Background

Gastric conduit has emerged as the preferred treatment option for both esophageal bypass and replacement for corrosive stricture of the esophagus. There is a lack of consensus and a dearth of published literature regarding the short- and long-term complications of using a gastric conduit. This meta-analysis aims to evaluate the outcomes, morbidity, and complications associated with it.

Methods

MEDLINE, Cochrane Library, and Google Scholar (January 1960 to May 2020) were systematically searched for all studies reporting short- and/or long-term outcomes and complications following the use of a gastric conduit for corrosive esophageal stricture.

Results

Seven observational studies involving 489 patients (53.2% males, mean age ranging from 22.1 to 41 years) who had ingested a corrosive substance (acid in 74.8%, alkali in 20.7%, and unknown in the rest) were analyzed. Gastric pull-up was performed in 56.03% (274/489) of patients. Median blood loss in the procedure was 187.5 ml with a mean operative duration of 298.75 ± 55.73 min. The overall pooled prevalence rate of anastomotic leak was 14.4% [95% CI (6.2–24.0); p < 0.05, I² = 67.38], and anastomotic stricture was 27.2% [95% CI (13–42.8); p < 0.001, I² = 80.11]. Recurrent dysphagia according to pooled prevalence estimates occurred in 14.4% patients [95% CI (5.4–25.1); p < 0.05, I² = 69.1] and 90-day mortality in 4.8% patients [95% CI (1.5–9.1%); I² = 31.1, p = 0.202]. The dreaded complication of conduit necrosis had a pooled prevalence of 1.3% [95% CI (0.1–3.4%); I² = 0, p = 0.734].

Conclusion

The stomach can be safely used as the conduit of choice in corrosive strictures with an acceptable rate of complications, postoperative morbidity, and mortality.

中文翻译：

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腐蚀性食管狭窄中胃导管的结果：系统评价和 Meta 分析

背景

胃导管已成为食道旁路和替代食道腐蚀性狭窄的首选治疗方案。关于使用胃导管的短期和长期并发症，缺乏共识和已发表的文献。该荟萃分析旨在评估与之相关的结果、发病率和并发症。

方法

系统地搜索了 MEDLINE、Cochrane 图书馆和 Google Scholar（1960 年 1 月至 2020 年 5 月）中所有报告使用胃导管治疗腐蚀性食管狭窄后短期和/或长期结果和并发症的研究。

结果

七项观察性研究涉及 489 名患者（53.2% 男性，平均年龄为 22.1 至 41 岁），这些患者摄入了腐蚀性物质（74.8% 为酸，20.7% 为碱，其余为未知）。56.03% (274/489) 的患者进行了胃引流术。手术中的中位失血量为 187.5 毫升，平均手术时间为 298.75 ± 55.73 分钟。吻合口瘘的总体合并患病率为 14.4% [95% CI (6.2–24.0)；p  < 0.05，I ²  = 67.38]，吻合口狭窄为 27.2% [95% CI (13–42.8)；p  < 0.001，I ²  = 80.11]。根据汇总的患病率估计，复发性吞咽困难发生在 14.4% 的患者中 [95% CI (5.4–25.1)；p  < 0.05，I ²  = 69.1] 和 4.8% 患者的 90 天死亡率 [95% CI (1.5–9.1%); I ²  = 31.1，p  = 0.202]。导管坏死的可怕并发症的合并患病率为 1.3% [95% CI (0.1–3.4%)；I ²  = 0，p  = 0.734]。

结论

胃可安全地用作腐蚀性狭窄的首选导管，并发症、术后发病率和死亡率均可接受。