Comparison of postoperative reflux esophagitis in different digestive tract reconstruction methods after proximal gastrectomy for proximal gastric cancer patients: a network meta-analysis and systematic review.

[BACKGROUND] Reflux esophagitis (RE) is an important complication after proximal gastrectomy (PG) among proximal gastric cancer (PGC) patients. In recent years, different digestive reconstruction methods have been used to reduce the risk of RE.

[OBJECTIVE] To present and synthesize the clinical trial evidence regarding the postoperative RE associated with different digestive tract reconstruction methods following PG in patients with PGC.

[METHODS] We conducted an electronic literature search on PubMed, Web of Science (WOS), and Embase from the time of establishment of the database to February 14, 2025. Two independent reviewers screened studies that adhered to inclusion and exclusion criteria. The main outcome was the incidence of postoperative RE after PG among PG patients, which was analyzed by network meta-analysis with a consistency model. Newcastle-Ottawa Scale (NOS) and Cochrane Collaboration's tool were used to assess the risk of bias in the included studies. Heterogeneity and inconsistency analysis to evaluate the robustness of the results.

[RESULTS] 30 studies involving 2,411 PGC patients were included in the analysis. The average incidence rates were as follows: DFT: 0.04, JI: 0.06, DTR: 0.08, JPI: 0.12, GT: 0.14, and EG: 0.24. DFT was associated with a lower risk of postoperative RE compared to EG (0.08 [0.02-0.27]). DTR also showed a lower risk of postoperative RE compared to EG (0.18 [0.10-0.36]). Conversely, EG had a higher risk of postoperative RE compared to JI (4.83 [2.33-10.06]). Possible rankings for reducing the incidence of RE were as follows: DFT > DTR>JI > JPI > GT > EG. Inconsistencies were noted between DTR and EG. However, the direct, indirect, and consistent effects all exhibited the same directional trend. Heterogeneity was identified in comparisons between EG vs GT and GT vs DFT (I > 50%).

[CONCLUSION] DFT, DTR, and JI had a significantly lower risk of postoperative RE compared with EG. To prevent postoperative RE, DFT was the best, DTR second best.