BACKGROUND: The diagnosis and treatment of chronic abdominal pain related to the appendix have always been challenging. In the past, an appendectomy was the main approach for suspected chronic abdominal pain related to the appendix, but there was an associated risk of negative appendectomy. In recent years, cholangioscope-assisted endoscopic retrograde appendicitis therapy (ERAT) has been used to view the appendiceal cavity directly for flushing, stone removal, biopsy, and other operations, thereby achieving precise treatment. AIMS: The aim of this study was to investigate the safety and efficacy of cholangioscope-assisted ERAT in the management of chronic abdominal pain related to the appendix. METHODS: We evaluated 60 patients with chronic abdominal pain related to the appendix between January 2023 and January 2024, all of whom underwent cholangioscope-assisted endoscopic retrograde appendicitis therapy. The success rate (technical and clinical), procedure time, visual analog scale (VAS) score, length of hospital stay, and complication rate were recorded and analyzed. RESULTS: The technical success rate of cholangioscopy was 100%, and the clinical success rate was 90%. The mean procedure time was 5.4 ± 1.9 min (standard deviation [SD]). The abdominal pain score at the mean follow-up time of 6.6 ± 1.4 months after the procedure was 0 (VAS method) in 90% of the patients. The average length of hospital stay was 2.1 ± 0.7 days. No adverse events occurred. CONCLUSION: Cholangioscope-assisted endoscopic retrograde appendicitis therapy appears to be an effective novel therapy for chronic abdominal pain related to the appendix.