Selective decontamination of the digestive tract in upper gastrointestinal surgery: systematic review with meta-analysis of randomized clinical trials

Background: Infectious complications are common after gastrointestinal surgery. Selective decontamination of the digestive tract (SDD) might reduce their incidence. SDD is used widely in colorectal resections, but its role in upper gastrointestinal resection is less clear. The aim of this study was to investigate the impact of SDD on postoperative outcome in upper gastrointestinal surgery. Methods: Studies investigating SDD in upper gastrointestinal surgery were included after search of medical databases (PubMed, Ovid, Cochrane Library and Google Scholar). Results were analysed according to predefined criteria. The incidence of perioperative overall complications and death was pooled. Risk of bias was assessed using the revised Cochrane risk-of-bias tool. Results: Some 1384 studies were identified, of which four RCTs were included in the final analysis. These studies included 415 patients, of whom 213 (51.3 per cent) received standard treatment/placebo and 202 (48.7 per cent) had SDD. The incidence of anastomotic leakage (odds ratio (OR) 0.39, 95 per cent c.i. 0.19 to 0.80;P = 0.010) and pneumonia (OR 0.42, 0.23 to 0.78;P = 0.006) was reduced in patients receiving SDD. Rates of surgical-site infection (P = 0.750) and mortality (P = 0.130) were not affected by SDD. Conclusion: SDD seems to be associated with reduction of anastomotic leakage and pneumonia following upper gastrointestinal resection, without affecting postoperative mortality.