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Objective To evaluate the efficacy and safety of modified endoscopic retrograde appendicitis therapy (mERAT) for acute uncomplicated appendicitis in children. Methods From October 2018 to May 2021, clinical data were retrospectively reviewed for 228 hospitalized children of acute uncomplicated appendicitis. They were followed up by telephone and outpatient and inpatient electronic information systems in June 2022.The follow-up time was 19(15, 22) months. Clinical profiles, treatment success rate, recurrence within 1 year of cured and discharged children, operative duration, total hospitalization time, hospitalization time after mERAT, hospitalization expense, success rate of intubation, stent implantation rate, stent self-shedding rate, postoperative stent removal time, number of fecal stones, parasites and food seeds detected in appendix cavity and incidence of adverse events during hospitalization were summarized. Results There were 127 boys and 101 girls. Success rate of intubation was 96.9%(221/228), success rate of treatment 96.9%(221/228) and operative duration 40.0(36.0-45.0) min. Rate of stent placement was 83.3%(184/221) and rate of stent shedding 48.4%(89/184).Total hospitalization time was 3(3, 4) day, hospitalization time after mERAT 2(1, 3) day and total hospitalization expense 12787.0(11770.1, 13585.5) yuan. Seventeen cases were lost to follow-ups and recurrence rate within 1 year was 6.9%(14/204).And the incidence of adverse events during hospitalization was 3.5%(8/228). Conclusion mERAT is both safe and effective for acute uncomplicated appendicitis in children. [ABSTRACT FROM AUTHOR]