Electrical acupoint stimulation for gastrointestinal recovery after gastrectomy for gastric cancer: a systematic review and meta-analysis

Delayed gastrointestinal recovery remains a challenge after gastrectomy for gastric cancer, with residual variability even within enhanced recovery after surgery (ERAS) pathways. This residual variability has prompted interest in adjunctive approaches such as electrical acupoint stimulation (EAS), but gastrectomy-specific anatomical and neural features may limit extrapolation from broader abdominal-surgery populations. We therefore synthesized randomized evidence on EAS for postoperative gastrointestinal recovery and examined variation across study-level characteristics. We searched PubMed, Embase, Scopus, CENTRAL, China National Knowledge Infrastructure, Wanfang Data, SinoMed, and four registries from inception to a 1 August 2026 cutoff. We included randomized trials in patients undergoing gastrectomy for gastric cancer when EAS was separable from other traditional or acupoint-based co-interventions. Outcomes were time to first flatus (primary), first defecation, first liquid intake, and length of hospital stay. Safety was summarized descriptively. Risk of bias was assessed with the Cochrane Risk of Bias 2 tool and certainty with GRADE; exploratory subgroup differences were examined using interaction tests. Fifteen trials were eligible; 13 contributed to the primary pairwise comparison (1,357 participants) and two to narrative synthesis only. EAS was associated with shorter times to first flatus [13 trials; mean difference (MD), −9.61 h; 95% CI, −12.81 to −6.42; I 2 = 82.6%; very low certainty], first defecation (9 trials; MD, −15.88 h; 95% CI, −23.31 to −8.46; I 2 = 90.3%; low certainty), and first liquid intake (2 trials; MD, −10.65 h; 95% CI, −18.20 to −3.10; I 2 = 0%; low certainty). Length of hospital stay did not differ significantly (7 trials; MD, −0.63 days; 95% CI, −1.36 to 0.10; I 2 = 57.0%; low certainty). Prediction intervals narrowly excluded the null for flatus but included it for defecation. For flatus, funnel-plot asymmetry and trim-and-fill attenuation raised publication-bias concerns. None of the 12 primary interaction tests across comparator design, perioperative care, stimulation modality, and frequency strategy was significant. Safety reporting was limited; no serious intervention-related adverse events were reported where assessed. Current evidence indicates a consistent directional signal favoring EAS for early postoperative gastrointestinal recovery milestones, but the magnitude, reproducibility, and clinical importance of this association remain uncertain. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261289414 , identifier CRD420261289414.