Perioperative Electroacupuncture Can Accelerate the Recovery of Gastrointestinal Function in Cancer Patients Undergoing Pancreatectomy or Gastrectomy: A Randomized Controlled Trial

Guotong Qiu, Tao Huang, Yang Lu, Lipeng Zhang, Yajie Zhao, Yong Yuan, Hu Ren, Jun An, Jincao Zhou, Rongjun Li, Yongxing Du, Tuoran Wang, Peng Wang, Fang He, Yunqing Ding, Jianwei Zhang, Bin Han, Zhongmin Lan, Shulan Qi, Zongze Li, Jianyong Gao, Zongting Gu, Yuemin Sun, Xiaofeng Bai, Saderbieke Aimaiti, Yunmian Chu, Chengfeng Wang, Guotong Qiu, Tao Huang, Yang Lu, Lipeng Zhang, Yajie Zhao, Yong Yuan, Hu Ren, Jun An, Jincao Zhou, Rongjun Li, Yongxing Du, Tuoran Wang, Peng Wang, Fang He, Yunqing Ding, Jianwei Zhang, Bin Han, Zhongmin Lan, Shulan Qi, Zongze Li, Jianyong Gao, Zongting Gu, Yuemin Sun, Xiaofeng Bai, Saderbieke Aimaiti, Yunmian Chu, Chengfeng Wang

Abstract

The effect of perioperative acupuncture on accelerating gastrointestinal function recovery has been reported in colorectal surgery and distal gastrectomy (Billroth-II). However, the evidence in pancreatectomy and other gastrectomy is still limited. A prospective, randomized controlled trial was conducted between May 2018 and August 2019. Consecutive patients undergoing pancreatectomy or gastrectomy in our hospital were randomly assigned to the electroacupuncture (EA) group and the control group. The patients in the EA group received transcutaneous EA on Bai-hui (GV20), Nei-guan (PC6), Tian-shu (ST25), and Zu-san-li (ST36) once a day in the afternoon, and the control group received sham EA. Primary outcomes were the time to first flatus and time to first defecation. In total, 461 patients were randomly assigned to the groups, and 385 were analyzed finally (EA group, n = 201; control group, n = 184). Time to first flatus (3.0 ± 0.7 vs 4.2 ± 1.0, P < 0.001) and first defecation (4.2 ± 0.9 vs 5.4 ± 1.2, P < 0.001) in the EA group were significantly shorter than those in the control group. Of patients undergoing pancreatectomy, those undergoing pancreaticoduodenectomy and intraoperative radiation therapy (IORT) surgery benefitted from EA in time to first flatus (P < 0.001) and first defecation (P < 0.001), while those undergoing distal pancreatectomy did not (P flatus=0.157, P defecation=0.007) completely. Of patients undergoing gastrectomy, those undergoing total gastrectomy and distal gastrectomy (Billroth-II) benefitted from EA (P < 0.001), as did those undergoing proximal gastrectomy (P=0.015). Patients undergoing distal gastrectomy (Billroth-I) benefitted from EA in time to first defecation (P=0.012) but not flatus (P=0.051). The time of parenteral nutrition, hospital stay, and time to first independent walk in the EA group were shorter than those in the control group. No severe EA complications were reported. EA was safe and effective in accelerating postoperative gastrointestinal function recovery. Patients undergoing pancreaticoduodenectomy, IORT surgery, total gastrectomy, proximal gastrectomy, or distal gastrectomy (Billroth-II) could benefit from EA. This trial is registered with NCT03291574.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2021 Guotong Qiu et al.

Figures

Figure 1
Figure 1
(a) Randomizing card. (b) Transcutaneous EA. (c) Sham EA with adhesive pads. (d) EA in patients.
Figure 2
Figure 2
(a) Bai-hui (GV 20). (b) Tian-shu (ST25). (c) Nei-guan (PC6). (d) Zu-san-li (ST36).
Figure 3
Figure 3
The CONSORT diagram.

