A Comparison of Postoperative Early Enteral Nutrition with Delayed Enteral Nutrition in Patients with Esophageal Cancer

Wang, Gongchao; Chen, Hongbo; Li, Jun; Ma, Yue; Jia, Haiyong

doi:10.3390/nu7064308

Cited by 48 publications

(37 citation statements)

References 18 publications

(19 reference statements)

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“…The incidence of pneumonia was higher in Group 3. Finally, all postoperative outcomes of nutritional status were worst in Group 3 [74]. Similarly, one systematic review demonstrated that early oral EN was associated with reduced length of stay and did not increase complication rates [75].…”

Section: Early Enteral Nutritionmentioning

confidence: 92%

Nutritional Management of Esophageal Cancer Patients

Schizas¹,

Lidoriki²,

Moris³

et al. 2017

Esophageal Abnormalities

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Esophageal cancer is associated with malnutrition in the vast majority of patients. This phenomenon is partly attributed to the disease process itself, the location of the tumor and other factors, such as dysphagia which is often accentuated due to chemotherapy/ radiotherapy treatment or surgical intervention. The poor nutritional status of these patients is often related to the presence of cancer cachexia, altered metabolism, and tissue wasting. Malnutrition in this patient population affects quality of life, worsens patient's tolerance to chemotherapy and accounts for lower survival. Nutritional management of these patients includes both proper nutritional assessment and support and might prevent, to a certain extent, the manifestation of malnutrition-related consequences. The purpose of this article is to review the current literature in order to focus on the etiology and diagnosis of malnutrition in esophageal cancer patients, emphasizing also on the optimal nutritional support during multimodality treatment.

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Section: Early Enteral Nutritionmentioning

confidence: 92%

Nutritional Management of Esophageal Cancer Patients

Schizas¹,

Lidoriki²,

Moris³

et al. 2017

Esophageal Abnormalities

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“…Rather, the earlier reintroduction of oral or enteral fluids was associated with a reduced length of hospital stay, with a combined mean length of hospital stay of 19±5 vs 25±18 days (mean ± standard deviation [SD]). [15][16][17] The overall complication rates were similar between the two groups (40% vs 45%). The three studies that measured duration of postoperative ileus time found that earlier reintroduction of oral or enteral intake reduced duration of ileus from a mean of 7 days (SD 2) to a mean of 5 days (SD 1).…”

Section: Early Challenges Interruption Of Oral Dietmentioning

confidence: 74%

“…Table 2 summarizes the four cohort studies that evaluated optimal timing of reestablishing oral or enteral fluid intake. [15][16][17][18] The earlier reintroduction of oral or enteral fluid had no deleterious effects on clinical outcome, specifically anastomotic leak. Rather, the earlier reintroduction of oral or enteral fluids was associated with a reduced length of hospital stay, with a combined mean length of hospital stay of 19±5 vs 25±18 days (mean ± standard deviation [SD]).…”

Section: Early Challenges Interruption Of Oral Dietmentioning

confidence: 93%

“…The three studies that measured duration of postoperative ileus time found that earlier reintroduction of oral or enteral intake reduced duration of ileus from a mean of 7 days (SD 2) to a mean of 5 days (SD 1). [15][16][17] It should be highlighted that in common with most studies, resumption of eating did not occur until the seventh day, irrespective of when fluids were permitted.…”

Section: Early Challenges Interruption Of Oral Dietmentioning

confidence: 97%

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Nutritional support and dietary interventions following esophagectomy: challenges and solutions

