thereby, appendix should not be removed arbitrarily.With the improvement of endoscopic techniques, many disease can be treated with the minimal invasive method. For example, the ERCP techniques enable the mortality of acute cholangitis to decrease to 0.5 percent or below. Recently, more and more surgeons treated these patients with ERCP techniques. We proposed to the concept of endoscopic retrograde appendicitis therapy (ERAT) and treated successfully the patients with acute appendicitis in 2012. At present, the technique can be adapted for all types of acute appendicitis including peri-appendiceal abscess. The aim of this article is to discuss the develop history of treatment method for the patients with acute appendicitis and provide the physicians with another new concept and method for the treatment of the patients.