Clinical Evidence for Association of Electroacupuncture with Improved Colorectal Postoperative Gastrointestinal Function Recovery: A Systematic Review and Meta-Analysis

Abstract

Background: Studies on the efficacy of electroacupuncture (EA) on postoperative gastrointestinal function (PGIF) recovery in colorectal cancer (CRC) patients have been increasing, but the findings are inconsistent. To evaluate the effectiveness and safety of EA on PGIF recovery in patients with CRC based on existing randomized controlled trials (RCTs) and assess whether the current evidence is conclusive by trial sequential analysis (TSA). Materials and Methods: PubMed, Embase (Ovid), Medline, Cochrane Library, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang) were searched for RCTs published from inception to November 6, 2022. RCTs in which EA was compared with sham control (sham electroacupuncture, SA) or usual care (UC) for managing PGIF recovery in patients with CRC were included. Following the preferred reporting items for systematic reviews and meta-analyses, two reviewers independently extracted data as well as assessed the risk of bias using the cochrane risk of bias tool (ROB 2.0) and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Data were screened and extracted independently using predesigned forms. Data were pooled using a random-effects model. Results: Sixteen studies, including 1290 patients with CRC that showed PGIF recovery met the inclusion criteria. The meta-analysis revealed that compared with the UC group, EA + UC group showed a significant improvement in the time to first flatus (MD: -14.59, 95% CI: -22.75 to -6.43, P < 0.01), time to first defecation (MD: -20.28, 95% CI: -28.14 to -12.42, P < 0.01), and time to first bowel sounds (MD: -11.79, 95% CI: -18.97 to -4.60, P < 0.01). The TSA confirmed the better treatment outcomes of EA compared with UC. Compared with the SA group, EA + UC group showed a significant improvement in the time to first flatus (MD: -10.48, 95% CI: [-13.74, -7.21], P < 0.01) and time to first defecation (MD: -10.72, 95% CI: [-20.14, -1.30], P = 0.03), and the improvement in time to first bowel sounds (MD: -5.41, 95% CI -12.43 to 1.60, P = 0.13) was similar. The TSA indicated there might be false positive results and further studies with a larger overall sample size are deemed necessary. The reported adverse events related to acupuncture were less serious. Conclusion: EA has great potential to accelerate the recovery of PGIF for patients with CRC. RCTs with usual care control was sufficient. Additional pre-registered and sham-controlled RCTs are still needed to validate the safety and efficacy of EA.