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Gastric ischemic conditioning prior to esophagectomy reduces anastomotic leaks and strictures: a systematic review and meta-analysis

  • 2021 SAGES Oral
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Abstract

Background

Gastric ischemic conditioning (GIC) is a strategy to promote neovascularization of the gastric conduit to reduce the risk of anastomotic complications following esophagectomy. Despite a number of studies and reviews published on the concept of ischemic conditioning, there remains no clear consensus regarding its utility. We performed an updated systematic review and meta-analysis to determine the impact of GIC, particularly on anastomotic leaks, conduit ischemia, and strictures.

Methods

A systematic search of MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library was performed on February 5th, 2020 by a university librarian after selection of key search terms with the research team. Inclusion criteria included human participants undergoing esophagectomy with gastric conduit reconstruction, age ≥ 18, N ≥ 5, and GIC performed prior to esophagectomy. Our primary outcome of interest was anastomotic leaks. Our secondary outcome was gastric conduit ischemia, anastomotic strictures, and overall survival. Meta-analysis was performed with RevMan 5.4.1 using a Mantel–Haenszel fixed-effects model.

Results

A total of 1712 preliminary studies were identified and 23 studies included for final review. GIC was performed in 1178 (53.5%) patients. Meta-analysis revealed reduced odds of anastomotic leaks (OR 0.67; 95% CI 0.46–0.97; I2 = 5%; p = 0.03) and anastomotic strictures (OR 0.48; 95% CI 0.29–0.80; I2 = 65%; p = 0.005). Meta-analysis revealed no difference in odds of conduit ischemia (OR 0.40; 95% CI 0.13–1.23; I2 = 0%; p = 0.11) and no difference in odds of overall survival (OR 0.54; 95% CI 0.29–1.02; I2 = 22%; p = 0.06).

Conclusion

GIC is associated with reduced odds of anastomotic leaks and anastomotic strictures and may decrease morbidity in patients undergoing esophagectomy. Further prospective randomized trials are needed to better identify the optimal patient population, timing, and techniques used to best achieve GIC.

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Acknowledgements

The research team would like to thank the University of Alberta’s library service for facilitating inter-library loans for inaccessible research articles during this review.

Funding

No funding was secured for this systematic review and meta-analysis.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Canada

    Uzair M. Jogiat, Warren Y. L. Sun, Jerry T. Dang, Valentin Mocanu, Shahzeer Karmali & Noah J. Switzer

  2. John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada

    Janice Y. Kung

  3. Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada

    Simon R. Turner

  4. Division of General Surgery, Department of Surgery, Royal Alexandra Hospital, Room 415 Community Services Center, 10240 Kingsway Avenue, Edmonton, AB, T5H3V9, Canada

    Noah J. Switzer

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  1. Uzair M. Jogiat
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Correspondence to Noah J. Switzer.

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Drs. Jogiat, Sun, Dang, Mocanu, Karmali, Turner, and Switzer have no conflict of interest or financial ties to disclose. Librarian Janice Kung has no conflict of interest or financial ties to disclose.

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Jogiat, U.M., Sun, W.Y.L., Dang, J.T. et al. Gastric ischemic conditioning prior to esophagectomy reduces anastomotic leaks and strictures: a systematic review and meta-analysis. Surg Endosc 36, 5398–5407 (2022). https://doi.org/10.1007/s00464-021-08866-4

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