Acute appendicitis is one of the common causes of acute abdominal pain. In the past, the main clinical treatment for acute appendicitis was appendectomy. However, with deeper research in the function of appendix and considering issues such as residual surgical scars from surgical procedures, along with the rapid development of endoscopic technology, endoscopic retrograde appendicitis therapy (ERAT) was pioneered in 2012 by Professor Liu Bingrong's team. After more than a decade of development, ERAT technology has become quite mature and can be used to treat various types of acute appendicitis, including peri-appendiceal abscesses and appendiceal fecalith impactions. Moreover, with the advent of currently direct endoscopic retrograde appendicitis therapy（D-ERAT）, the success rate and safety of the procedure have improved, significantly reducing radiation exposure to patients and medical staff, and addressing the difficulty of performing ERAT in special patient populations such as pregnant women. This article briefly reviews the historical development of the ERAT procedure, explores the innovative treatment approach of D-ERAT, and looks forward to the future prospects of D-ERAT.