Comparison of Clinical Efficacy of Different Acupuncture Therapies for Grade C Delayed Gastric Emptying after Pancreaticoduodenectomy: A Retrospective Cohort Study Based on Propensity Score Matching

  Objective  To investigate the effect of different acupuncture methods on gastric juice drainage in patients with grade C delayed gastric emptying (DGE) after pancreaticoduodenectomy.

  Methods  This was a retrospective cohort study of patients with grade C DGE after pancreaticoduodenectomy who received acupuncture treatment from January 2015 to September 2021. According to the acupuncture methods, the patients were divided into body acupuncture group and ear-body acupuncture group. The patients in both groups were matched 1∶1, using propensity score matching based on the baseline gastric fluid drainage. The differences in the primary outcome indicatorsshort-term (within 3 d) outcome, long-term (within 10 d) outcome and secondary outcome indicators (length of postoperative hospital stay, proportion of patients discharged with a gastric tube, incidence of adverse events during treatment) were compared between the two groups.

  Results  A total of 65 patients with DGE who met the inclusion and exclusion criteria were enrolled, including 34 patients (52.3%) in the ear-body acupuncture group and 31 patients (47.7%) in the body acupuncture group. (1)Short-term efficacy: A total of 23 patients in the ear-body acupuncture group and 23 patients in the body acupuncture group were enrolled after matching by propensity score method. The short-term decrease rate of gastric fluid drainage in the ear-body acupuncture group was higher than that in the body acupuncture group42.7%(19.6%, 65.1%) vs. 6.5%(-14.7%, 50.6%), P=0.034. (2) Long-term efficacy and secondary outcome indicators: There were 4 and 6 patients in the body acupuncture group and the ear-body acupuncture group, respectively, who had their gastric tubes successfully removed within 3 d of treatment. Their long-term efficacy of treatment could not be calculated, so they were excluded. After matching the two groups again using the propensity score method, a total of 16 patients in the ear-body acupuncture group and 16 patients in the body acupuncture group were included. There were no adverse events during treatment in both groups, and the rate of long-term gastric drainage decline was higher in the ear-body acupuncture group 49.6% (15.7%, 56.9%) vs. 8.8%(-9.3%, 33.1%), P=0.024 than the body acupuncture group, the postoperative hospital stay30.0(26.0, 38.5) d vs. 31.0(24.3, 43.8) d, P=0.748 and the proportion of patients discharged with a gastric tube (18.8% vs. 25.0%, P > 0.999) were not significantly different between the two groups.

  Conclusion  Compared with body acupuncture alone, auricular acupuncture combined with body acupuncture therapy is more effective in reducing gastric drainage in patients with grade C DGE after pancreaticoduodenectomy, which may be beneficial to patients' postoperative recovery.