Loo Jing Hong, Ng Aubrey Ding Rui, Chan Kai Siang, Oo Aung Myint
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
J Gastrointest Surg. 2023 Apr;27(4):823-835. doi: 10.1007/s11605-022-05573-w. Epub 2023 Jan 17.
Intraoperative pyloric drainage in esophagectomy may reduce delayed gastric emptying (DGE) but is associated with risk of biliary reflux and other complications. Existing evidence is heterogenous. Hence, this meta-analysis aims to compare outcomes of intraoperative pyloric drainage versus no intervention in patients undergoing esophagectomy.
PubMed/MEDLINE, Embase, Web of Science, and the Cochrane were searched from inception up to July 2022. Exclusion criteria were lack of objective evidence (e.g., symptoms of nausea or vomiting) of DGE. The primary outcome was incidence of DGE. Secondary outcomes were incidence of pulmonary complications, bile reflux, anastomotic leak, operative time, and mortality.
There were nine studies including 1164 patients (pyloric drainage n = 656, no intervention n = 508). Intraoperative pyloric drainage included pyloroplasty (n = 166 (25.3%)), pyloromyotomy (n = 214 (32.6%)), botulinum toxin injection (n = 168 (25.6%)), and pyloric dilatation (n = 108 (16.5%)). Pyloric drainage is associated with reduced DGE (odds ratio (OR): 0.54, 95% confidence interval (CI): 0.39-0.74, I = 50%). There was no significant difference in incidence of pulmonary complications (OR: 0.74, 95% CI: 0.51-1.08; I = 0%), biliary reflux (OR: 1.43, 95% CI: 0.80-2.54, I = 0%), anastomotic leak (OR: 0.79, 95% CI: 0.48-1.29; I = 0%), operative time (MD: + 22.16 min, 95% CI: - 13.27-57.59 min; I = 76%), and mortality (OR: 1.13, 95% CI: 0.48-2.64, I = 0%) between the pyloric drainage and no intervention groups.
Pyloric drainage in esophagectomy reduces DGE but has similar post-operative outcomes. Further prospective studies should be carried out to compare various pyloric drainage techniques and its use in esophagectomy, especially minimally-invasive esophagectomy.
食管癌切除术中进行幽门引流可能会减少胃排空延迟（DGE），但与胆汁反流及其他并发症风险相关。现有证据存在异质性。因此，本荟萃分析旨在比较食管癌切除术患者术中进行幽门引流与不进行干预的效果。
检索了PubMed/MEDLINE、Embase、Web of Science和Cochrane数据库，检索时间范围从建库至2022年7月。排除标准为缺乏DGE的客观证据（如恶心或呕吐症状）。主要结局为DGE的发生率。次要结局包括肺部并发症、胆汁反流、吻合口漏、手术时间和死亡率。
共纳入9项研究，涉及1164例患者（幽门引流组n = 656，未干预组n = 508）。术中幽门引流包括幽门成形术（n = 166（25.3%））、幽门肌切开术（n = 214（32.6%））、肉毒杆菌毒素注射（n = 168（25.6%））和幽门扩张术（n = 108（16.5%））。幽门引流与DGE减少相关（比值比（OR）：0.54，95%置信区间（CI）：0.39 - 0.74，I² = 50%）。幽门引流组与未干预组在肺部并发症发生率（OR：0.74，95% CI：0.51 - 1.08；I² = 0%）、胆汁反流发生率（OR：1.43，95% CI：0.80 - 2.54，I² = 0%）、吻合口漏发生率（OR：0.79，95% CI：0.48 - 1.29；I² = 0%）、手术时间（MD：+22.16分钟，95% CI： - 13.27 - 57.59分钟；I² = 76%）和死亡率（OR：1.13，95% CI：0.48 - 2.64，I² = 0%）方面无显著差异。
食管癌切除术中进行幽门引流可减少DGE，但术后结局相似。应开展进一步的前瞻性研究，以比较各种幽门引流技术及其在食管癌切除术，尤其是微创食管癌切除术中的应用。
