Does preoperative enteral nutrition reduce the incidence of surgical complications in patients with Crohn’s disease? A case‐matched study

Abstract

Aim Currently, the notion that preoperative optimization with enteral nutrition (EN) reduces the incidence of complication after surgery in Crohn's disease (CD) patients is being debated. This case-matched study was to evaluate the impact of preoperative EN on surgical outcomes in patients with CD.Method Twenty-four patients received EN therapy with an elemental diet (1800-2400 kcal/day) for at least 2 weeks before the planned surgery (EN group). A further 24 patients who underwent surgery without receiving preoperative EN or parenteral nutrition formed a control group based on four matched criteria: age (≤/ >40 years), the use of preoperative medications (corticosteroids/azathioprine/biologics), disease behaviour (inflammatory/stricturing/penetrating) and main surgical procedure (ileal resection/ileocolonic resection/ colectomy). The incidence of complications observed within 30 days after surgery was compared between the two groups. Septic complications were defined as anastomotic leak, intra-abdominal abscess, entero-cutaneous fistula or wound infection. ResultsIn the EN group, the median serum albumin level significantly increased, while C-reactive protein (CRP) significantly decreased during the preoperative EN (albumin, from 3.0 mg/dl to 3.1 mg/dl, P = 0.04; CRP, from 3.05 mg/dl to 2.52 mg/dl, P = 0.02). The incidence of postoperative septic complications was significantly lower in the EN group compared with the control group (4% vs 25%, P = 0.04). The occurrence rate of overall complications was lower in the EN group (21% vs 29%, P = 0.51), but not statistically significant.Conclusion In patients with CD, preoperative optimization with EN reduced the overall rate of postoperative complications and significantly decreased postoperative septic complications.What does this paper add to the literature? Preoperative optimization with enteral nutrition significantly improved patients' nutritional status, Crohn's disease activity and reduced the rate of septic complications following surgical interventions. Malnourished patients with Crohn's disease given preoperative enteral nutrition may recover from planned surgery with fewer complications.

Nutritional Treatment in Crohn’s Disease

“…Moreover, patients who were referred to surgery displayed a nine-fold increase in the incidence of post-operative abscesses and/or anastomotic leak compared to those who were pre-treated with EEN. Similar results were obtained by Yamamoto et al [ 73 ] in 24 CD patients receiving EN for 2–4 weeks before surgery compared to 24 untreated (control) patients. In the EN treated arm, the median serum albumin levels increased, while CRP significantly decreased.…”

Digesting research on preoperative nutrition in Crohn’s disease

“…We read with interest the recent article by Yamamoto et al . on preoperative enteral nutrition and its role in reducing complications following surgery . Whilst the study provides interesting information, we have some comments.…”

Reply to Lee and Brown

“…The impact of preoperative optimization with enteral nutrition (EN) on the rate of incidence of complications after surgery in Crohn’s disease (CD) remains to be fully validated. We undertook a case‐matched study to assess the relevance of nutritional optimization prior to surgery for CD .…”

“…In that study we used four matching criteria: age, treatment with corticosteroids or immunosuppressive drugs, disease profile and surgical procedure. In our previous studies , the impact of age (older or younger than 40 years) on postoperative complications in patients with CD was investigated.…”

“…Therefore, we used this age cut‐off for young and old patients. Additionally, preoperative biological therapy was included as a matching criterion (Table 1 in ). We did not apply the Crohn’s Disease Activity Index (CDAI) score as a matching criterion, but based on the CDAI, the majority of patients in both groups had moderately active disease before surgery.…”