Efficacy and safety of selective decontamination of the digestive tract in oesophageal surgery: A systematic review and meta-analysis

Justin G A Grootenhuis; Ward Seurs; Nynke G L Jager; Jaap Ten Oever; Hans Van Veer; Bastiaan R Klarenbeek; Jeroen A Schouten

doi:10.1016/j.ijantimicag.2025.107637

Efficacy and safety of selective decontamination of the digestive tract in oesophageal surgery: A systematic review and meta-analysis

Int J Antimicrob Agents. 2025 Oct 8;66(6):107637. doi: 10.1016/j.ijantimicag.2025.107637. Online ahead of print.

Authors

Justin G A Grootenhuis¹, Ward Seurs², Nynke G L Jager³, Jaap Ten Oever⁴, Hans Van Veer², Bastiaan R Klarenbeek⁵, Jeroen A Schouten⁶

Affiliations

¹ Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands. Electronic address: justin.grootenhuis@radboudumc.nl.
² Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; BREATHE Laboratory, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium.
³ Department of Pharmacy, Pharmacology and Toxicology, Radboud University Medical Centre and Radboud Institute for Health Sciences, Nijmegen, the Netherlands.
⁴ Department of Internal Medicine & Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.
⁵ Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
⁶ Department of Intensive Care Medicine, Nijmegen, the Netherlands; Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre Nijmegen, the Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Centre Nijmegen, the Netherlands.

PMID: 41072856
DOI: 10.1016/j.ijantimicag.2025.107637

Abstract

Objectives: Oesophagectomy 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 oesophagus, thereby providing a perioperative prophylactic strategy. While SDD has shown benefits in intensive care units and lower gastrointestinal surgery, its efficacy and safety in oesophagectomy remains unclear. This study aimed to evaluate the efficacy and safety of perioperative SDD in patients undergoing oesophagectomy.

Methods: A systematic review and meta-analysis were conducted, including all relevant studies published up to April 3, 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.

Results: 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 the 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 significant, 30-day mortality should be interpreted with caution due to the limited number of studies and the high risk of bias among them. No significant reduction was observed for in-hospital mortality or surgical site infections.

Conclusions: The meta-analysis indicates that perioperative SDD may reduce pneumonia and anastomotic leakage after oesophagectomy. However, the large heterogeneity, risk of bias and the lack of adequate safety assessment make the available studies insufficient to advance a qualitative recommendation on the topic. For this, a large randomised controlled trial is imperative.

Keywords: Anastomotic leakage; Oesophageal cancer; Oesophagectomy; Pneumonia; Selective digestive tract decontamination.

Publication types

Review