Clinical Trials Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2018; 10(2): 13-20
Published online Feb 27, 2018. doi: 10.4240/wjgs.v10.i2.13
Transcutaneous electroacupuncture alleviates postoperative ileus after gastrectomy: A randomized clinical trial
Kai-Bo Chen, Yi-Qiao Lu, Jian-De Chen, Di-Ke Shi, Zhi-Hui Huang, Yi-Xiong Zheng, Xiao-Li Jin, Zhe-Fang Wang, Wei-Dong Zhang, Yi Huang, Zhi-Wei Wu, Guo-Ping Zhang, Hang Zhang, Ying-Hao Jiang, Li Chen
Kai-Bo Chen, Di-Ke Shi, Yi-Xiong Zheng, Xiao-Li Jin, Zhi-Wei Wu, Hang Zhang, Li Chen, Yi-Huang, Department of General Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Yi-Qiao Lu, Department of Obstetrics and Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Jian-De Chen, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States
Zhi-Hui Huang, Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
Zhe-Fang Wang, Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne 50937, Germany
Wei-Dong Zhang, Department of Thyroid Surgery, Ningbo No. 2 Hospital, Ningbo 315000, Zhejiang Province, China
Guo-Ping Zhang, Department of Chinese Medicine Rehabilitation, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Ying-Hao Jiang, Department of General Surgery, First People’s Hospital of Wenling, Taizhou 317500, Zhejiang Province, China
Author contributions: Chen KB, Lu YQ, Chen JD, Chen L, Shi DK and Huang ZH designed and established the study process; Chen KB, Lu YQ, Chen L and Shi DK performed the study, collected and analyzed the data and wrote and revised the manuscript; Wang ZF, Huang Y, Wu ZW and Jiang YH contributed to patient recruitment and performing the study; Zheng YX assisted with protocol development and patient management; Zhang GP assisted with acupuncture techniques; Chen KB and Lu YQ contributed equally to this research.
Supported by Zhejiang Provincial Chinese Medicine Scientific Research Fund, No. 2017ZA085.
Institutional review board statement: Institutional review board of the Second Affiliated Hospital of Zhejiang University School of Medicine passed ethics for this research (No. 2013-051-C01).
Informed consent statement: Informed consents were obtained from all participates.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Li Chen, MD, Professor, Department of General Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jie-fang Road, Hangzhou 310000, Zhejiang Province, China.
Telephone: +86-571-87783777
Received: November 14, 2017
Peer-review started: November 15, 2017
First decision: December 8, 2017
Revised: December 9, 2017
Accepted: February 5, 2018
Article in press: February 6, 2018
Published online: February 27, 2018
Research background

Postoperative ileus (POI) after gastrectomy is not rare and causes various symptoms, which probably affects patient recovery, prolongs hospital stay, and increases cost. However, there is no effective way to alleviate POI until now.

Research motivation

Transcutaneous electroacupuncture (TEA) is a new-developed, non-invasive and portable device. It has been validated to improve intestinal dysmotility in dog experiment. But it remains unknown whether it is useful to alleviate POI for post-gastrectomy patients clinically.

Research objectives

The aim of this article was investigating the efficacy and safety of TEA to alleviate POI after gastrectomy.

Research methods

From April 2014 to February 2017, 63 gastric cancer patients were recruited from the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China. After gastrectomy, the patients were randomly allocated to the TEA (n = 33) or control (n = 30) group. The patients in the TEA group received 1 h TEA on Neiguan (ST36) and Zusanli (PC6) twice daily in the morning and afternoon until they passed flatus. The main outcomes were hours to the first flatus or bowel movement, time to nasogastric tube removal, time to liquid and semi-liquid diet, and hospital stay. The secondary outcomes included postoperative symptom assessment and complications.

Research results

Time to first flatus in the TEA group was significantly shorter than in the control group (73.19 ± 15.61 vs 82.82 ± 20.25 h, P = 0.038), especially for open gastrectomy (76.53 ± 14.29 vs 87.23 ± 20.75 h, P = 0.048). Bowel sounds on day 2 in the TEA group were significantly greater than in the control group (2.30 ± 2.61/min vs 1.05 ± 1.26/min, P = 0.017). Time to nasogastric tube removal in the TEA group was earlier than in the control group (4.22 ± 1.01 vs 4.97 ± 1.67 d, P = 0.049), as well as the time to liquid diet (5.0 ± 1.34 vs 5.83 ± 2.10 d, P = 0.039). Hospital stay in the TEA group was significantly shorter than in the control group (8.06 ± 1.75 vs 9.40 ± 3.09 d, P = 0.041). No significant differences in postoperative symptom assessment and complications were found between the groups. There were no severe adverse events related to TEA.

Research conclusions

In this prospective and randomized clinical study, we confirmed the role of TEA in the treatment of post-gastrectomy bowel motility recovery for the first time. TEA in gastric cancer patients significantly increased postoperative bowel movement; shortened time to first flatus, nasogastric tube removal, liquid diet and hospital stay, and it was safe.

Research perspectives

The authors proved that TEA was effective and safe to recovery post-gastrectomy patients from POI. So it will probably provide clinical surgeons with a novel non-invasive device to accelerate bowel function recovery and reduce hospital stay, which satisfies the concept of enhanced recovery after surgery (ERAS). Besides, TEA could be considered to be applied on other abdominal surgeries as well.