Early enteral versus total parenteral nutrition in patients undergoing pancreaticoduodenectomy: a randomized multicenter controlled trial (Nutri-DPC)

Périnel, Julie; Mariette, C.; Dousset, B.; Sielezneff, I.; Gainant, A; Mabrut, Jean Yves; Dorel, S. Bin; Bechwaty, M. El; Delaunay, Dominique; Bernard, Louis; Sauvanet, Alain; Pocard, Marc; Buc, Emmanuel; Adham, Marlinda

doi:10.1016/j.hpb.2019.10.1322

Cited by 23 publications

(53 citation statements)

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“…S4, supporting information). Rather, POPF occurred more frequently in patients with nasojejunal tube feeding than among those who received parenteral nutrition (OR 2⋅67, 1⋅43 to 5⋅01; P = 0⋅002; I 2 = 0 per cent) 20,21 .…”

Section: Enteral Versus Parenteral Nutritionmentioning

confidence: 97%

“…All studies were graded as high risk for performance bias (blinding of participants) because the nutrition route was apparent to the clinical staff. In five studies 20,23,[25][26][27] attrition bias (incomplete outcome data) was reduced by the performance of intention-to-treat analyses. Table 3 summarizes the statistical findings of meta-analyses comparing enteral nutrition with non-enteral nutrition, enteral nutrition with parenteral nutrition, enteral feeding using a percutaneous tube with parenteral nutrition, and enteral feeding using a nasojejunal tube with parenteral nutrition.…”

Section: Risk Of Biasmentioning

confidence: 99%

“…S2, supporting information). No statistically significant difference was found in the incidence of DGE (OR 0⋅89, 0⋅47 to 1⋅69; P = 0⋅718; I 2 = 32 per cent) 20 -22,26,27 or POPF (OR 0⋅98, 0⋅38 to 2⋅56; P = 0⋅974; I 2 = 68 per cent) 20 -22,26,27 , or in the time to first oral intake (MD -0⋅37 (-2⋅64 to 1⋅91) days; P = 0⋅751; I 2 = 86 per cent) 20,21,26,27 between enteral and parenteral nutrition.…”

Section: Enteral Versus Parenteral Nutritionmentioning

confidence: 99%

“…Enteral nutrition, compared with parenteral nutrition, significantly reduced the incidence of infection (OR 0⋅70, 95 per cent c.i. 0⋅45 to 0⋅96; P = 0⋅045; I 2 = 10 per cent)20,21,26,27 , and shortened the hospital stay (MD -1⋅59 (95 per cent c.i. -2⋅53 to -0⋅64) days; P = 0⋅001; I 2 = 17 per cent)20 -22,26,27 and time to first flatus (MD -1⋅75 (-2⋅58 to -0⋅93) days; P < 0⋅001; I 2 = 82 per cent)20,21,26,27 (…”

mentioning

confidence: 98%

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

Tanaka

Heckler

Mihaljevic

et al. 2019

British Journal of Surgery

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Background The optimal nutritional treatment after pancreatoduodenectomy is still unclear. The aim of this meta‐analysis was to investigate the impact of routine enteral nutrition following pancreatoduodenectomy on postoperative outcomes. Methods RCTs comparing enteral nutrition (regular oral intake with routine tube feeding) with non‐enteral nutrition (regular oral intake with or without parenteral nutrition) after pancreatoduodenectomy were sought systematically in the MEDLINE, Cochrane Library and Web of Science databases. Postoperative data were extracted. Random‐effects meta‐analyses were performed to compare postoperative outcomes in the two arms, and pooled odds ratios (ORs) or mean differences (MDs) were calculated with 95 per cent confidence intervals. In subgroup analyses, the routes of nutrition were assessed. Percutaneous tube feeding and nasojejunal tube feeding were each compared with parenteral nutrition. Results Eight RCTs with a total of 955 patients were included. Enteral nutrition was associated with a lower incidence of infectious complications (OR 0·66, 95 per cent c.i. 0·43 to 0·99; P = 0·046) and a shorter length of hospital stay (MD –2·89 (95 per cent c.i. –4·99 to –0·80) days; P < 0·001) than non‐enteral nutrition. Percutaneous tube feeding had a lower incidence of infectious complications (OR 0·47, 0·25 to 0·87; P = 0·017) and a shorter hospital stay (MD –1·56 (–2·13 to –0·98) days; P < 0·001) than parenteral nutrition (3 RCTs), whereas nasojejunal tube feeding was not associated with better postoperative outcomes (2 RCTs). Conclusion As a supplement to regular oral diet, routine enteral nutrition, especially via a percutaneous enteral tube, may improve postoperative outcomes after pancreatoduodenectomy.

