Efficacy and safety of selective decontamination of the digestive tract in esophageal surgery: a systematic review and meta-analysis
Abstract
Esophagectomy is a complex surgery with high mortality and morbidity caused by postoperative infectious complications such as pneumonia and anastomotic leakage. Selective decontamination of the digestive tract (SDD) with non-absorbable antimicrobial agents may lower the density of pathogenic organisms in the oropharynx and esophagus, thereby providing a perioperative prophylactic strategy. While SDD has shown benefits in intensive care units and lower gastrointestinal surgery, its efficacy and safety in esophagectomy remains unclear. This study aimed to evaluate the efficacy and safety of perioperative SDD in patients undergoing esophagectomy. A systematic review and meta-analysis were conducted, including all relevant studies published up to April 3rd 2025. The primary outcome was the efficacy, defined as reduced incidence of pneumonia, anastomotic leakage, surgical site infection and mortality. Safety, measured by reported side effects, was the secondary outcome. Out of 628 articles screened, six studies comprising 1074 patients were included. Of these, 487 (45.3%) received SDD and 587 (54.7%) received placebo or standard care. None of the studies focused primarily on safety of SDD, and side effects were not systematically reported. SDD was significantly associated with a lower incidence of pneumonia (OR 0.42, 95% CI: 0.30-0.58, P< 0.01), anastomotic leakage (OR 0.43, 95% CI: 0.29-0.65, P< 0.01) and, 30-day mortality (OR 0.25, 95% CI: 0.07-0.94; P= 0.04). Although…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,074 participants or records.
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