Supplementary Material for: Use of acetylcholinesterase inhibitors in reducing time to gastrointestinal function recovery following abdominal surgery: A systematic review.

Introduction: Postoperative ileus (POI) is a significant complication following abdominal surgery, increasing morbidity and mortality. The cholinergic anti-inflammatory response is one of the major pathways involved in developing POI, but current recommendations to prevent POI do not target this. This review aims to summarise evidence for the use of acetylcholinesterase inhibitors, neostigmine and pyridostigmine, to reduce the time to return of gastrointestinal function (GI) following abdominal surgery.

Methods: A systematic search of various databases was performed from 1946 to May 2023. Randomised controlled trials (RCT) on acetylcholinesterase inhibitors in intra-abdominal surgery were included. Data on time to flatus and/or stool and side effects were extracted.

Results: Among 776 screened manuscripts, 8 RCTs (703 patients) investigating acetylcholinesterase inhibitors, in intra-abdominal surgery were analysed. Five studies showed a significant reduction in time to flatus and/or stool by 17-47.6 hours. Methodological variations, differing procedure types, and potential bias were observed. Limited studies reported side effects or length of stay.

Conclusion: Acetylcholinesterase inhibitors may reduce the time for gastrointestinal function to return. However, current evidence is limited and biased. Further studies incorporating acetylcholinesterase inhibitors in an enhanced recovery protocol are required to address this question, especially for patients undergoing colorectal surgery.

引言：术后肠麻痹（Postoperative Ileus, POI）是腹部手术后的严重并发症，可增加患者的发病率与死亡率。胆碱能抗炎通路是参与POI发病的主要通路之一，但当前预防POI的临床推荐方案并未针对该通路进行干预。本综述旨在系统总结使用乙酰胆碱酯酶抑制剂（acetylcholinesterase inhibitors）、新斯的明（neostigmine）及吡啶斯的明（pyridostigmine）以缩短腹部手术后胃肠功能（Gastrointestinal function, GI）恢复时间的相关证据。
方法：本综述于1946年至2023年5月期间对多个数据库开展系统性检索，纳入腹部手术中使用乙酰胆碱酯酶抑制剂的随机对照试验（Randomised Controlled Trials, RCT），并提取排气/排便时间及不良反应相关数据。
结果：在筛选的776篇文献中，最终纳入8项随机对照试验（共703例患者），分析腹部手术中应用乙酰胆碱酯酶抑制剂的效果。其中5项研究显示，患者的排气/排便时间显著缩短17~47.6小时。本综述观察到各研究间存在方法学差异、手术类型各异且存在潜在偏倚。仅有少数研究报告了不良反应或住院时长。
结论：乙酰胆碱酯酶抑制剂或可缩短胃肠功能恢复所需时间，但当前相关证据有限且存在偏倚。未来需开展将乙酰胆碱酯酶抑制剂纳入加速康复外科方案的相关研究，尤其针对结直肠手术患者。