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Table 4 Summary of findings (11 meta-analyzed studies)

From: Interventions to prevent anastomotic leak after esophageal surgery: a systematic review and meta-analysis

Intervention

No. participants (studies)

Quality of evidence

Measure of effect, RR (95% CI)

Omentoplasty vs. conventional anastomosisa

611 (3 studies)

+  +  +  + (high quality)

− 1: unclear risk of biasb

+ 1: large magnitude of effect

RR = 0.22 (78% risk reduction)

95% CI = 0.1, 0.5*

Early NG tube removal (or no NG tube) vs. prolonged NG tube removal

374 (2 studies)

+  +  + − (moderate quality)

− 2: high risk of biasc

+ 1: large magnitude of effect

RR = 0.38 (62% risk reduction)

95% CI = 0.02, 0.65*

Stapled anastomosis vs. hand-sewn anastomosis

1532 (6 studies)

− − − − (very low quality)

− 2: high risk of biasc

− 1: imprecision in measure of effectd

− 1: inconsistency across studiese

RR = 0.92 (8% risk reduction)

95% CI = 0.45, 1.87

  1. RR risk ratio, CI confidence interval, GRADE: working group grades of evidence
  2. High quality (+ +  + +): more research very unlikely to change the estimate of effect
  3. Moderate quality (+ +  + −): means further research is likely to have an important impact on our confidence in the estimate of effect and may alter the estimate
  4. Low quality (+ +− −): means that the effect estimate is limited and may substantially differ from
  5. Very low quality (+−−− or − − − −): grade means that we have little confidence in the effect estimate
  6. *Statistically significant confidence interval
  7. aStapled or hand-sewn anastomosis
  8. bOne study lacked allocation concealment
  9. cLack of randomization and allocation concealment
  10. dOptimal information size not met (Additional file 1: Table S5) and the 95% CI for the effect estimate crosses the null (RR = 1.0)
  11. eModerate heterogeneity (I2 = 40.1%)