Early feeding after esophageal variceal band ligation in cirrhotics is safe: Randomized controlled trial

Abstract

Background and Aim Oral feeding following variceal ligation in cirrhotics is usually delayed due to fear of rebleeding. Solid diet is usually further delayed (until 72 h) despite lack of evidence. We aimed to compare the impact of early versus delayed feeding on rebleeding following variceal ligation. Methods This was a prospective randomized controlled trial including patients undergoing variceal ligation for active esophageal variceal bleeding. Patients were randomized into two groups. In the early‐feeding group, liquid diet was given after 1 h following variceal ligation and a regular solid diet was resumed after 4 h. In the delayed‐feeding group, patients fasted for the first 4 h after variceal ligation, liquid diet was given until 24 h, soft diet for the next 48 h and a regular solid diet after 72 h. Results There were 52 and 49 patients in the early and delayed feeding groups, respectively. Very early rebleeding rates [2 (3.84%) vs 1 (2.04%); P ≥ 0.99] and delayed rebleeding rates [2 (3.84%) vs 4 (8.16%); P = 0.75] were similar in both groups. Protein and calorie intake in the early‐feeding group was significantly better and early infections in active bleeders were significantly lower compared to the delayed‐feeding group. One‐month mortality was similar in both groups [3 (5.76%) vs 4 (8.16%); P = 0.75]. Conclusion Early feeding with a regular solid diet in conscious patients after successful variceal ligation for esophageal varices is safe, provides better nutrition and results in lower incidence of infections in bleeders compared to delayed feeding.

Clinical outcomes of sedation during emergency endoscopic band ligation for variceal bleeding: Multicenter cohort study

“…[30][31][32] Optimal sedation during therapeutic endoscopic procedures provides good treatment outcomes and promotes patient satisfaction. [33][34][35][36][37] Nevertheless, some endoscopists hesitate to use sedation during emergency endoscopy for gastrointestinal bleeding because of fear of potential adverse events related to sedatives, such as respiratory depression and cardiovascular instability. 38 Sedation may prevent early resuscitation because it interferes with evaluation of mental status during the procedure.…”

Early versus delayed feeding after therapeutic endoscopic procedures: Meta‐analysis of randomized controlled trials

“…In most trials included in the current study, a liquid diet was initiated within 24 h, followed by a solid diet; however, in the study by Hepworth et al, 14 patients with bleeding peptic ulcers began solid diets immediately following endoscopic hemostasis. Moreover, Sidhu et al 7 suggested that beginning a solid diet 4 h after EVL was safe for patients with acute variceal bleeding. In addition, Miyakawa et al 20 suggested that an early solid diet could improve the satisfaction of patients who Figure 3 Comparison of postprocedural bleeding rate within 7 days between the early and delayed feeding groups.…”

ESPEN guideline on hospital nutrition

“…In unstable patients and patients with endoscopic findings predictive of a high risk of rebleeding, feeding should be delayed. An RCT showed that early feeding with a regular solid diet in patients after successful variceal ligation for esophageal varices is safe, provides better nutrition, and results in a lower incidence of infections in bleeders compared to delayed feeding [224]. The results are promising, however, they included only patients with lowrisk varices.…”