Selective decontamination of the digestive tract in esophagectomy and the incidence of pneumonia and anastomotic leakage: A systematic review and meta-analysis

Sander Du X. Oei; Jasper Gerrit Jan Verbruggen; Sanne Elisabeth Hoeks; Marcus Paulus Buise

doi:10.1371/journal.pone.0325241

Selective decontamination of the digestive tract in esophagectomy and the incidence of pneumonia and anastomotic leakage: A systematic review and meta-analysis

Sander Du X. Oei
, Jasper Gerrit Jan Verbruggen
, Sanne Elisabeth Hoeks
, Marcus Paulus Buise^*

^*Corresponding author for this work

Anesthesiology

Maastricht University Medical Centre

Research output: Contribution to journal › Article › Academic › peer-review

3 Citations (Scopus)

32 Downloads (Pure)

Abstract

Background:

Despite advances in surgery, esophagectomy remains a major operation in which pneumonia and anastomotic leakage are causes of morbidity. It is currently unknown whether selective decontamination of the digestive tract (SDD) affects the incidence of postoperative pneumonia and anastomotic leakage in patients undergoing esophagectomy. The aim of this systematic review and meta-analysis is to summarize current evidence regarding SDD in patients undergoing esophagectomy.

Methods:

We performed a comprehensive search in Medline, Web of Science, Embase, Cochrane Library and Google Scholar with articles included until August 2024. We included observational studies and clinical trials which were scored using the Cochrane Risk of Bias tool and The Risk Of Bias In Non-randomized Studies – of Interventions. A fixed effects model was used to pool results of the former studies.

Results:

A total of five studies were identified with a total of 924 patients. All studies were assessed as either having serious bias or a high risk of bias. SDD usage was associated with a significantly lower incidence of pneumonia (OR 0.41; 95% CI 0.29 to 0.58; p<0.00001; I²=26%; n=924) and anastomotic leakage (OR 0.48; 95% CI 0.30 to 0.74; p=0.001; I²=0%; n=810). Pooled analysis regarding mortality, duration of hospitalization and duration of Intensive Care Unit stay could not be performed due to heterogeneous data, 4 of 5 studies reported lower mortality rates in patients receiving SDD.

Conclusion:

Although the data indicates that using SDD in patients undergoing an esophagectomy was associated with a lower incidence of postoperative pneumonia and anastomotic leakage, the available studies were not of sufficient quality to make a recommendation, given their age and risk of bias. A high-quality randomized controlled trial using standardized outcome definitions is needed to substantiate claims about SDD use in esophagectomy.

Original language	English
Article number	e0325241
Journal	PLoS ONE
Volume	20
Issue number	6 June
DOIs	https://doi.org/10.1371/journal.pone.0325241
Publication status	Published - Jun 2025

Bibliographical note

Publisher Copyright:
© 2025 Oei et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Selective decontamination of the digestive tract in esophagectomy and the incidence of pneumonia and anastomotic leakageFinal published version, 934 KBLicence: CC BY

Cite this

@article{7b41c61b967242668c09027324494157,

title = "Selective decontamination of the digestive tract in esophagectomy and the incidence of pneumonia and anastomotic leakage: A systematic review and meta-analysis",

abstract = "Background:Despite advances in surgery, esophagectomy remains a major operation in which pneumonia and anastomotic leakage are causes of morbidity. It is currently unknown whether selective decontamination of the digestive tract (SDD) affects the incidence of postoperative pneumonia and anastomotic leakage in patients undergoing esophagectomy. The aim of this systematic review and meta-analysis is to summarize current evidence regarding SDD in patients undergoing esophagectomy. Methods: We performed a comprehensive search in Medline, Web of Science, Embase, Cochrane Library and Google Scholar with articles included until August 2024. We included observational studies and clinical trials which were scored using the Cochrane Risk of Bias tool and The Risk Of Bias In Non-randomized Studies – of Interventions. A fixed effects model was used to pool results of the former studies. Results: A total of five studies were identified with a total of 924 patients. All studies were assessed as either having serious bias or a high risk of bias. SDD usage was associated with a significantly lower incidence of pneumonia (OR 0.41; 95\% CI 0.29 to 0.58; p<0.00001; I2=26\%; n=924) and anastomotic leakage (OR 0.48; 95\% CI 0.30 to 0.74; p=0.001; I2=0\%; n=810). Pooled analysis regarding mortality, duration of hospitalization and duration of Intensive Care Unit stay could not be performed due to heterogeneous data, 4 of 5 studies reported lower mortality rates in patients receiving SDD. Conclusion:Although the data indicates that using SDD in patients undergoing an esophagectomy was associated with a lower incidence of postoperative pneumonia and anastomotic leakage, the available studies were not of sufficient quality to make a recommendation, given their age and risk of bias. A high-quality randomized controlled trial using standardized outcome definitions is needed to substantiate claims about SDD use in esophagectomy.",

