Safety and efficacy of gastrointestinal motility agents following elective colorectal surgery: a systematic review and meta-analysis of randomised controlled trials.
Rathin Gosavi, Nagendra N Dudi-Venkata, Simon Xu, Mohammad Asghari-Jafarabadi, Simon Wilkins, T C Nguyen, William Teoh, Raymond Yap, Paul McMurrick, Vignesh Narasimhan
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引用次数: 0
Abstract
Background: Postoperative ileus (POI) is a frequent complication after elective colorectal surgery, delaying gastrointestinal (GI) recovery and discharge. While pharmacologic agents such as laxatives and prokinetics are often included in enhanced recovery after surgery (ERAS) protocols, their efficacy and safety remain uncertain.
Methods: A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted to evaluate the effect of Gastrointestinal (GI) motility agents on postoperative recovery in elective colorectal surgery. Primary outcomes included GI-2 recovery (tolerance of solid diet and stool passage), time to first defaecation, and safety endpoints. Data was pooled using random-effects models.
Results: Seven RCTs involving 849 patients were included. GI motility agents significantly accelerated GI-2 recovery (mean difference -1.01 days; 95% CI -1.29 to -0.73; p < 0.001) and reduced time to first defaecation (mean difference -1.07 days; 95% CI -1.40 to -0.73; p < 0.001). No significant differences were observed in safety outcomes, including anastomotic leak (OR 0.97; 95% CI 0.53 to 1.77), nasogastric tube reinsertion (OR 0.86; 95% CI 0.49 to 1.51), or readmission rates (OR 1.03; 95% CI 0.62 to 1.72).
Conclusion: Motility agents enhance postoperative GI recovery without compromising safety in patients undergoing elective colorectal surgery. Given their low cost, wide availability, and favourable safety profile, gastrointestinal motility agents may be considered for integration into ERAS protocols. However, further high-quality, standardised trials are needed to confirm their benefits across diverse surgical populations.
背景：术后肠梗阻（POI）是择期结直肠手术后常见的并发症，延迟了胃肠道（GI）的恢复和出院。虽然药物制剂如泻药和促生剂经常被包括在促进术后恢复（ERAS）方案中，但它们的有效性和安全性仍然不确定。方法：对随机对照试验（RCTs）进行系统回顾和荟萃分析，以评估胃肠（GI）运动药物对择期结直肠手术术后恢复的影响。主要结局包括GI-2恢复（对固体饮食和粪便通过的耐受性）、首次排便时间和安全性终点。使用随机效应模型汇总数据。结果：纳入7项随机对照试验，共849例患者。胃肠蠕动剂显著加速胃肠蠕动功能2的恢复(平均差-1.01天；95% CI -1.29 ~ -0.73；结论：动力剂在不影响择期结肠手术患者安全性的前提下，可促进术后胃肠道恢复。鉴于其低成本、广泛可用性和良好的安全性，胃肠道运动药物可能被考虑纳入ERAS方案。然而，需要进一步的高质量、标准化的试验来证实它们在不同手术人群中的益处。
期刊介绍：
The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies.
The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.
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