Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-10T07:03:53.028Z Has data issue: false hasContentIssue false
  • English
  • Français

Early enteral feeding compared with parenteral nutrition after oesophageal or oesophagogastric resection and reconstruction

Published online by Cambridge University Press:  08 March 2007

S. Gabor ,
H. Renner ,
V. Matzi ,
B. Ratzenhofer ,
J. Lindenmann ,
O. Sankin ,
H. Pinter ,
A. Maier ,
J. Smolle  and
F. M. Smolle-Jüttner
S. Gabor*
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
H. Renner
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
V. Matzi
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
B. Ratzenhofer
Affiliation:
Department of Anesthesiology, University of Medicine Graz, Auenbruggerplatz 29, A-8036, Graz, Austria
J. Lindenmann
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
O. Sankin
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
H. Pinter
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
A. Maier
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
J. Smolle
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
F. M. Smolle-Jüttner
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
*
*Corresponding author: Dr S. Gabor, fax +43 316 385 4679, email Sabine.Gabor@meduni-graz.at
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

After resective and reconstructive surgery in the gastrointestinal tract, oral feeding is traditionally avoided in order to minimize strain to the anastomoses and to reduce the inherent risks of the postoperatively impaired gastrointestinal motility. However, studies have given evidence that the small bowel recovers its ability to absorb nutrients almost immediately following surgery, even in the absence of peristalsis, and that early enteral feeding would preserve both the integrity of gut mucosa and its immunological function. The aim of this study was to investigate the impact of early enteral feeding on the postoperative course following oesophagectomy or oesophagogastrectomy, and reconstruction. Between May 1999 and November 2002, forty-four consecutive patients (thirty-eight males and six females; mean age 62, range 30–82) with oesophageal carcinoma (stages I–III), who had undergone radical resection and reconstruction, entered this study (early enteral feeding group; EEF). A historical group of forty-four patients (thirty-seven males and seven females; mean age 64, range 41–79; stages I–III) resected between January 1997 and March 1999 served as control (parenteral feeding group; PF). The duration of both postoperative stay in the Intensive Care Unit (ICU) and the total hospital stay, perioperative complications and the overall mortality were compared. Early enteral feeding was administered over the jejunal line of a Dobhoff tube. It started 6 h postoperatively at a rate of 10 ml/h for 6 h with stepwise increase until total enteral nutrition was achieved on day 6. In the controls oral enteral feeding was begun on day 7. If compared to the PF group, EEF patients recovered faster considering the duration of both stay in the ICU and in the hospital. There was a significant difference in the interval until the first bowel movements. No difference in overall 30 d mortality was identified. A poor nutritional status was a significant prognostic factor for an increased mortality. Early enteral feeding significantly reduces the duration of ICU treatment and total hospital stay in patients who undergo oesophagectomy or oesophagogastrectomy for oesophageal carcinoma. The mortality rate is not affected.

Keywords

Early enteral feedingOesophagusImmunonutritionParenteral nutritionNutrition
Type
Research Article
Information
British Journal of Nutrition , Volume 93 , Issue 4 , April 2005 , pp. 509 - 513
Copyright
Copyright © The Nutrition Society 2005