Paul¹,

Baker²,

Williams³

et al. 2017

NDS

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Background and aims: Provision of adequate nutrition after esophagectomy remains a major challenge. The aims of this review were to describe the challenges facing this patient population and to determine the evidence base underpinning current nutritional and dietetic interventions after esophagectomy. Methods: Medline, Embase and CINAHL databases were searched for English language publications of the period 1990-2016 reporting on the outcome of nutritional or dietetic interventions after esophagectomy or patient-related symptoms. Results: Four studies demonstrated that early reintroduction of oral fluids was safe and was associated with a shorter hospital stay and ileus duration. One of three studies comparing in-hospital enteral nutrition against usual care showed that enteral feeding was well tolerated and was associated with a shorter hospital stay. Eight studies comparing enteral with parenteral nutrition showed similar surgical complication rates. Enteral feeding was associated with a shorter duration of ileus and lower health care costs. In hospital, all types of enteral access (nasoenteral, jejunostomy) were equivalent in their safety profiles. Cohort studies indicate that technical (tube dysfunction) and feed (diarrhea, distention) problems were common with jejunostomies but are easily managed. The mortality risk associated with jejunostomy in hospital is 0.2% (reported range 0%-1%), principally due to small bowel ischemia. There have been no reports of serious jejunostomy complications in patients receiving home feeding. One study demonstrated the advantages of home feeding in weight, muscle and fat preservation. Studies reporting 12 months or more after esophagectomy indicate a high frequency of persistent symptoms, dumping syndrome 15%-75% (median 46%), dysphagia 11%-38% (median 27%), early satiety 40%-90% (median 65%) and reflux 19%-61% (median 29%). Conclusion: Patients should resume oral intake as soon as possible after surgery. In hospital, all forms of enteral access appear to be safe. Out of hospital, the ability to provide home feeding by feeding jejunostomy is likely where meaningful nutritional improvements can be made. Improving nutrition and related quality of life in the early months might improve the long-term outcome.

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“…Early EN was compared with delayed nutrition by Wang et al, and was found to be associated with a short LOS, fewer incidences of pneumonia and better nutrition outcomes. 20 The authors advocated starting enteral feeding within 48 hours of oesophagectomy. EN was compared with PN in a randomised controlled trial (RCT) by Takesue et al 21 They presented the data of 47 patients who had undergone a thoracic oesophagectomy.…”

Section: Discussionmentioning

confidence: 99%

Routes of early enteral nutrition following oesophagectomy

Elshaer

Gravante

White

et al. 2016

annals

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INTRODUCTION Oesophagectomy for cancer is a challenging procedure with a five-year overall survival rate of 15-20%. Early enteral nutrition following oesophagectomy is a crucial component of the postoperative recovery and carries a significant impact on the outcome. Different methods of enteral feeding were conducted in our unit. The aim of this study was to examine the efficacy and safety of nasojejunal tube (NJT), jejunostomy tube (JT) and pharyngostomy tube (PT) feeding after oesophagectomy. METHODS A retrospective review was carried out of prospectively collected data on patients with oesophageal cancer who underwent an oesophagectomy between 2011 and 2014. The primary outcome was feeding tube related complications such as occlusion, dislocation and leak. The secondary outcomes were length of stay and 30-day morbidity. RESULTS A total of 90 oesophagectomies were included in the study. A NJT was inserted in 41 patients (45.6%), a JT was used in 14 patients (15.5%) and a PT was the route for enteral nutrition in 35 patients (38.9%). In total, five patients (5.5%) developed tube related complications. There were no tube related complications in the NJT group but one JT patient (7.1%) developed tube related cellulitis (p=0.189) and four PT patients (11.4%) developed tube related haemorrhage (p=0.544), tube dislocation (p=0.544) or cellulitis (p=0.189). The median length of stay and 30-day postoperative morbidity were similar between the groups. CONCLUSIONS NJT feeding is a less invasive, feasible route for early enteral nutrition following oesophagectomy. A randomised controlled trial is recommended to verify these findings.

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A Comparison of Postoperative Early Enteral Nutrition with Delayed Enteral Nutrition in Patients with Esophageal Cancer

Cited by 48 publications

References 18 publications

Nutritional Management of Esophageal Cancer Patients

Nutritional Management of Esophageal Cancer Patients

Nutritional support and dietary interventions following esophagectomy: challenges and solutions

Routes of early enteral nutrition following oesophagectomy

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