Effects of prucalopride succinate on postoperative bowel motility and inflammation following minimally invasive gastrectomy

Abstract

The enhanced recovery after surgery (ERAS) protocol includes prokinetic agents to reduce postoperative ileus. This double-blind, randomized controlled trial enrolled patients scheduled for minimally invasive gastrectomy for gastric cancer. Patients were randomly assigned to receive either mosapride citrate (control) or prucalopride succinate (experimental) from postoperative days 1 to 4. Bowel motility was assessed by tracking radiopaque marker migration on serial abdominal radiographs, along with first-flatus time, food intake, and inflammatory markers. Baseline characteristics were comparable between groups. The primary endpoint, bowel transit rate on postoperative day 3, showed no significant difference between the control (58.3%) and experimental groups (67.5%, p = 0.223). However, on postoperative day 5, the experimental group showed significantly higher colonic transit (96.9% vs. 90.2%, p = 0.012) and a greater increase in oral intake over time. The neutrophil-to-lymphocyte ratio (NLR) was significantly lower in the experimental group on POD 3 (p = 0.035). Although prucalopride succinate did not accelerate recovery of bowel motility on POD 3, it demonstrated delayed physiological improvement by POD 5 and attenuation of early inflammatory markers, without significant differences in clinical outcomes. Further research is needed to obtain confirmatory evidence before routine incorporation into ERAS protocols.