Journal of Gastrointestinal Surgery

, Volume 21, Issue 9, pp 1523–1532 | Cite as

Gastric Preconditioning in Advance of Esophageal Resection-Systematic Review and Meta-Analysis

  • Patrick Heger
  • Susanne Blank
  • Markus K. Diener
  • Alexis Ulrich
  • Thomas Schmidt
  • Markus W. Büchler
  • André L. Mihaljevic
Original Article
First Online:
Received:
Accepted:

Abstract

Background

Anastomotic leakage is one of the most severe complications following esophageal resection. Among other strategies, gastric ischemic preconditioning has been proposed to improve anastomotic integrity. The aim of this systematic review is to investigate whether gastric preconditioning has influence on peri- or postoperative outcomes after esophageal resection.

Methods

A systematic literature search was performed to identify studies comparing gastric preconditioning with non-preconditioned patients for any indication of esophageal resection. Random-effects meta-analyses were conducted for main outcomes.

Results

Gastric preconditioning did not reduce anastomotic leakages (OR 0.76; 95%-CI 0.51 to 1.13; p = 0.18), anastomotic strictures (OR 1.10; 95%-CI 0.58 to 2.10; p = 0.76;), major complications (OR 1.14; 95%-CI 0.60 to 2.14; p = 0.69), or in-hospital mortality (OR 0.62; 95%-CI 0.28 to 1.40; p = 0.25). However, preconditioning reduced the rate of severe leaks requiring reoperation (OR 0.20; 95%-CI 0.08 to 0.53; p = 0.001). Increasing the period between preconditioning and esophageal resection over 2 weeks did not reduce anastomotic leakage compared to shorter waiting times (OR 0.65; 95%-CI 0.38 to 1.13; p = 0.13).

Conclusion

With current evidence, gastric preconditioning does not seem to reduce overall rates of anastomotic leakage after esophageal resection but seems to reduce severity of leakages.

Keywords

Esophageal neoplasms Ischemic preconditioning Anastomotic leak 
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Notes

Acknowledgements

No additional funding source is available. However, the resources and facilities of the University of Heidelberg were used in conducting this study.

Authors’ Contributions

PH, SB, TS, and ALM developed the study concept. MKD helped to develop the study concept and gave methodological advice. PH and SB made the acquisition of literature and data extraction. PH, SB, TS, and ALM conducted the statistical analyses. PH and SB wrote the first draft of the manuscript. MKD, AU, and MWB provided the scientific input for the study’s background and rationale and contributed to the interpretation of the data. All authors read, critically revised, and approved the final manuscript.

Compliance with Ethical Standards

Conflict of Interests

The authors declare that they have no conflict of interest.

Supplementary material

11605_2017_3416_MOESM1_ESM.docx (28 kb)
ESM 1 (DOCX 27 kb)
11605_2017_3416_MOESM2_ESM.docx (33 kb)
ESM 2 (DOCX 32 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Patrick Heger
    • 1
    • 2
  • Susanne Blank
    • 1
  • Markus K. Diener
    • 1
    • 2
  • Alexis Ulrich
    • 1
  • Thomas Schmidt
    • 1
  • Markus W. Büchler
    • 1
  • André L. Mihaljevic
    • 1
    • 2
  1. 1.Department of General, Visceral and Transplantation SurgeryUniversity of Heidelberg, University Hospital HeidelbergHeidelbergGermany
  2. 2.The Study Centre of the German Surgical Society (SDGC)University of HeidelbergHeidelbergGermany

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