Prospective multicentre randomised controlled trial of early enteral nutrition for patients undergoing major upper gastrointestinal surgical resection

Barlow, Rachael; Price, Patricia Elaine; Reid, T. D.; Hunt, Sarah K.; Clark, Geoffrey W.B.; Havard, Timothy; Puntis, M. C. A.; Lewis, Wyn G.

doi:10.1016/j.clnu.2011.02.006

Cited by 151 publications

(120 citation statements)

References 25 publications

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“…by supplying the patient with a jejunostomy. There is also some evidence from RCTs showing shortened length of hospital stay and improved clinical outcomes of using jejunostomy in the postoperative period, 112 including continued use at home. 113 …”

Section: Survivorshipmentioning

confidence: 99%

Oesophageal cancer

et al. 2017

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SummaryOesophageal cancer is a clinically challenging disease requiring a multidisciplinary approach.The extensive treatment may be associated with serious limitations in health-related quality of life and yet still a poor prognosis. Recent decades have witnessed a gradual improvement in prognosis in many countries. Endoscopic procedures have increasingly been used in the treatment of premalignant and early oesophageal tumours. Neoadjuvant therapy with chemotherapy or chemoradiotherapy has supplemented surgery as standard treatment of locally advanced oesophageal cancer. Surgery has become more standardised and centralised. There are several therapeutic alternatives for palliative treatment. This review aims to provide insights into the current clinical management, on-going controversies and future needs in oesophageal cancer.3

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Section: Survivorshipmentioning

confidence: 99%

Oesophageal cancer

et al. 2017

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“…12,20,21 These showed that enteral feeding was generally well tolerated and safe. A study by Barlow et al 12 was the only one that demonstrated a significant difference in the length of hospital stay; median length of hospital stay was 16 days (interquartile range 9) vs 19 days (interquartile range 11) in favor of enteral feeding compared to usual care (p=0.023). The other two studies showed no advantage for enteral feeding over intravenous fluids alone.…”

Section: Provision and Value Of Postoperative Nutritional Supportmentioning

confidence: 99%

“…12,13 After full study review, 47 articles met the inclusion criteria and formed the basis of this review (Table 1). These fell into five categories: two-arm studies comparing the outcome n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a …”

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confidence: 99%

Nutritional support and dietary interventions following esophagectomy: challenges and solutions

Paul¹,

Baker²,

Williams³

et al. 2017

NDS

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Background and aims: Provision of adequate nutrition after esophagectomy remains a major challenge. The aims of this review were to describe the challenges facing this patient population and to determine the evidence base underpinning current nutritional and dietetic interventions after esophagectomy. Methods: Medline, Embase and CINAHL databases were searched for English language publications of the period 1990-2016 reporting on the outcome of nutritional or dietetic interventions after esophagectomy or patient-related symptoms. Results: Four studies demonstrated that early reintroduction of oral fluids was safe and was associated with a shorter hospital stay and ileus duration. One of three studies comparing in-hospital enteral nutrition against usual care showed that enteral feeding was well tolerated and was associated with a shorter hospital stay. Eight studies comparing enteral with parenteral nutrition showed similar surgical complication rates. Enteral feeding was associated with a shorter duration of ileus and lower health care costs. In hospital, all types of enteral access (nasoenteral, jejunostomy) were equivalent in their safety profiles. Cohort studies indicate that technical (tube dysfunction) and feed (diarrhea, distention) problems were common with jejunostomies but are easily managed. The mortality risk associated with jejunostomy in hospital is 0.2% (reported range 0%-1%), principally due to small bowel ischemia. There have been no reports of serious jejunostomy complications in patients receiving home feeding. One study demonstrated the advantages of home feeding in weight, muscle and fat preservation. Studies reporting 12 months or more after esophagectomy indicate a high frequency of persistent symptoms, dumping syndrome 15%-75% (median 46%), dysphagia 11%-38% (median 27%), early satiety 40%-90% (median 65%) and reflux 19%-61% (median 29%). Conclusion: Patients should resume oral intake as soon as possible after surgery. In hospital, all forms of enteral access appear to be safe. Out of hospital, the ability to provide home feeding by feeding jejunostomy is likely where meaningful nutritional improvements can be made. Improving nutrition and related quality of life in the early months might improve the long-term outcome.

