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

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.