title: Zusanli (ST36) acupoint injection for preventing postoperative ileus: A systematic review and meta-analysis of randomized clinical trials.
abstract: OBJECTIVE
  To evaluate the preventive effect of Zusanli (ST36) acupoint injections with various agents, for postoperative ileus (POI).
  
  
  METHODS
  We searched electronic databases for randomized controlled trials from inception to 1st February 2015 evaluating ST36 acupoint injection for preventing POI. Revman 5.2.0 was used for data analysis with effect estimates presented as mean difference (MD) with 95% confidence interval (CI). Statistical heterogeneity was tested using I(2) (defined as significant if I(2)>75%). We used a random effects model (REM) for pooling data with significant heterogeneity.
  
  
  RESULTS
  Thirty trials involving 2967 participants were included. All trials were assessed as high risk of bias (poor methodological quality). For time to first flatus, meta-analysis favored ST36 acupoint injection of neostigmine (MD -20.70h, 95% CI -25.53 to -15.87, 15 trials, I(2)=98%, REM), vitamin B1 (MD -11.22h, 95% CI -17.01 to -5.43, 5 trials, I(2)=98%, REM), and metoclopramide (MD -15.65h, 95% CI -24.77 to -6.53, 3 trials, I(2)=94%, REM) compared to usual care alone. Meta-analysis of vitamin B1 favored ST36 acupoint injection compared to intra-muscular injection (MD -17.21h, 95% CI -21.05 to -13.36, 4 trials, I(2)=89%, REM). Similarly, for time to bowel sounds recovery and first defecation, ST36 acupoint injection also showed positive effects.
  
  
  CONCLUSIONS
  ST36 acupoint injections with various agents may have a preventive effect for POI. Safety is inconclusive as few of included trials reported adverse events. Due to the poor methodological quality and likely publication bias further robust clinical trials are required to arrive at a definitive conclusion.
authors.affiliation: School of Preclinical Medicine, Liaoning University of Traditional Chinese Medicine, 79 Chong Shan Dong Lu, Huanggu District, Shenyang 110847, China. Electronic address: linhan616@126.com.
authors.forename: Mei
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, 33 Bei Ling Street, Huanggu District, Shenyang 110032, China. Electronic address: gaoyh-573@163.com.
authors.forename: Yun-Hai
authors.initials: YH
authors.lastname: Gao
authors.affiliation: School of Preclinical Medicine, Liaoning University of Traditional Chinese Medicine, 79 Chong Shan Dong Lu, Huanggu District, Shenyang 110847, China. Electronic address: xujie729@yeah.net.
authors.forename: Jie
authors.initials: J
authors.lastname: Xu
authors.affiliation: School of Preclinical Medicine, Liaoning University of Traditional Chinese Medicine, 79 Chong Shan Dong Lu, Huanggu District, Shenyang 110847, China. Electronic address: chemcy@mail.dlut.edu.cn.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Chi
authors.affiliation: Department of General Surgery, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, 33 Bei Ling Street, Huanggu District, Shenyang 110032, China. Electronic address: weixiaobing1314@126.com.
authors.forename: Xiao-Bing
authors.initials: XB
authors.lastname: Wei
authors.affiliation: Primary Care, Faculty of Medicine, University of Southampton, Hampshire SO16 5ST, UK. Electronic address: glewith@scmrt.org.uk.
authors.forename: George
authors.initials: G
authors.lastname: Lewith
authors.affiliation: School of Preclinical Medicine, Liaoning University of Traditional Chinese Medicine, 79 Chong Shan Dong Lu, Huanggu District, Shenyang 110847, China; Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing 100029, China. Electronic address: jianping_l@hotmail.com.
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Liu
mesh_terms: D015669:Acupuncture Points; D015670:Acupuncture Therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D045823:Ileus / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy*; D055815:Young Adult
keywords: Meta-analysis; Postoperative ileus; Randomized controlled trial; ST36 acupoint injection; Systematic review