References

    1. Chen W., Zheng R., Baade P. D., et al. Cancer statistics in China. CA: A Cancer Journal for Clinicians. 2016;66(2):115–132. doi: 10.3322/caac.21338.
    1. Ouyang H., Chen J. D. Z. Therapeutic roles of acupuncture in functional gastrointestinal disorders. Alimentary Pharmacology & Therapeutics. 2004;20(8):831–841. doi: 10.1111/j.1365-2036.2004.02196.x.
    1. Takahashi T. Acupuncture for functional gastrointestinal disorders. Journal of Gastroenterology. 2006;41(5):408–417. doi: 10.1007/s00535-006-1773-6.
    1. Ezzo J., Vickers A., Richardson M. A., et al. Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting. Journal of Clinical Oncology. 2005;23(28):7188–7198. doi: 10.1200/JCO.2005.06.028.
    1. Liu Z., Liu Y., Xu H., et al. Effect of electroacupuncture on urinary leakage among women with stress urinary incontinence. Journal of the American Medical Association. 2017;317(24):2493–2501. doi: 10.1001/jama.2017.7220.
    1. Ng S. S. M., Leung W. W., Mak T. W. C., et al. Electroacupuncture reduces duration of postoperative ileus after laparoscopic surgery for colorectal cancer. Gastroenterology. 2013;144(2):307–313. doi: 10.1053/j.gastro.2012.10.050.
    1. Chen K.-B., Lu Y.-Q., Chen J.-D., et al. Transcutaneous electroacupuncture alleviates postoperative ileus after gastrectomy: a randomized clinical trial. World Journal of Gastrointestinal Surgery. 2018;10(2):13–20. doi: 10.4240/wjgs.v10.i2.13.
    1. Iyer S., Saunders W. B., Stemkowski S. Economic burden of postoperative ileus associated with colectomy in the United States. Journal of Managed Care Pharmacy. 2009;15(6):485–494. doi: 10.18553/jmcp.2009.15.6.485.
    1. Senagore A. J. Pathogenesis and clinical and economic consequences of postoperative ileus. American Journal of Health-System Pharmacy. 2007;64(13):S3–S7. doi: 10.2146/ajhp070428.
    1. Asgeirsson T., El-Badawi K. I., Mahmood A., Barletta J., Luchtefeld M., Senagore A. J. Postoperative ileus: it costs more than you expect. Journal of the American College of Surgeons. 2010;210(2):228–231. doi: 10.1016/j.jamcollsurg.2009.09.028.
    1. van Bree S. H. W., Nemethova A., Cailotto C., Gomez-Pinilla P. J., Matteoli G., Boeckxstaens G. E. New therapeutic strategies for postoperative ileus. Nature Reviews Gastroenterology & Hepatology. 2012;9(11):675–683. doi: 10.1038/nrgastro.2012.134.
    1. The F. O., Buist M. R., Lei A., et al. The role of mast cell stabilization in treatment of postoperative ileus: a pilot study. The American Journal of Gastroenterology. 2009;104(9):2257–2266. doi: 10.1038/ajg.2009.268.
    1. Ulloa L., Quiroz-Gonzalez S., Torres-Rosas R. Nerve stimulation: immunomodulation and control of inflammation. Trends in Molecular Medicine. 2017;23(12):1103–1120. doi: 10.1016/j.molmed.2017.10.006.
    1. Perinel J., Mariette C., Dousset B., et al. Early enteral versus total parenteral nutrition in patients undergoing pancreaticoduodenectomy. Annals of Surgery. 2016;264(5):731–737. doi: 10.1097/SLA.0000000000001896.
    1. Meng Z. Q., Garcia M. K., Chiang J. S, et al. Electro-acupuncture to prevent prolonged postoperative ileus: a randomized clinical trial. World Journal of Gastroenterology. 2010;16(1):104–111. doi: 10.3748/wjg.v16.i1.104.
    1. Lee H.-J., Hyung W. J., Yang H.-K., et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT) Annals of Surgery. 2019;270(6):983–991. doi: 10.1097/SLA.0000000000003217.
    1. Iwa M., Nakade Y., Pappas T. N., Takahashi T. Electroacupuncture improves restraint stress-induced delay of gastric emptying via central glutaminergic pathways in conscious rats. Neuroscience Letters. 2006;399(1-2):6–10. doi: 10.1016/j.neulet.2005.11.069.
    1. Chen J., Song G.-Q., Yin J., Koothan T., Chen J. D. Z. Electroacupuncture improves impaired gastric motility and slow waves induced by rectal distension in dogs. American Journal of Physiology-Gastrointestinal and Liver Physiology. 2008;295(3):G614–G620. doi: 10.1152/ajpgi.90322.2008.
    1. Xu X., Zheng P., Zhao H., Song B., Wang F. Effect of electroacupuncture at GV20 on sleep deprivation-induced depression-like behavior in mice. Evidence-Based Complementary and Alternative Medicine. 2020;2020:11. doi: 10.1155/2020/7481813.7481813
    1. Lu M.-J., Yu Z., He Y., Yin Y., Xu B. Electroacupuncture at ST36 modulates gastric motility via vagovagal and sympathetic reflexes in rats. World Journal of Gastroenterology. 2019;25(19):2315–2326. doi: 10.3748/wjg.v25.i19.2315.
    1. Li W., Lu M. J., Yu Z., Han X., He Y., Xu B. Effect of electroacupuncture or moxibustion of “Tianshu” (ST25) on intragastric pressure in rats. Zhen Ci Yan Jiu. 2019;44(11):822–825. doi: 10.13702/j.1000-0607.190025.
    1. Lu M., Chen C., Li W., Yu Z., Xu B. EA at PC6 promotes gastric motility: role of brainstem vagovagal neurocircuits. Evidence-Based Complementary and Alternative Medicine. 2019;2019:10. doi: 10.1155/2019/7457485.7457485
    1. Wang C.-P., Kao C.-H., Chen W.-K., Lo W.-Y., Hsieh C.-L. A single-blinded, randomized pilot study evaluating effects of electroacupuncture in diabetic patients with symptoms suggestive of gastroparesis. The Journal of Alternative and Complementary Medicine. 2008;14(7):833–839. doi: 10.1089/acm.2008.0107.
    1. Zhou J., Li S., Wang Y., et al. Inhibitory effects and mechanisms of electroacupuncture via chronically implanted electrodes on stress-induced gastric hypersensitivity in rats with neonatal treatment of iodoacetamide. Neuromodulation: Technology at the Neural Interface. 2017;20(8):767–773. doi: 10.1111/ner.12602.
    1. Zhang X., Jin H.-F., Fan Y.-H., Lu B., Meng L.-N., Chen J. D. Z. Effects and mechanisms of transcutaneous electroacupuncture on chemotherapy-induced nausea and vomiting. Evidence-Based Complementary and Alternative Medicine. 2014;2014:6. doi: 10.1155/2014/860631.860631
    1. Chen J. D. Z., Ni M., Yin J. Electroacupuncture treatments for gut motility disorders. Neurogastroenterol Motil. 2018;30(7) doi: 10.1111/nmo.1339310.1111/nmo.13393.e13393

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