Impact of Preoperative Exclusive Enteral Nutrition on Postoperative Complications and Recurrence After Bowel Resection in Patients with Active Crohn’s Disease

Wang, Honggang; Zuo, Lugen; Zhao, Jie; Dong, Jiahao; Li, Yi; Gu, Lili; Gong, Jianfeng; Liu, Qinghong; Zhu, Weiming

doi:10.1007/s00268-016-3488-z

Cited by 53 publications

(69 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of these, one had no English abstract [39] and three had no English full text [40-42]. The main features of the 14 full-text excluded articles are summarized in Table 1 [43-56] – eight of them had no separate results on different nutritional regimens or on treated patients [44, 47-50, 52-54] and four had no data on EN regimen [43, 45, 55, 56]; two other articles [46, 51] met the inclusion criteria but overlapped patients with a third study which contained a larger number of patients and was therefore detrimentally included. All studies in which supplemental EN was used with conventional diet or with PN did not meet the inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Rocha

Bessa

Lago

et al. 2018

GE Port J Gastroenterol

View full text Add to dashboard Cite

Background and Aim: Enteral nutrition (EN) is applicable to adult Crohn’s disease (CD) in treating malnutrition and in inducing remission – here as a less effective alternative than corticosteroids. The purpose of this review is to determine whether preoperative EN impacts postoperative complications of adult CD, either by means of nutritional or therapeutic effects. Summary: A systematic review of English written full-text research articles published between January 1990 and November 2017, including adult patients undergoing abdominal surgery for complicated CD after EN, was performed. Four studies out of 22 were selected, all of which institutional, retrospective, case-control cohorts, one classified as “good quality” and three as “poor quality,” as rated by the Newcastle-Ottawa Scale. The application of inclusion and exclusion criteria resulted in a non-intentional absence of studies referring to supplemental EN among those reviewed. The reduced number of heterogeneous eligible studies impeded meta-analysis. In all studies, exclusive EN (EEN) was used and well tolerated, allowing to defer or even avoid surgery altogether, improving patients’ global state. The two studies with the greatest number of patients found preoperative EEN to be an independent factor against infectious and non-infectious complications in 219 patients and against anastomotic leaks or abscesses in 38 patients. Also, in univariate analysis, EEN was found to increase preoperative immunosuppressant-free intervals and to protect against anastomotic dehiscences, intra-abdominal abscesses, surgical wound infections, ileus, stomas, and reoperations in the largest study; in another study it was related to fewer intra-abdominal septic complications. Key Messages: All reviewed studies are retrospective and, consequently, of limited relevance. Nonetheless, all of them call the attention of the scientific community to the potential benefits of preoperative EEN on postoperative outcomes in adult CD, calling for prospective multi-institutional studies and randomized controlled trials.

show abstract

Section: Resultsmentioning

confidence: 99%

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Rocha

Bessa

Lago

et al. 2018

GE Port J Gastroenterol

View full text Add to dashboard Cite

show abstract

“…Use of preoperative EEN may have long-lasting effects. Wang et al found that EEN prior to resection was accompanied by a significant reduction of endoscopic recurrence rates after resection for CD after 6 months 96. In addition, a large retrospective study demonstrated that administration of EEN for approximately 4 weeks led to lower rates of stoma creation (p<0.05), a decrease in urgent operation requirement (p<0.05) and extended preoperative drug-free intervals (p<0.001) 97…”

Section: Introductionmentioning

confidence: 99%

Evolving role of diet in the pathogenesis and treatment of inflammatory bowel diseases

Levine

Boneh

Wine

2018

Gut

276

284

View full text Add to dashboard Cite

Recent advances in basic and clinical science over the last 3 years have dramatically altered our appreciation of the role of diet in inflammatory bowel diseases (IBD). The marked increase in incidence of these diseases along with the important role of non-genetic susceptibility among patients with IBD has highlighted that these diseases have a strong environmental component. Progress in the field of microbiome and IBD has demonstrated that microbiome appears to play an important role in pathogenesis, and that diet may in turn impact the composition and functionality of the microbiome. Uncontrolled clinical studies have demonstrated that various dietary therapies such as exclusive enteral nutrition and newly developed exclusion diets might be potent tools for induction of remission at disease onset, for patients failing biologic therapy, as a treatment for disease complications and in reducing the need for surgery. We review these advances from bench to bedside, along with the need for better clinical trials to support these interventions.

show abstract

“…Six were subsequently excluded for the following reasons: incomplete data or not within the scope of the present analysis ( n = 4) [20,21,22,23], language restriction ( n = 1) [24], and risk of double publication ( n = 1) [25] (Figure 1). For final analysis, 14 original studies [26,27,28,29,30,31,32,33,34,35,36,37,38,39] and 15 reviews [4,5,17,19,40,41,42,43,44,45,46,47,48,49,50] were retained (Table 1, Table 2 and Table 3). All studies except one were indexed in PubMed.…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies (64%) were retrospective [26,27,29,30,32,33,34,36,37] totaling 1783 patients. The remaining 358 patients were studied in 4 (29%) prospective [28,35,38,39] and 1 randomized controlled trial (RCT) [31].…”

Section: Resultsmentioning

confidence: 99%

“…In the only RCT, patients were not randomized to a nutritional regimen but to different endpoint measures, and thus no nutritional control group was available. Nutritional control groups were available in nine studies (64%) [26,28,29,30,32,33,35,37,38]. Only three studies (21%) [26,29,35] matched study and control groups, however, matching criteria were inconsistent among these studies.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Preoperative Nutritional Conditioning of Crohn’s Patients—Systematic Review of Current Evidence and Practice

Grass¹,

Pache²,

Martín³

et al. 2017

Nutrients

View full text Add to dashboard Cite

Crohn’s disease is an incurable and frequently progressive entity with major impact on affected patients. Up to half of patients require surgery in the first 10 years after diagnosis and over 75% of operated patients require at least one further surgery within lifetime. In order to minimize surgical risk, modifiable risk factors such as nutritional status need to be optimized. This systematic review on preoperative nutritional support in adult Crohn’s patients between 1997 and 2017 aimed to provide an overview on target populations, screening modalities, routes of administration, and expected benefits. Pertinent study characteristics (prospective vs. retrospective, sample size, control group, limitations) were defined a priori. Twenty-nine studies were retained, of which 14 original studies (9 retrospective, 4 prospective, and 1 randomized controlled trial) and 15 reviews. Study heterogeneity was high regarding nutritional regimens and outcome, and meta-analysis could not be performed. Most studies were conducted without matched control group and thus provide modest level of evidence. Consistently, malnutrition was found to be a major risk factor for postoperative complications, and both enteral and parenteral routes were efficient in decreasing postoperative morbidity. Current guidelines for nutrition in general surgery apply also to Crohn’s patients. The route of administration should be chosen according to disease presentation and patients’ condition. Further studies are needed to strengthen the evidence.

show abstract

Impact of Preoperative Exclusive Enteral Nutrition on Postoperative Complications and Recurrence After Bowel Resection in Patients with Active Crohn’s Disease

Abstract: Preoperative exclusive EN therapy for 4 weeks reduced postoperative complications, which may be associated with improvement of nutritional and inflammatory status in patients with active CD.

Cited by 53 publications

References 48 publications

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Evolving role of diet in the pathogenesis and treatment of inflammatory bowel diseases

Preoperative Nutritional Conditioning of Crohn’s Patients—Systematic Review of Current Evidence and Practice

Contact Info

Product

Resources

About