title: Nasogastric decompression following esophagectomy: a systematic literature review and meta-analysis.
abstract: Routine use of nasogastric tubes for gastric decompression has been abolished in nearly all types of gastro-intestinal surgery after introduction of enhanced recovery after surgery programs. However, in esophagectomy the routine use of nasogastric decompression is still a matter of debate. To determine the effects of routine nasogastric decompression following esophagectomy compared with early or peroperative removal of the nasogastric tube on pulmonary complications, anastomotic leakage, mortality, and postoperative recovery. A systematic literature review and meta-analysis of studies comparing early or peroperative versus late removal of nasogastric tubes. A total of seven comparative studies were included (n = 608). In two randomized trials, and one retrospective cohort study, peroperative removal of the nasogastric tube was compared with routine nasogastric decompression. In one randomized trial early removal of the nasogastric tube (on postoperative day 2) was compared with removal of the nasogastric tube on the 6th-10th postoperative day. In the remaining three trials a fast-track protocol without a nasogastric tube was compared with conventional care with a nasogastric tube during the first postoperative days. Peroperative or early removal of the nasogastric tube did not result in a significantly different rate of anastomotic leakage, pulmonary complications or mortality in individual studies, nor in the meta-analysis. In the meta-analysis, hospital stay was significantly shorter with peroperative or early removal of the nasogastric tube when all studies were included, but not when the meta-analysis was limited to randomized trials. This systematic review did not find a difference in adverse outcomes between nasogastric decompression or no nasogastric decompression following esophagectomy.
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
authors.forename: Teus J
authors.initials: TJ
authors.lastname: Weijs
authors.affiliation: Division of Surgery, CLINTEC, Karolinska Institutet, and Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.|Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Koshi
authors.initials: K
authors.lastname: Kumagai
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
authors.forename: Gijs H K
authors.initials: GH
authors.lastname: Berkelmans
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
authors.forename: Grard A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.affiliation: Division of Surgery, CLINTEC, Karolinska Institutet, and Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Nilsson
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
authors.forename: Misha D P
authors.initials: MD
authors.lastname: Luyer
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control; D019299:Decompression, Surgical / Q000379:methods*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors
keywords: anastomotic leak; esophagectomy; nasogatric tube; pneumonia