scholarly journals Early oral intake and early removal of nasogastric tube post‐esophagectomy: A systematic review and meta‐analysis

2021 ◽  
Author(s):  
Suha Kaaki ◽  
Emma J. M. Grigor ◽  
Donna E. Maziak ◽  
Andrew J. E. Seely
Keyword(s):  
Systematic Review ◽  
Nasogastric Tube ◽  
Meta Analysis ◽  
Oral Intake ◽  
Early Removal

675 FUNDOPLICATION VERSUS ORAL PROTON PUMP INHIBITORS FOR GASTROESOPHAGEAL REFLUX DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Luca Schiliró Tristão ◽  
Francisco Tustumi ◽  
Guilherme Tavares ◽  
Letícia Nogueira Datrino ◽  
Maria Carolina Andrade Serafim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Adverse Events ◽  
Proton Pump ◽  
Reflux Disease ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Oral Intake

Abstract   Gastroesophageal reflux disease (GERD) is a widely studied and highly prevalent condition. However, few is reported about the exact efficacy and safety of fundoplication (FPT) compared to oral intake proton-pump inhibitors (PPI). This systematic review and meta-analysis of randomized clinical trials (RCT) aims to compare PPI and FPT in relation to the efficacy, as well as the adverse events associated with these therapies. Methods This systematic review was guided by PRISMA statement. Search carried out in June 2020 was conducted on Medline, Cochrane, EMBASE and LILACS. The inclusion criteria were (I) patients with GERD; (II) Randomized clinical trials, comparing oral intake PPI with FPT; (III) relevant outcomes for this review. The exclusion criteria were (I) reviews, case reports, editorials and letters (II) transoral or endoscopic FPT (III) studies with no full text. No restrictions were set for language or period. Certainty of evidence and risk of bias were assessed with GRADE Pro and with Review Manager Version 5.4 bias assessment tool. Results Ten RCT were included. Meta-analysis showed that heartburn (RD = −0.19; 95% CI = −0.29, −0.09) was less frequently reported by patients that underwent FPT. Furthermore, patients undergoing surgery had greater pressure on the lower esophageal sphincter than those who used PPI (MD = 7.81; 95% CI 4.79, 10.83). There was no significant difference between groups in the percentage of time with pH less than 4 in 24 hours, sustained remission and Gastrointestinal Symptom Rating Scale. Finally, FPT did not increase significantly the risk for adverse events such as postoperative dysphagia and impaired belching. Conclusion FPT is a more effective therapy than PPI treatment for GERD, without significantly increasing the risk for adverse events. However, before indicating a possible surgical approach, it is extremely important to correctly assess and select the patients who would benefit from FPT, such as those with severe erosive esophagitis, severe respiratory symptoms, low adherence to continuous drug treatment and patients with non-acid reflux, to ensure better results.

Mo1668 The Risk of Clostridium difficile Associated Diarrhea in Nasogastric Tube Insertion: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 150 (4) ◽  
pp. S748
Author(s):  
Karn Wijarnpreecha ◽  
Suthanya Sornprom ◽  
Charat Thongprayoon ◽  
Parkpoom Phatharacharukul ◽  
Wisit Cheungpasitporn ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clostridium Difficile ◽  
Nasogastric Tube ◽  
Meta Analysis ◽  
Tube Insertion ◽  
Clostridium Difficile Associated Diarrhea ◽  
Nasogastric Tube Insertion

Is NGT (Nasogastric tube) really necessary in patients after pancreatoduodenectomy: The first systematic review and meta-analysis

Pancreatology ◽  
2021 ◽  
Vol 21 ◽  
pp. S99-S100
Author(s):  
K. Wei ◽  
R. Klotz ◽  
P. Probst ◽  
J. Neoptolemos ◽  
T. Hackert
Keyword(s):  
Systematic Review ◽  
Nasogastric Tube ◽  
Meta Analysis

scholarly journals Interventions to prevent anastomotic leak after esophageal surgery: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Emma J.M. Grigor ◽  
Suha Kaaki ◽  
Dean A. Fergusson ◽  
Donna E. Maziak ◽  
Andrew J.E. Seely
Keyword(s):  
Systematic Review ◽  
Critical Appraisal ◽  
Meta Analysis ◽  
Quality Of Evidence ◽  
Randomized Controlled ◽  
Practice Recommendations ◽  
Early Removal ◽  
Tube Removal ◽  
Risk Ratios

