Efficacy and safety of acupuncture for postoperative gastroparesis syndrome: a systematic review and meta-analysis

Abstract

Background: Postoperative gastroparesis syndrome (PGS) is a common postoperative complication characterized by epigastralgia, nausea, and vomiting. Acupuncture is widely used to aid recovery, but its efficacy and safety have not been systematically evaluated.

Method: We retrieved randomized controlled trials (RCTs) using acupuncture as the primary intervention from six databases. After study selection and data extraction, a meta-analysis was performed using Review Manager 5.4.1. Study quality was assessed with the Cochrane risk of bias tool, and publication bias was quantitatively evaluated using Egger's test and was corrected using the trimming and filling method.

Results: A total of 12 RCTs involving 709 participants (363 in the acupuncture group and 346 in the control group) were included. The meta-analysis showed a significantly higher overall response rate in the acupuncture group than the control group [RD = 0.16, 95% CI (0.11, 0.21), p < 0.001]. Acupuncture also reduced gastric tube indwelling time [MD = -2.36, 95% CI (-3.14, -1.59), p < 0.001], decreased gastric juice drainage [MD = -166.88, 95% CI (-176.57, -156.18), p < 0.001], and improved serum motilin levels [MD = 41.65, 95% CI (30.14, 53.15), p < 0.001]. Four studies reported no adverse events in either group, but the majority of studies did not provide safety data.

Conclusion: Acupuncture may alleviate clinical symptoms and shorten hospitalization, potentially by enhancing gastrointestinal motility. However, the lack of safety data in the majority of studies raises concerns about the reliability of these findings and the transferability of the results. Future trials should focus on rigorous randomization, blinding, and comprehensive safety reporting to improve the quality of evidence in this field.

Systematic review registration: ID: INPLASY202320035 URL: https://inplasy.com/inplasy-2023-2-0035/.

Keywords: acupoint; acupuncture; meta-analysis; postoperative gastroparesis syndrome; systematic review.

Figure 1

PRISMA flowchart for literature search and screening.

Figure 2

Results of the risk of bias assessment. (A) Risk of bias graph and (B) risk of bias summary. Red represents high risk, green represents low risk, and yellow represents uncertain risk.

Figure 3

Forest plot of overall response rate after treatment. The coordinate values corresponding to the squares represent the response rate difference between the experimental group and control group of each study, and the range of values spanned by the horizontal lines represents the confidence interval of each study. The diamond at the bottom represents a pooled effect.

Figure 4

Forest plot of the decrease of gastric drainage after treatment. The coordinate values corresponding to the green squares represent the additional reduction in gastric drainage volume brought about by acupuncture in each study. The size of the square represents the weight of each study. The range of values spanned by the horizontal line represents the confidence interval. The top and middle diamonds represent the results of the subgroup analysis. The diamond at the bottom represents the overall effect.

Figure 5

Forest plot of the decrease of gastric tube indwelling time after treatment. The coordinate values corresponding to the green squares represent the additional reduction in gastric tube removal time brought about by acupuncture in each study. The size of the squares represents the weight of each study. The range of values spanned by the horizontal line represents the confidence interval. The diamond at the bottom represents the combined result.

Figure 6

Forest plot of the increase of serum motilin level after treatment. The coordinate values corresponding to the green squares represent the additional increase in serum motilin brought about by acupuncture in each study. The size of the squares represents the weight of each study. The numerical range spanned by the horizontal line represents the confidence interval, and the diamond at the bottom represents the combined result.

Figure 7

Results of sensitivity analysis. (A) Funnel plot of the overall response rate. (B) Funnel plot after the correction of trimming and filling method. The solid circles represent each included study. The hollow circles represent virtual studies added based on the trimming and filling method.