Caffeine for intestinal transit after laparoscopic colectomy: randomized clinical trial (CaCo trial)

Abstract

Background Coffee has been suggested to help postoperative gastrointestinal motility but the mechanism is not known. This trial assessed whether caffeine shortened time to bowel activity after laparoscopic colectomy. Methods This was a single-centre, randomized, double-blinded, placebo-controlled superiority trial (October 2015 to August 2020). Patients aged at least 18 years undergoing elective laparoscopic colectomy were assigned randomly to receive 100 mg or 200 mg caffeine, or a placebo (250 mg corn starch) three times a day orally. The primary endpoint was the time to first bowel movement. Secondary endpoints included colonic transit time, time to tolerance of solid food, duration of hospital stay, and perioperative morbidity. Results Sixty patients were assigned randomly to either the 200-mg caffeine group (20 patients), the 100-mg caffeine group (20) or the placebo group (20). In the intention-to-treat analysis, the mean(s.d.) time to first bowel movement was 67.9(19.2) h in the 200-mg caffeine group, 68.2(32.2) h in the 100-mg caffeine group, and 67.3(22.7) h in the placebo group (P = 0.887). The per-protocol analysis and measurement of colonic transit time confirmed no measurable difference with caffeine. Conclusion Caffeine was not associated with reduced time to first bowel movement. Registration number NCT02510911 (http://www.clinicaltrials.gov).

Caffeine intake enhances bowel recovery after colorectal surgery: a meta-analysis of randomized and non-randomized studies

“…Six of the included studies were RCTs [ 20 – 23 , 34 , 36 ], while two studies did not use randomization [ 35 , 37 ]. Five studies originated from Europe [ 20 , 22 , 34 – 36 ], two from the Middle East [ 21 , 37 ], and one from North America [ 23 ]. In all but one study [ 34 ], patients were assigned on a single-center basis.…”

“…All studies used caffeinated drinks (mostly coffee) as the main intervention of interest. In two studies, caffeine was given in apple-flavored water and cornstarch drinks [ 21 , 22 ]. In all studies, caffeinated drinks (single dose of 100–150 ml) were administered three times daily from the same day of surgery until the second postoperative day.…”

“…Adherence to fast-track protocols was mentioned in four studies [ 20 , 23 , 34 , 36 ]. A thoracic epidural catheter was used for analgesia in two studies [ 22 , 34 ]. A detailed summary of the study, patient, and surgical characteristics are presented in Tables 1 , 2 , and 3 .…”

“…colorectal resection Yes No Coffee (150 ml)/3× daily, (coffee beans) Tea (150 ml) POD 1 Parnasa et al [ 21 ] 2021 Israel Nov 2017–Mar 2019 Single-center, prospective, double blinded RCT 63 (ITT)/58 (PP) Elective lap. colorectal resection NS No caffeine citrate (100 mg)/apple-flavored water (50 ml)/3× daily Apple-flavored water (50 ml) POD 1 Abbassi et al [ 22 ] 2022 Switzerland Oct 2015–Aug 2020 Single-center, placebo-controlled, double blinded, RCT 60 (ITT)/27 (PP) Elective lap. colorectal resection NS Yes Caffeine (100/200 mg)/3× daily, dispensed into capsules with corn starch Corn starch capsules Same day of surgery Bildirici et al [ 37 ] 2022 Turkey Nov 2018–Jun 2019 Single-center, prospective, non-randomized 60 (ITT)/51 (PP) Elective lap.…”

“…2 b). The main limitations were that blinding of patients and outcome assessors was evident in only three studies [ 20 – 22 ]. In addition, the different proportions of right- and left-sided colectomies performed in the caffeine and control groups in four studies [ 21 , 23 , 35 , 36 ] could lead to significant selection bias.…”