Abstract：
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, I2 = 50%). There was no significant difference in incidence of pulmonary complications (OR: 0.74, 95% CI: 0.51-1.08; I2 = 0%), biliary reflux (OR: 1.43, 95% CI: 0.80-2.54, I2 = 0%), anastomotic leak (OR: 0.79, 95% CI: 0.48-1.29; I2 = 0%), operative time (MD: + 22.16 min, 95% CI: - 13.27-57.59 min; I2 = 76%), and mortality (OR: 1.13, 95% CI: 0.48-2.64, I2 = 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.
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, I2 = 50%). There was no significant difference in incidence of pulmonary complications (OR: 0.74, 95% CI: 0.51-1.08; I2 = 0%), biliary reflux (OR: 1.43, 95% CI: 0.80-2.54, I2 = 0%), anastomotic leak (OR: 0.79, 95% CI: 0.48-1.29; I2 = 0%), operative time (MD: + 22.16 min, 95% CI: - 13.27-57.59 min; I2 = 76%), and mortality (OR: 1.13, 95% CI: 0.48-2.64, I2 = 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.
摘要：
背景：食管切除术中幽门引流可减少胃排空延迟（DGE），但与胆道反流和其他并发症的风险相关。现有的证据是异质的。因此，本荟萃分析旨在比较食管癌切除术患者术中幽门引流与未介入治疗的结局.
方法：PubMed/MEDLINE，Embase,WebofScience,和Cochrane从成立到2022年7月被搜索。排除标准是缺乏客观证据(例如，DGE的恶心或呕吐症状）。主要结果是DGE的发生率。次要结果是肺部并发症的发生率，胆汁反流,吻合口漏,手术时间,和死亡率。
结果：共有9项研究，包括1164例患者（幽门引流n=656，无干预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％）），肉毒杆菌毒素注射液(n=168(25.6%))，幽门扩张(n=108(16.5%))。幽门引流与DGE降低相关(比值比(OR):0.54,95%置信区间(CI):0.39-0.74,I2=50%)。肺部并发症发生率无显著差异(OR:0.74,95%CI:0.51-1.08;I2=0%),胆汁反流（OR：1.43，95%CI：0.80-2.54，I2=0%），吻合口漏(OR:0.79,95%CI:0.48-1.29;I2=0%),手术时间(MD:+22.16min,95%CI：-13.27-57.59分钟；I2=76%），幽门引流组和无干预组之间的死亡率（OR：1.13，95％CI：0.48-2.64，I2=0％）。
结论：食管切除术中幽门引流可降低DGE，但术后结局相似。应进行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切除术中的应用。尤其是微创食管切除术.
方法：PubMed/MEDLINE，Embase,WebofScience,和Cochrane从成立到2022年7月被搜索。排除标准是缺乏客观证据(例如，DGE的恶心或呕吐症状）。主要结果是DGE的发生率。次要结果是肺部并发症的发生率，胆汁反流,吻合口漏,手术时间,和死亡率。
结果：共有9项研究，包括1164例患者（幽门引流n=656，无干预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％）），肉毒杆菌毒素注射液(n=168(25.6%))，幽门扩张(n=108(16.5%))。幽门引流与DGE降低相关(比值比(OR):0.54,95%置信区间(CI):0.39-0.74,I2=50%)。肺部并发症发生率无显著差异(OR:0.74,95%CI:0.51-1.08;I2=0%),胆汁反流（OR：1.43，95%CI：0.80-2.54，I2=0%），吻合口漏(OR:0.79,95%CI:0.48-1.29;I2=0%),手术时间(MD:+22.16min,95%CI：-13.27-57.59分钟；I2=76%），幽门引流组和无干预组之间的死亡率（OR：1.13，95％CI：0.48-2.64，I2=0％）。
结论：食管切除术中幽门引流可降低DGE，但术后结局相似。应进行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切除术中的应用。尤其是微创食管切除术.
