Dataset Information

Early oral intake and early removal of nasogastric tube post-esophagectomy: A systematic review and meta-analysis.

ABSTRACT:

Background

Early oral intake (EOI: initiated within 1 day) and early nasogastric tube removal (ENR: removed ≤2 days) post-esophagectomy is controversial and subject to significant variation.

Aim

Our aim is to provide the most up-to-date evidence from published randomized controlled trials (RCTs) addressing both topics.

Methods

We searched MEDLINE and Embase (1946-06/2019) for RCTs that investigated the effect of EOI and/or ENR post-esophagectomy with gastric conduit for reconstruction. Our main outcomes of interest were anastomotic leak, aspiration pneumonia, mortality, and length of hospital stay (LOS). Pooled mean differences (MD) and risk ratios (RR) estimates were obtained using a DerSimonian random effects model.

Results

Two reviewers screened 613 abstracts and identified 6 RCTs eligible for inclusion; 2 regarding EOI and 4 for ENR. For EOI (2 studies, n = 389), was not associated with differences in risk of: anastomotic leak (RR: 1.01; 95% CI: 0.407, 2.500; I² : 0%), aspiration pneumonia (RR: 1.018; 95% CI: 0.407, 2.500), mortality (RR: 1.00; 95% CI: 0.020, 50.0). The LOS was significantly shorter in the EOI group: LOS (MD: -2.509; 95% CI: -3.489, -1.529; I² : 90.44%). For ENR (4 studies, n = 295), ENR (removed at POD0-2 vs. 5-8 days) was not associated with differences in risk of: anastomotic leak (RR: 1.11; 95% CI 0.336, 3.697; I² : 25.75%) and pneumonia group (RR: 1.11; 95% CI: 0.336, 3.697; I² : 25.75%), mortality (RR: 0.87; 95% CI: 0.328, 2.308; I² : 0%)or LOS (MD: 1.618; 95% CI: -1.447, 4.683; I² : 73.03%).

Conclusions

Our analysis showed that EOI as well as ENR post-esophagectomy do not significantly increase the risk of anastomotic leak, pneumonia, and mortality. The LOS was significantly shorter in the EOI group, and there was no significant difference in the ENR group. A paucity of RCTs has evaluated this question, highlighting the need for further high-quality evidence to address these vital aspects to post-esophagectomy care.

Systematic review registration

CRD42019138600.

SUBMITTER: Kaaki S

PROVIDER: S-EPMC9124520 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Early oral intake and early removal of nasogastric tube post-esophagectomy: A systematic review and meta-analysis.

Kaaki Suha S Grigor Emma J M EJM Maziak Donna E DE Seely Andrew J E AJE

Cancer reports (Hoboken, N.J.) 20210907 5

<h4>Background</h4>Early oral intake (EOI: initiated within 1 day) and early nasogastric tube removal (ENR: removed ≤2 days) post-esophagectomy is controversial and subject to significant variation.<h4>Aim</h4>Our aim is to provide the most up-to-date evidence from published randomized controlled trials (RCTs) addressing both topics.<h4>Methods</h4>We searched MEDLINE and Embase (1946-06/2019) for RCTs that investigated the effect of EOI and/or ENR post-esophagectomy with gastric conduit for rec ...[more]

PMID: 34494402

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Project description:BackgroundNasogastric (NG) tube insertion is a common procedure in the clinical setting that causes much discomfort and pain for the patient. Pain control is often suboptimal, as many NG tube insertions are performed without any pain-relieving supplements. The aim of this study was to summarize and critically evaluate the evidence from randomized controlled trials (RCTs) on the effect and adverse effects of lidocaine agents in reducing pain and discomfort associated with NG tube insertion.MethodsDatabases from the Cochrane Library, MEDLINE, EMBASE, Airiti Library, PerioPath Index to Taiwan Periodical Literature, and Cumulative Index of Nursing and Allied Health (CINAHL) were searched from inception to April 2017. RCTs focusing on lidocaine before NG tube insertion were appraised. The primary outcome was the visual analog scale (VAS) score. The modified Jadad scale was used for quality assessment. Mean difference (MD) with 95% confidence intervals (95% CIs) and odds ratio (OR) for binary outcomes were assessed by a random effects model. Heterogeneity was determined by using the Cochran Q test and I statistics. Publication bias was analyzed by using a funnel plot analysis.ResultsTen RCTs enrolling 734 patients were included in the meta-analysis. Eight of the 10 RCTs reporting VAS scores had sufficient quantitative data to be pooled through meta-analysis. Results revealed a significant reduction in VAS score, with a MD of -26.05 and a CI of -28.21 to -23.89 with moderate heterogeneity (P?<?.001, I?=?56%). There were no significant changes in difficulty of NG tube insertions (MD?=?-0.30, 95% CI, -1.30 to 0.70, P?=?.55), number of NG tube insertion attempts (MD?=?-0.22, 95% CI, -0.98 to 0.53, P?=?.56), nasal bleeding (OR?=?0.62, 95% CI, 0.11-3.41, P?=?.59), and vomiting (OR?=?0.30, 95% CI, 0.07-1.27, P?=?.10).ConclusionThis meta-analysis suggests that applying lidocaine before NG tube insertion can alleviate pain and discomfort by 26% without increasing nasal bleeding or vomiting.

Dataset Information

Early oral intake and early removal of nasogastric tube post-esophagectomy: A systematic review and meta-analysis.

Background

Aim

Methods

Results

Conclusions

Systematic review registration

Publications

Early oral intake and early removal of nasogastric tube post-esophagectomy: A systematic review and meta-analysis.

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