Abstract Background: Anastomotic leakage (AL) is a common and serious complication following esophagectomy. We aimed to provide an up-to-date review and critical appraisal of interventions designed to reduce AL risk. Methods: We searched MEDLINE and Embase from 1946 to January 2019 for randomized controlled trials (RCTs) evaluating interventions to minimize esophagogastric AL. Pooled risk ratios (RR) for AL was performed using random effects. Results: Two reviewers screened 441 abstracts and identified 17 RCTs eligible for inclusion; 11 studies were meta-analyzed. Omentoplasty reduced the risk of AL significantly by 78% [RR: 0.22; 95% CI: 0.10, 0.50] compared to no omentoplasty (3 studies, n = 611 patients). Early removal of NG tube reduced AL risk significantly by 62% [RR: 0.38; 95% CI: 0.02, 0.65] compared to prolonged NG tube (2 studies, n = 293 patients); Stapled (vs. hand-sewn) anastomosis did not significantly reduce AL risk [RR: 0.92; 95% CI: 0.45, 1.87] compared to hand-sewn (6 studies, n = 1,454 patients). The quality of evidence was high for omentoplasty (vs. no omentoplasty), moderate for early removal of NG tube (vs. conventional removal), and very low for stapled anastomosis (vs. hand-sewn). Conclusions: This is the first meta-analysis to summarize the graded quality of evidence for all RCT interventions designed to reduce AL following esophagectomy. Our findings demonstrated that omentoplasty reduced the risk of AL with a high quality of evidence. Although early nasogastric tube removal reduced AL risk, there is a need for further research to strengthen the quality of evidence. Evidence profiles presented in our review may help inform the development of clinical practice recommendations. Systematic review registration: CRD42019127181

scholarly journals Interventions to Prevent Anastomotic Leak After Esophageal Surgery: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Emma Jayne Myfanwy Grigor ◽  
Suha Kaaki ◽  
Dean A Fergusson ◽  
Donna E Maziak ◽  
Andrew J E Seely
Keyword(s):  
Systematic Review ◽  
Critical Appraisal ◽  
Meta Analysis ◽  
Quality Of Evidence ◽  
Randomized Controlled ◽  
Practice Recommendations ◽  
Early Removal ◽  
Tube Removal ◽  
Risk Ratios

Abstract Background: Anastomotic leakage (AL) is a common and serious complication following esophagectomy. We aimed to provide an up-to-date review and critical appraisal of interventions designed to reduce AL risk.Methods: We searched MEDLINE and Embase from 1946 to January 2019 for randomized controlled trials (RCTs) evaluating interventions to minimize esophagogastric AL. Pooled risk ratios (RR) for AL was performed using random effects. Results: Two reviewers screened 441 abstracts and identified 17 RCTs eligible for inclusion; 11 studies were meta-analyzed. Omentoplasty reduced the risk of AL significantly by 78% [RR: 0.22; 95% CI: 0.10, 0.50] compared to no omentoplasty (3 studies, n=611 patients). Early removal of NG tube reduced AL risk significantly by 88% [RR: 0.12; 95% CI: 0.02, 0.65] compared to prolonged NG tube (2 studies, n=293 patients); Stapled (vs. hand-sewn) anastomosis did not significantly reduce AL risk [RR: 0.92; 95% CI: 0.45, 1.87] compared to hand-sewn (6 studies, n=1454 patients). The quality of evidence was high for omentoplasty (vs. no omentoplasty), moderate for early removal of NG tube (vs. conventional removal), and very low for stapled anastomosis (vs. hand-sewn). Conclusions: This is the first meta-analysis to summarize the graded quality of evidence for all RCT interventions designed to reduce AL following esophagectomy. Our findings demonstrated that omentoplasty reduced the risk of AL with a high quality of evidence. Although early nasogastric tube removal reduced AL risk, there is a need for further research to strengthen the quality of evidence. Evidence profiles presented in our review may help inform the development of clinical practice recommendations.Systematic review registration: CRD42019127181

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