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Outcomes of Intraoperative Pyloric Drainage on Delayed Gastric Emptying Following Esophagectomy: A Systematic Review and Meta-analysis

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Data Availability

All data collected for this study were obtained from published articles. Requests may be made to the corresponding author for data collected.

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Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Jing Hong Loo, Aubrey Ding Rui Ng & Aung Myint Oo

  2. Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore

    Kai Siang Chan & Aung Myint Oo

  3. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore

    Aung Myint Oo

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AMO contributed to study concept and design; LJH, ADRN, and KSC contributed to systematic review of literature and drafting of manuscript; all authors did critical review of manuscript.

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Correspondence to Aung Myint Oo.

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Loo, J.H., Ng, A.D.R., Chan, K.S. et al. Outcomes of Intraoperative Pyloric Drainage on Delayed Gastric Emptying Following Esophagectomy: A Systematic Review and Meta-analysis. J Gastrointest Surg 27, 823–835 (2023). https://doi.org/10.1007/s11605-022-05573-w

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