Beneficial Effects of Early Enteral Nutrition After Major Rectal Surgery: A Possible Role for Conditionally Essential Amino Acids? Results of a Randomized Clinical Trial

Barneveld, Kevin W. Y. van; Smeets, Boudewijn J. J.; Heesakkers, Fanny F. B. M.; Bosmans, Joanna W. A. M.; Luyer, Misha; Wasowicz, Dareczka K.; Bakker, J.; Roos, Arnout N.; Rutten, H.J.T.; Bouvy, Nicole D.; Boelens, Petra G.

doi:10.1097/ccm.0000000000001640

Cited by 25 publications

(11 citation statements)

References 32 publications

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“…[ 25 ] In this study, the postoperative ileus was significantly reduced with ERAS implementation. Excess crystalloids were proposed to be implicated in coagulation disturbance, which may be associated with the thrombosis event, [ 21 ] although this was not found in this study. In addition, tissue oxygenation might decline with fluid supersaturation, which is unfavorable for postoperative recovery.…”

Section: Discussionmentioning

confidence: 61%

“…Unless contraindicated, early enteral nutrition has been encouraged to be initiated as early as possible, with several benefits, including modulating the inflammatory response and metabolism and preserving gut integrity, thereby dampening postoperative ileus (POI). Enteral feeding should stimulate bowel movements, which also contribute to the beneficial effect of early enteral nutrition [ 20 , 21 ] . A common worry for early EN is complications such as diarrhea, abdominal distention, and abdominal cramps, which worsen with increasing caloric intake [ 22 ] and which could lead to discontinuance of enteral feeding.…”

Section: Discussionmentioning

confidence: 99%

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Modified enhanced recovery after surgery protocols are beneficial for postoperative recovery for patients undergoing emergency surgery for obstructive colorectal cancer

2018

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Enhanced recovery after surgery (ERAS) is acknowledged to reduce perioperative stress in several surgical diseases. Here, we investigated whether modified ERAS is associated with beneficial effects in the setting of emergency colorectal surgery.We retrospectively evaluated the medical records of 839 consecutive patients with obstructive colorectal cancer undergoing surgical intervention at 4 institutes. Among them, 356 cases were managed with a multidisciplinary team approach to care (modified ERAS protocols), and the remaining 483 cases were treated based on traditional protocols. According to modified ERAS or traditional care, propensity score (PS) matching was performed to adjust biases in patient selection. The primary outcome was gastrointestinal function recovery. Secondary outcomes included postoperative complications and length of hospital stay.Modified ERAS was associated with postoperative gastrointestinal function recovery, including time to first flatus (P = .002), first defecation (P = .008), and prolonged ileus (P = .016). According to the Clavien–Dindo classification, fewer total episodes of grade II or higher postoperative complications were observed in patients cared for with modified ERAS than in patients with traditional care (P = .002). Median (interquartile range) postoperative hospital stay in the modified ERAS group was 6 (3–22) days versus 9 (7–27) days in the traditional care group (P < .001). Furthermore, the interval from operation to postoperative chemotherapy (d) was significantly shorter in the modified ERAS group (35.6 ± 11.5 vs 47.6 ± 23.8, P < .001).The modified ERAS was safe and associated with clinical benefits, including fast recovery of bowel function, reduced postoperative complications, and shorter hospital stay for patients with obstructive colorectal cancer.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Modified enhanced recovery after surgery protocols are beneficial for postoperative recovery for patients undergoing emergency surgery for obstructive colorectal cancer

2018

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“…14,15 The rapid recovery of gastrointestinal function in the ERAS group may have been due to their early enteral nutrition, mobilization, and receipt of appropriate intravenous fluids and was comparable with the results seen in other studies. 16–20 Research has also indicated that exercise can relieve pain and reduce the risk of both cancer and disease recurrence. 21,22 Excessive intravenous fluid administration can cause postoperative intestinal edema, which slows the recovery of gastrointestinal function.…”

Section: Discussionmentioning

confidence: 99%

Enhanced recovery after surgery in pediatric gastrointestinal surgery

Gao

Yang

et al. 2019

J Int Med Res

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Objective: Enhanced recovery after surgery (ERAS) protocols help optimize inpatient care and minimize discomfort. This study was performed to explore the safety, feasibility, and clinical and social value of ERAS in pediatric gastrointestinal surgery. Methods: This study included all children (n ¼ 125) who underwent appendectomy, pyloromyotomy, transabdominal Soave's procedure, Meckel's diverticulum resection, or reduction of intussusception in our institution from January to September 2018. We compared surgical outcomes between children who underwent surgery under conventional perioperative regimens (control group, n ¼ 57) and those who were treated with ERAS protocols (ERAS group, n ¼ 68). Results: There were no significant intergroup differences in demographic or surgical data. However, the bowel function recovery time, postoperative intravenous nutrition time, duration of postoperative hospital stay, and hospital costs were significantly lower in the ERAS group than control group. There was no significant intergroup difference in the complication rate. Conclusions: Our results indicate that implementation of ERAS protocols is safe and feasible in pediatric gastrointestinal surgery. They can improve patient comfort, shorten the duration of the postoperative hospital stay, reduce hospital costs, and accelerate postoperative rehabilitation without increasing the risk of postoperative complications. Therefore, ERAS protocols deserve wider implementation and promotion.

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“…The use of EN with Gln may not be enough to full up plasma concentration up to normal level; new remarkable data showed that enteral supplementation only is not enough to revert the Gln depletion [34]. The values and data accumulated in PN cannot be directly extrapolated to EN supplementation and, therefore, cannot be used as the base for recommendation.…”

Section: Enteral and Parenteral Glutamine Supplementationmentioning

confidence: 99%

Glutamine: A Conditionally Essential Amino Acid with Multiple Biological Functions

Leguina-Ruzzi¹,

Cariqueo²

2017

Superfood and Functional Food - The Development of Superfoods and Their Roles as Medicine

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Glutamine (Gln) is the most abundant free amino acid (AA) in the body with concentrations fluctuating around 500-900 μmol/L. The biological functions of Gln have been widely studied, and they have opened new targets because Gln could modulate physiological functions such as immune enhancer, muscular maintainer, nitrogen transporter, neuronal mediator, pH homeostasis, gluconeogenesis, amino sugar synthesis, and insulin release modulation. In 1990, it was identified that Gln is a conditionally essential AA, meaning that in hypercatabolic or stress conditions, the body suffers depletion in its circulating levels. Moreover, this condition is an independent risk factor of mortality, has been correlated with increase in infection rates, and length of hospital stay in intensive care units (ICU) patients. This characteristic confers the option of Gln use, meaning that through its targets, it could improve the outcome of patients who are suffering a hypercatabolic or hypermetabolic condition.

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Beneficial Effects of Early Enteral Nutrition After Major Rectal Surgery: A Possible Role for Conditionally Essential Amino Acids? Results of a Randomized Clinical Trial

Cited by 25 publications

References 32 publications

Modified enhanced recovery after surgery protocols are beneficial for postoperative recovery for patients undergoing emergency surgery for obstructive colorectal cancer

Modified enhanced recovery after surgery protocols are beneficial for postoperative recovery for patients undergoing emergency surgery for obstructive colorectal cancer

Enhanced recovery after surgery in pediatric gastrointestinal surgery

Glutamine: A Conditionally Essential Amino Acid with Multiple Biological Functions

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