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Needleless Transcutaneous Electrical Acustimulation: A Pilot Study Evaluating Improvement in Post-Operative Recovery

Zhang, Bo MD1,2; Xu, Feng MD3; Hu, Pingping MD3; Zhang, Mingyuan MD4; Tong, Kehui MD4; Ma, Gang MD2,5; Xu, Yuemei MD3; Zhu, Liang MD1; Chen, Jiande D. Z. PhD2,6

American Journal of Gastroenterology: July 2018 - Volume 113 - Issue 7 - p 1026–1035
doi: 10.1038/s41395-018-0156-y

BACKGROUND: Functional gastrointestinal disturbance occurs after abdominal surgeries and could last for an extended period of time in some cases. This study was designed (1) to evaluate the effects of needleless transcutaneous electrical acustimulation (TEA) on postoperative recovery, and (2) to investigate the mechanisms involving autonomic function in postoperative patients after removal of gastrointestinal cancers.

METHODS: Forty-two patients (33 male, age: 69.5 ± 1.5 years) scheduled for abdominal surgical removal of gastrointestinal cancers were randomized to TEA (n= 21) and sham-TEA (n= 21). TEA was performed via acupoints ST36 and PC6 1 h twice daily from the postoperative day (POD) 1 to day 3. Sham-TEA was performed at non-acupoints.

RESULTS: (1) TEA improved major postoperative symptoms by about 30%, including a reduction in time to defecation by 31.7% (P< 0.01 vs. sham-TEA), time to first flatus by 35.9% (P< 0.001), time to ambulation by 42.8% (P< 0.01), time to resuming diet by 26.5% (P< 0.01) and hospital stay by 30% (P< 0.05) as well as pain score by 50% (P< 0.01). (2) TEA significantly increased vagal activity (P< 0.001) and decreased sympathetic activity on POD 4 (P< 0.001) compared with POD 1 as well as the serum level of NE (P< 0.05). (3) The vagal activity, high frequency assessed from the spectral analysis of heart rate variability, was negatively correlated with time to resuming diet, whereas the sympathetic measurement, serum norepinephrine was positively correlated with time to resuming diet and time to flatus. (4) TEA but not sham-TEA decreased TNF-α by 17.4% from POD 1 to POD 4. (5) TEA was an independent predictor of a shorter hospital stay.

CONCLUSIONS: Needleless TEA improves major postoperative symptoms by enhancing vagal and suppressing sympathetic activities.

1Department of Gastroenterology, Changzheng Hospital affiliated to Second Military Medical University, Shanghai, 200003, China. 2Ningbo Pace Translational Medical Research Center, Ningbo, Zhejiang, China. 3Division of Gastroenterology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, Zhejiang, China. 4Gastroenterology Surgical Department, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, Zhejiang, China. 5Department of Gastroenterology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China. 6Division of Gastroenterology and Hepatology, Johns Hopkins Center for Neurogastroenterology, Baltimore, MD 21224, USA. These authors contributed equally: Bo Zhang, Feng Xu.

Correspondence: L.Z. (email: or J.D.Z.C. (email:

Received 20 November 2017; accepted 30 April 2018; Published online 21 June 2018

© The American College of Gastroenterology 2018. All Rights Reserved.
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