A Comparative Study between Outcomes of Gastric, Jejunal and Colonic Conduits after Esophagectomy: A Systematic Review and Meta-Analysis

Abstract Background: Reconstruction of the digestive tract after es-ophagectomy is necessary to enable the passage of food and liquids. Common types of conduits are gastric conduit, colonic conduit or jejunal conduit. The choice of conduit depends on the length of the gap, the availability of conduit, and the sur-geon’s experience with the procedure. The stomach is the most common conduit used to replace the resected esophagus. The stomach is preferred due to its length, adequate vascular supply and the need for a single anastomosis. Aim of Study: To perform a systematic review and me-ta-analysis about literature that have compared the clinical out-comes of gastric, jejunal and colonic conduits after esophagec-tomy, the advantages and disadvantages of each conduit, and to assess whether this practices increase the risk of post-operative complications. Patients and Methods: The current study included adult participants who had been operated for esophageal resection due to malignant or benign causes, and esophageal recon-struction using gastric, pedicled jejunal or colonic conduit.The primary search identified 1400 potentially eligible citations. Among these, 399 were identified as duplicates and removed. Among the remaining full texts 110 studies were reviewed in detail. After the evaluation of the titles and abstracts of these studies, the reviewers removed 101 citations. The remaining 9 articles included a total of 2713 patients [2187 treated with gastric pull up (GPU), 92 treated with jejunal flap (JF) and 434 treated with colon interposition (CI)], and were the basis of the present meta-analysis. Results: Anastomosis Leakage: The odds ratio showed that free jejunal flap (0.8255) was better than gastric pull-up (0.4509) and that colon interposition had a high probability of anastomosis leakage (0.2236). Stricture Formation: The odds ratio showed that colon interposition (0.9201) was better than gastric pull-up (0.3131) and that free jejunal flap had a high probability of stricture formation (0.2668). Mortality Rate: The odds ratio showed that free jejunal flap (0.9547) was better than colon interposition (0.3665) and that gastric pull-up had a high probability of mortality rate (0.1788). Length of Hospital Stay: the odds ratio showed that gastric pull-up (0.6495) was better than free jejunal flap (0.5444) and that colon interposition had a high probability of prolonging the length of hospital stay (0.3060). Conclusion: Regarding the complication of anastomosis leakage; it is not possible to determine the best procedure for reducing anastomosis leakage, but comparing the studies had shown that free jejunal flap was better than gastric pull-up and that colon interposition had a high probability of anastomosis leakage. About stricture formation; it was found that colon in-terposition was better than gastric pull-up and that free jejunal flap had a high probability of stricture formation. About mor-tality rate; it was discovered that free jejunal flap was superior to colon interposition and that gastric pull-up had a high prob-ability of increased mortality rate. Regarding the length of hos-pital stay; it was found that gastric pull-up was better than free jejunal flap and that colon interposition had a high probability of prolonging the length of hospital stay. The choice of conduit should be individualized based on patient characteristics, surgi-cal experience, and institutional resources; with consideration given to the balance between pre -operative risks and long-term functional outcomes.