Acute appendicitis (AA) is one of the most common general surgical emergencies. The laparoscopic appendectomy is the main therapeutic approach for AA, but the non-operative management such as the antibiotic-first strategy can be considered safe and effective in selected patients with uncomplicated AA. At present, with the continuous development of the technology and concept of natural orifice transluminal endoscopic surgery, endoscopic retrograde appendicitis therapy and endoscopic appendectomy begin to be used in the treatment of uncomplicated AA. This article introduces the current status and prospect of endoscopic therapeutic strategy for AA.