Are acupuncture and related therapies effective in treating postoperative gastroparesis syndrome?
Date of publication of the systematic review: August 2014
Design
Systematic review of 16 randomized controlled trials (RCTs).
Participants
Patients with postoperative gastroparesis syndrome (PGS) which is a complex disorder characterized by post-prandial nausea and vomiting, and gastric atony in the absence of mechanical gastric outlet obstruction. Patients with PGS regardless of age, gender, ethnicity, type of anaesthesia or surgery were included (age range: 34 to 78 years, male%: 64.9%). The reviewers did not report the number of patients.
Intervention
Intervention 1: Acupuncture and related therapies included manual acupuncture with needle retention and acupuncture with magnetic circular needle. Common acupoints for acupuncture were ST36, CV12 and PC6. In 2 included studies, application of SP6, ST40, SP9, LV3 and tapping along the Stomach Meridian of Foot-Yangming were additionally performed. Treatments were performed for 15-30 minutes once daily;
Intervention 2: Acupuncture and related therapies combined with medications including mosapride, Chinese herbal medicine, metoclopramide and cisapride. The common acupoints for acupuncture combined with Mosapride were CV12, ST36 and PC6. In one included study, ST37, LV3 and SP10 were selected in addition. Besides, ST36 was selected for the acupuncture combined with Chinese herbal medicine. Acupuncture and related therapies were performed for 15-30 minutes one daily.
Comparator
Comparison 1: Acupuncture and related therapies versus usual care or medications alone;
Comparison 2: Acupuncture and related therapies plus medications versus usual care or medications alone.
Major Outcomes
Outcome 1: Global effectiveness rate of acupuncture and related therapies for the treatment of PGS.
Settings
The reviewers did not state whether the studies were conducted in inpatient or outpatient settings.
Comparison    Acupuncture and related therapies versus usual care or medications alone
Main Results
Compared to usual care or medications alone, acupuncture and related therapies showed significant higher global effectiveness rate in improving PGS (pooled risk ratio (RR): 1.27, 95%CI: 1.13 to 1.44).
Comparison 1: Acupuncture and related therapies versus usual care or medications alone among PGS patients
Outcomes (units) No. of studies (Total no. of participants) No. of participants who experienced the outcome / No. of participants Heterogeneity test (I2) Pooled RR (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 3 (181) 89/91 69/90 0% 1.27 (1.13 to 1.44) <0.0001 Moderate
Keys: SD = standard deviation; RR = risk ratio; CI = confidence interval.
Comparison    Acupuncture and related therapies plus medications versus usual care or medications alone
Main Results
Compared to usual care or medications alone, acupuncture and related therapies combined with medications showed a significant higher global effectiveness rate in improving PGS (pooled RR: 1.37, 95%CI: 1.18 to 1.58).
Comparison 2 Acupuncture and related therapies plus medications versus usual care or medications alone among PGS patients
Outcomes (units) No. of studies (Total no. of participants) No. of participants who experienced the outcome / No. of participants Heterogeneity test (I2) Pooled RR (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 4 (189) 91/97 63/92 0% 1.37 (1.18 to 1.58) <0.0001 Moderate
Keys: SD = standard deviation; RR = risk ratio; CI = confidence interval.
Comparison    Acupuncture and related therapies versus usual care or medications alone
Main Results
Compared to usual care or medications alone, acupuncture and related therapies showed significant higher global effectiveness rate in improving PGS (pooled risk ratio (RR): 1.27, 95%CI: 1.13 to 1.44).
Comparison 1: Acupuncture and related therapies versus usual care or medications alone among PGS patients
Outcomes (units) 1 (NA)
No. of studies (Total no. of participants) 3 (181)
No. of participants who experienced the outcome / No. of participants Intervention 89/91
Comparator 69/90
Pooled RR (95% CI) 1.27 (1.13 to 1.44)
p value <0.0001
Overall quality of evidence* Moderate
Keys: SD = standard deviation; RR = risk ratio; CI = confidence interval.
Comparison    Acupuncture and related therapies plus medications versus usual care or medications alone
Main Results
Compared to usual care or medications alone, acupuncture and related therapies combined with medications showed a significant higher global effectiveness rate in improving PGS (pooled RR: 1.37, 95%CI: 1.18 to 1.58).
Comparison 2 Acupuncture and related therapies plus medications versus usual care or medications alone among PGS patients
Outcomes (units) 1 (NA)
No. of studies (Total no. of participants) 4 (189)
No. of participants who experienced the outcome / No. of participants Intervention 91/97
Comparator 63/92
Pooled RR (95% CI) 1.37 (1.18 to 1.58)
p value <0.0001
Overall quality of evidence* Moderate
Keys: SD = standard deviation; RR = risk ratio; CI = confidence interval.
Conclusion
Benefits
This study showed that acupuncture and related therapies alone or along with medications may significantly improve PGS when compared to usual care or medications alone. For all outcomes, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported among the included studies.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/25146082
The synopsis is based on the following article:
Cheong KB, Zhang JP, Huang Y. The effectiveness of acupuncture in postoperative gastroparesis syndrome–A systematic review and meta-analysis. Complementary therapies in medicine. 2014 Aug 31;22(4):767-86.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.