Electroacupuncture for postoperative recovery of gastrointestinal function in patients with gastrointestinal cancers: A systematic review and meta-analysis

To evaluate the efficacy and safety of electroacupuncture (EA) for postoperative recovery in patients with gastrointestinal (GI) cancers. We retrieved articles from PubMed, Embase, OVID, Cochrane Library, Web of Science, CINAHL, SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang, and Technology Journal Database (VIP) from database inception to November 1 2024. Randomized controlled trials (RCTs) that examining the use of EA to improve GI function, reduce pain, and promote self-care ability after GI cancer surgery were included. Based on the type of control interventions, separate meta-analyses were conducted for EA vs postoperative nursing (PN) and EA vs sham acupuncture (SA). The primary outcomes were the time to first flatus (TFF) and the time to first defecation (TFD). The secondary outcomes included the time to recovery of bowel sounds (TRBS), the time to tolerance of liquid diet (TTLD), the time to tolerance of semiliquid diet (TTSD), the time to independent walking (TIW), the length of hospitalization (LH), and visual analog scale (VAS) immediate resting pain scores measured on the first, second and third postoperative days (POD 1-3). Results are reported as mean differences (MDs) with 95% confidence intervals (CIs). RevMan 5.3 was used for meta-analysis, StataSE 15.1 was used for sensitivity analyses and Egger’s tests. This study was registered on PROSPERO (CRD42022314754). A total of 19 RCTs involving 1902 participants were included, all of which were conducted in China between 2004 and 2023. When EA compared with PN, the meta-analysis showed EA significantly reduce TFF (n = 673, MD = -13.14, 95% CI = [-18.97 to -7.31], P < 0.00001), TFD (n = 598, MD = -19.86, 95% CI = [-27.83 to -11.89], P < 0.00001), TRBS (n = 216, MD = -12.44, 95% CI = [-15.00 to -9.87], P < 0.00001), TTLD (n = 268, MD = -18.14, 95% CI = [-24.98 to -11.29], P < 0.00001), TTSD (n = 141, MD = -20.44, 95% CI = [-33.84 to -7.04], P = 0.003), VAS on POD 1 (n = 299, MD = -0.52, 95% CI = [-0.92 to -0.11], P = 0.01), VAS on POD 2 (n = 256, MD = -0.91, 95% CI = [-1.23 to -0.60], P < 0.00001), VAS on POD 3 (n = 203, MD = -0.57, 95% CI = [-0.80 to -0.34], P < 0.00001), while no significantly decreasing in the LH (n = 322, MD = -1.16, 95% CI = [-2.56 to 0.24], P = 0.10). As EA compared with SA, EA could significantly reduce TFF (n = 782, MD = -15.78, 95% CI = [-24.96 to -6.60], P = 0.0008), TFD (n = 782, MD = -20.42, 95% CI = [-36.14 to -4.70], P = 0.01), LH (n = 782, MD = -1.37, 95% CI = [-2.69 to -0.05], P = 0.04), TIW (n = 743, MD = -0.33, 95% CI = [-0.62 to -0.04], P = 0.03).13 studies reported that EA reduced the incidence of postoperative complications, and 7 studies reported safety assessments of acupuncture-related adverse events, including hematoma, residual needling, sharp pain, pain, soreness or swelling after needle removal, with no serious adverse events. EA can significantly promote the recovery of GI function, reduce postoperative pain and accelerate the improvement of self-care ability in patients undergoing surgery for GI cancers.