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Section: Enteral Versus Parenteral Nutritionmentioning

confidence: 97%

Section: Risk Of Biasmentioning

confidence: 99%

Section: Enteral Versus Parenteral Nutritionmentioning

confidence: 99%

mentioning

confidence: 98%

See 2 more Smart Citations

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

Tanaka

Heckler

Mihaljevic

et al. 2019

British Journal of Surgery

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“…Comparing the outcomes of enteral nutrition and parenteral nutrition are major concerns among clinicians. Previous studies have demonstrated conflicting results among patients who received enteral nutrition versus those who received parenteral nutrition [11–13].…”

Section: Introductionmentioning

confidence: 99%

Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in the elderly with dysphagia: A propensity-matched cohort study

Masaki

Kimura

2019

Preprint

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21Background 22 The long-term outcomes of artificial nutrition and hydration (ANH) in the elderly with 23 dysphagia remain uncertain. Enteral nutrition via percutaneous endoscopic gastrostomy 24 (PEG) and total parenteral nutrition (TPN) are major methods of ANH. Although both 25 can be a life-prolonging treatments, Japan has recently come to view PEG as 26 representative of unnecessary life-prolonging treatment. Consequently, TPN is often 27 chosen for ANH instead. This study aimed to compare the long-term outcomes between 28 PEG and TPN in the elderly. 29 Methods 30This single-center retrospective cohort study identified 253 elderly patients with 31 dysphagia who received enteral nutrition via PEG (n=180) or TPN (n=73) between 32 January 2014 and January 2017. The primary outcome was survival time. Secondary 33 outcomes were oral intake recovery, discharge to home, and the incidence of severe 34 pneumonia and sepsis. We performed one-to-one propensity score matching using a 0.05 35 caliper. The Kaplan-Meier method, log-rank test, and Cox proportional hazards model 36 were used to analyze the survival time between groups. 37 Results 38Older patients with lower nutritional states, and severe dementia were more likely to 39 receive TPN. Propensity score matching created 55 pairs. Survival time was significantly 40 longer in the PEG group (median, 317 vs 195 days; P=0.017). The hazard ratio for PEG 41 relative to TPN was 0.60 (95% confidence interval: 0.39-0.92; P=0.019). There were no 42 significant differences between the groups in oral intake recovery and discharge to home. 43The incidence of severe pneumonia was significantly higher in the PEG group (50.9% vs 44 25.5%, P=0.010), whereas sepsis was significantly higher in the TPN group (10.9% vs 45 30.9%, P=0.018). 46 Conclusions 47PEG was associated with a significantly longer survival time, a higher incidence of 48 severe pneumonia, and a lower incidence of sepsis compared with TPN. These results can 49 be used in the decision-making process before initiating ANH. 50 51 4 56 developed as an enteral feeding technique for pediatric patients with dysphagia [1,2]. 57Compared to feeding via a nasogastric tube, enteral feeding via PEG can relieve 58 laryngopharyngeal discomfort and prevent intervention failure; therefore, its use has 59 become widespread for long-term enteral feeding in multiple patient groups including 60 pediatric and geriatric populations [3]. However, studies have reported worse outcomes 61 following PEG feeding in patients with dementia [4,5]; therefore, the use of PEG in 62 elderly populations is controversial [6,7]. 63TPN is another common method of nutritional management [8,9]. Similar to tube 64 feeding, TPN is also occasionally used for ANH in elderly patients with dysphagia [10]. 65 Comparing the outcomes of enteral nutrition and parenteral nutrition are major concerns 66 among clinicians. Previous studies have demonstrated conflicting results among patients 67 who received enteral nutrition versus those who received parenteral nutr...

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Role of nutrition in gastroenterological surgery

Fukatsu

2019

Annals of Gastroent Surgery

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Nutrition plays important roles in recovery after gastroenterological surgery. Severe surgical stress increases muscle breakdown and lipolysis, thereby accelerating wound healing and enhancing host defense against microbes. Malnourished patients have insufficient amounts of muscle and body fat. Therefore, they may not appropriately respond to surgical stress. Perioperative nutritional therapy maintaining nutritional status reduces postoperative complications and accelerates recovery after surgery, particularly for malnourished patients. In addition, perioperative oral or enteral nutrition is now recommended for preserving host defense mechanisms against microbes. Lack of enteral nutrition impairs gut and hepatic immunity, systemic mucosal defense and peritoneal host defense, even when nutrient amounts supplied by parenteral nutrition are adequate. Thus, surgeons should avoid no oral or enteral nutrition periods. Supplemental administration of specific nutrients such as glutamine, arginine and ω‐3 fatty acids is termed “immunonutrition”, and is expected to reduce the morbidity of infectious complications and length of hospital stay. Nutritional therapy is important even after discharge to maintain body weight and compensate for abnormalities in the digestion and absorption of nutrients. Understanding the significance of nutrition in gastroenterological patients leads to better outcomes.

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Early enteral versus total parenteral nutrition in patients undergoing pancreaticoduodenectomy: a randomized multicenter controlled trial (Nutri-DPC)

Abstract: Background: A recent survey revealed that many European surgeons have concerns about the oncological safety

Cited by 23 publications

References 0 publications

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

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

Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in the elderly with dysphagia: A propensity-matched cohort study

Role of nutrition in gastroenterological surgery

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