Abstract
One of the key principles of Enhanced Recovery After Surgery (ERAS) protocols is the early resumption of oral
intake, which has been shown to improve patient outcomes, reduce hospital stays, and facilitate faster return to
baseline function. However, in the immediate postoperative period, many patients experience varying degrees of
ileus, often accompanied by abdominal distension and discomfort, which can hinder the progression of diet and
delay recovery.
To overcome this, various pharmacologic agents are suggested in the ERAS guidelines to promote early
gastrointestinal motility. Among these, mosapride is the most commonly used prokinetic agent in clinical practice,
particularly in East Asian surgical settings. However, the actual clinical efficacy of mosapride in the context of
major abdominal surgeries such as gastrectomy remains questionable. Therefore, I conducted RCTs with
prokinetics for intestinal recovery after gastrectomy.
In this presentation, I would like to share clinical trials comparing mosapride with prucalopride, a newer 5-HT4
receptor agonist with high selectivity and predominant colonic action. I observed that while mosapride had no
impact on intestinal recovery, prucalopride appeared to facilitate earlier passage of small intestinal contents to
colon, particularly in patients undergoing laparoscopic gastrectomy for gastric cancer.
It is important to recognize that postoperative bowel recovery is influenced by the type and extent of surgery,
anesthesia, fluid balance, and other perioperative factors. Nonetheless, in my practice focused on gastric cancer,
prucalopride showed potential as a more effective agent than mosapride in the context of early postoperative
care. These findings suggest a need to revisit our pharmacologic strategies within ERAS protocols and to tailor
bowel management approaches to specific surgical populations.
