Early enteral nutrition after pancreatoduodenectomy: a meta-analysis of randomized controlled trials

Abstract

Current RCTs suggests that early EN appears safe and tolerated for patients after PD, but does not show advantages in infection and postoperative hospital stay.

Impact of delayed gastric emptying after pancreaticoduodenectomy on survival

“…Feeding jejunostomy can also slow intestinal motility . Although a recent meta‐analysis of randomized controlled trials found that early enteral nutrition after PD did not increase DGE incidence , foreign body placement in the afferent loop of the jejunum can disturb its recovery or motility. Prevention of intraoperative blood loss and stent placement at CJ through the RTBD route might reduce the incidence of primary DGE.…”

“…Kaplan–Meier survival curve estimates and log–rank tests were used to compare survival rates. Cox proportional hazards analyses were carried out to estimate the total effect of DGE on cancer‐specific survival adjusted for the following potential risk factors: age, primary disease for which PD was indicated, the Union for International Cancer Control pathological stage of primary disease , presence of diabetes mellitus, and DGE grade. All P ‐values were two‐sided, and P < 0.05 was considered significant.…”

Meta-analysis of effect of routine enteral nutrition on postoperative outcomes after pancreatoduodenectomy

“…Therefore, in the present study, the impact of enteral nutrition on the postoperative course was investigated without focusing on nutritional status. A recent meta‐analysis of routine enteral nutrition compared with other nutritional routes after pancreatoduodenectomy showed that enteral nutrition has no advantages in terms of postoperative outcomes. Nevertheless, the ISGPS guidelines recommend enteral nutrition over parenteral nutrition as nutritional support in patients with postoperative complications or malnutrition following pancreatoduodenectomy.…”

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“…In fact, most clinical studies have not been able to demonstrate the effectiveness of EN in the clinical course of these patients [9][10][11][12][13][14][15]. Shen et al reported that EN appeared safe and tolerable for patients after pancreatoduodenectomy, but they did not show advantages in terms of infectious complications and postoperative hospital stay by accumulation of data from recent RCTs [16]. In addition, the guidelines for preoperative care for pancreatoduodenectomy established by the Enhanced Recovery After Surgery society indicate that patients should be allowed a normal diet after pancreatoduodenectomy and that enteral tube feeding should not be placed routinely [17].…”