author = "Oei, \{Sander Du X.\} and Verbruggen, \{Jasper Gerrit Jan\} and Hoeks, \{Sanne Elisabeth\} and Buise, \{Marcus Paulus\}",

note = "Publisher Copyright: {\textcopyright} 2025 Oei et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2025",

month = jun,

doi = "10.1371/journal.pone.0325241",

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Selective decontamination of the digestive tract in esophagectomy and the incidence of pneumonia and anastomotic leakage: A systematic review and meta-analysis. / Oei, Sander Du X.; Verbruggen, Jasper Gerrit Jan; Hoeks, Sanne Elisabeth et al.
In: PLoS ONE, Vol. 20, No. 6 June, e0325241, 06.2025.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Selective decontamination of the digestive tract in esophagectomy and the incidence of pneumonia and anastomotic leakage

T2 - A systematic review and meta-analysis

AU - Oei, Sander Du X.

AU - Verbruggen, Jasper Gerrit Jan

AU - Hoeks, Sanne Elisabeth

AU - Buise, Marcus Paulus

N1 - Publisher Copyright: © 2025 Oei et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2025/6

Y1 - 2025/6

N2 - Background:Despite advances in surgery, esophagectomy remains a major operation in which pneumonia and anastomotic leakage are causes of morbidity. It is currently unknown whether selective decontamination of the digestive tract (SDD) affects the incidence of postoperative pneumonia and anastomotic leakage in patients undergoing esophagectomy. The aim of this systematic review and meta-analysis is to summarize current evidence regarding SDD in patients undergoing esophagectomy. Methods: We performed a comprehensive search in Medline, Web of Science, Embase, Cochrane Library and Google Scholar with articles included until August 2024. We included observational studies and clinical trials which were scored using the Cochrane Risk of Bias tool and The Risk Of Bias In Non-randomized Studies – of Interventions. A fixed effects model was used to pool results of the former studies. Results: A total of five studies were identified with a total of 924 patients. All studies were assessed as either having serious bias or a high risk of bias. SDD usage was associated with a significantly lower incidence of pneumonia (OR 0.41; 95% CI 0.29 to 0.58; p<0.00001; I2=26%; n=924) and anastomotic leakage (OR 0.48; 95% CI 0.30 to 0.74; p=0.001; I2=0%; n=810). Pooled analysis regarding mortality, duration of hospitalization and duration of Intensive Care Unit stay could not be performed due to heterogeneous data, 4 of 5 studies reported lower mortality rates in patients receiving SDD. Conclusion:Although the data indicates that using SDD in patients undergoing an esophagectomy was associated with a lower incidence of postoperative pneumonia and anastomotic leakage, the available studies were not of sufficient quality to make a recommendation, given their age and risk of bias. A high-quality randomized controlled trial using standardized outcome definitions is needed to substantiate claims about SDD use in esophagectomy.

AB - Background:Despite advances in surgery, esophagectomy remains a major operation in which pneumonia and anastomotic leakage are causes of morbidity. It is currently unknown whether selective decontamination of the digestive tract (SDD) affects the incidence of postoperative pneumonia and anastomotic leakage in patients undergoing esophagectomy. The aim of this systematic review and meta-analysis is to summarize current evidence regarding SDD in patients undergoing esophagectomy. Methods: We performed a comprehensive search in Medline, Web of Science, Embase, Cochrane Library and Google Scholar with articles included until August 2024. We included observational studies and clinical trials which were scored using the Cochrane Risk of Bias tool and The Risk Of Bias In Non-randomized Studies – of Interventions. A fixed effects model was used to pool results of the former studies. Results: A total of five studies were identified with a total of 924 patients. All studies were assessed as either having serious bias or a high risk of bias. SDD usage was associated with a significantly lower incidence of pneumonia (OR 0.41; 95% CI 0.29 to 0.58; p<0.00001; I2=26%; n=924) and anastomotic leakage (OR 0.48; 95% CI 0.30 to 0.74; p=0.001; I2=0%; n=810). Pooled analysis regarding mortality, duration of hospitalization and duration of Intensive Care Unit stay could not be performed due to heterogeneous data, 4 of 5 studies reported lower mortality rates in patients receiving SDD. Conclusion:Although the data indicates that using SDD in patients undergoing an esophagectomy was associated with a lower incidence of postoperative pneumonia and anastomotic leakage, the available studies were not of sufficient quality to make a recommendation, given their age and risk of bias. A high-quality randomized controlled trial using standardized outcome definitions is needed to substantiate claims about SDD use in esophagectomy.

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U2 - 10.1371/journal.pone.0325241

DO - 10.1371/journal.pone.0325241

M3 - Article

C2 - 40560890

AN - SCOPUS:105008993603

SN - 1932-6203

VL - 20

JO - PLoS ONE

JF - PLoS ONE

IS - 6 June

M1 - e0325241

ER -

Selective decontamination of the digestive tract in esophagectomy and the incidence of pneumonia and anastomotic leakage: A systematic review and meta-analysis

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