References

ASPEN Board of Directors (2002) Guidelines for the use of parenteral, enteral nutrition in adult and pediatric care. J Parenter Enteral Nutr 26, 9SA–12SAGoogle Scholar
Baeten, C & Hoefnagels, J (1992) Feeding via nasogastric tube or percutaneous endoscopic gastrostomy. Scand J Gastroenterol 27, Suppl. 194, 95–98.CrossRefGoogle Scholar
Bastian, L & Weimann, A (2002) Immunonutrition in patients after trauma. Br J Nutr 87, Suppl. 1, 133–134.CrossRefGoogle Scholar
Bone, RC, Sibbald, WJ & Sprung, CL (1992) The ACCP-SCCM Consensus Conference on sepsis and organ failure. Chest 101, 1481–1483.CrossRefGoogle ScholarPubMed
Braga, M, Vignali, A, Gianotti, L, Cestari, A, Profili, M, Di, Carlo V (1995) Benefits of early postoperative enteral feeling in cancer patients. Infusionther Transfusionmed 22, 280–284.Google Scholar
Briel, JW, Tamhankar, AP, Hagen, JA, DeMeester, SR, Johansson, J, Choustoulakis, E, Peters, JH, Bremner, CG & De Meester, TR (2004) Prevalence and risk factors for ischemia, leak and striature of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg 198, 536–541.CrossRefGoogle ScholarPubMed
Eddy, VA, Snell, JE & Morris, JA (1996) Analysis of complications and long-term outcome of trauma patients with needle catheter jejunostomy. Am Surg 62, 40–44.Google ScholarPubMed
Furst, H, Hartl, WH, Lohe, F & Schildberg, FW (2000) Colon interposition for esophageal replacement: an alternative technique based on the use of the right colon. Ann Surg 231, 173–178.CrossRefGoogle ScholarPubMed
Hochwald, SN, Harrison, LE, Heslin, MJ, Burt, ME & Brennan, MF (1997) Early postoperative enteral feeding improves whole body protein kinetics in upper gastrointestinal cancer patients. Am J Surg 174, 325–330.CrossRefGoogle ScholarPubMed
Kiyama, T, Efron, DT, Tantry, U & Barbul, A (1999) Effect of nutritional route on colonic anastomotic healing in the rat. J Gastrointest Surg 3, 441–446.CrossRefGoogle ScholarPubMed
Kudsk, KA, Croce, MA, Fabian, TC, Minare, G, Tolley, EA, Porci, A, Kuhl, MR & Brown, RO (1992) Enteral versus parenteral feeling. Ann Surg 215, 503–513.CrossRefGoogle Scholar
Maier, A, Pinter, H, Tomaselli, F, Sankin, O, Gabor, S, Ratzenhofer-Komenda, B & Smolle-Juttner, FM (2002) Retrosternal pedicled jejunum interposition: an alternative for reconstruction after total esophago-gastrectomy. Eur J Cardiothorac Surg 22, 661–665.CrossRefGoogle ScholarPubMed
Mercer, CD & Mungara, A (1996) Enteral feeding in esophageal surgery. Nutrition 12, 200–201.CrossRefGoogle ScholarPubMed
Moore, FA, Feliciano, DV & Andrassy, RJ (1992) Early enteral feeding compared with parenteral, reduces postoperative septic complications. Ann Surg 216, 172.CrossRefGoogle ScholarPubMed
Sand, J, Luostarinen, M & Matikainen, M (1997) Enteral or parenteral feeding after total gastrectomy: prospective randomized pilot study. Eur J Surg 163, 761–766.Google ScholarPubMed
Schilder, JM, Hurteau, JA, Look, KY, Moore, DH, Raff, G, Stehmann, FB & Sutton, GP (1999) A prospective controlled trial of early postoperative oral intake following major abdominal gynecologic surgery. Gynecol Oncol 67, 235–240.CrossRefGoogle Scholar
Swank, GM & Deitch, EA (1996) Role of the gut in multiple organ failure: bacterial translocation and permeability changes. World J Surg 20, 411–417.CrossRefGoogle ScholarPubMed
Velez, JP, Lince, LF & Restrepo, JI (1997) Early enteral nutrition in gastrointestinal surgery: a pilot study. Nutrition 13, 442–445.CrossRefGoogle ScholarPubMed
Weimann, A, Bastian, L, Grotz, M, Heine, J & Schlitt, HJ (1999) Welche Bedeutung besitzt der Darm in der Ätiologie des Multiorganversagens. Aktuelle Ernährungs-Med 24, 20–24.Google Scholar
Windsor, AC, Klava, A, Somers, SS, Giullou, PJ & Reynolds, VV (1995) Manipulation of local and systemic host defence in the prevention of perioperative sepsis. Br J Surg 82(11), 1460–1467.CrossRefGoogle ScholarPubMed
Yagi, M, Hashimoto, T, Nezuka, H, Ito, H, Tani, T, Shimizu, K & Miwa, K (1999) Complications associated with enteral nutrition using catheter jejunostomy after esophagectomy. Surg Today 29, 214–218.CrossRefGoogle ScholarPubMed