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“…Several studies have reported experience with oesophageal resection [12][13][14][15][16] and gastric resection [17][18][19][20][21] but reports of a unit's experience with both are rarer. 22 Laparoscopic surgery was undertaken in some studies [19][20][21] whereas others examined open surgery only. 12,[14][15][16][17] Variations in perioperative management included use of epidural analgesia, 12,13,15,17,20,23 the role of jejunal feeding [12][13][14]16 with most opting for early enteral feeding [12][13][14][15][16] and avoidance or early removal of drains.…”

Section: 11mentioning

confidence: 99%

“…12,[14][15][16][17] Variations in perioperative management included use of epidural analgesia, 12,13,15,17,20,23 the role of jejunal feeding [12][13][14]16 with most opting for early enteral feeding [12][13][14][15][16] and avoidance or early removal of drains. [12][13][14][15][16][17][18][19][20][21] Radiological contrast studies were undertaken in the majority of studies 12,14,15,19,22 although they were not used in all. [16][17][18] Complication rates varied, ranging from 7% to 45%.…”

Section: 11mentioning

confidence: 99%

Retrospective cohort study of an enhanced recovery programme in oesophageal and gastric cancer surgery

Gatenby

Shaw

Hine

et al. 2015

annals

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INTRODUCTION Enhanced recovery programmes have been established in some areas of elective surgery. This study applied enhanced recovery principles to elective oesophageal and gastric cancer surgery. METHODS An enhanced recovery programme for patients undergoing open oesophagogastrectomy, total and subtotal gastrectomy for oesophageal and gastric malignancy was designed. A retrospective cohort study compared length of stay on the critical care unit (CCU), total length of inpatient stay, rates of complications and in-hospital mortality prior to (35 patients) and following (27 patients) implementation. RESULTS In the cohort study, the median total length of stay was reduced by 3 days following oesophagogastrectomy and total gastrectomy. The median length of stay on the CCU remained the same for all patients. The rates of complications and mortality were the same. CONCLUSIONS The standardised protocol reduced the median overall length of stay but did not reduce CCU stay. Enhanced recovery principles can be applied to patients undergoing major oesophagogastrectomy and total gastrectomy as long as they have minimal or reversible co-morbidity. KEYWORDSGastric neoplasms -Oesophageal neoplasms -Surgical procedures -Perioperative careEnhanced recovery Accepted 24 January 2015 CORRESPONDENCE TO Piers Gatenby, E: p.gatenby@ucl.ac.uk Enhanced recovery after surgery (ERAS) or fast track programmes have been well established in elective surgery for colorectal resections and joint replacement.1-6 These programmes benefit patients, healthcare providers and those commissioning healthcare by providing earlier recovery with faster return to normal activity as well as improvement in quality of care, productivity, consistency and patient experience with innovative and efficient multidisciplinary practice. 7 The aim of this study was to examine the approach to and outcomes of the implementation of an ERAS programme in a group of patients admitted for open oesophageal and gastric resections for adenocarcinoma under a single upper gastrointestinal surgeon at a tertiary referral centre. MethodsA retrospective audit was performed of the periods prior to (control group) and following (intervention group) the implementation of an ERAS pathway. The study was undertaken in a specialist cancer centre that serves a population of 1.6 million, receiving over 350 new oesophagogastric referrals, and performing approximately 75 oesophageal and gastric resections annually. All patients involved in the study were under the care of a single oesophagogastric surgeon (WHA). The control cohort consisted of all patients undergoing surgery between 1 January and 31 December 2009. The intervention was then implemented over a three-month period and the intervention cohort comprised all patients from 1 April 2010 to 31 March 2011. Demographic data on age and sex, and use of preoperative chemotherapy were recorded.Following the introduction of the intervention, all patients who were fit enough for surgery proceeded along the ERAS pathway as the default...

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Prospective multicentre randomised controlled trial of early enteral nutrition for patients undergoing major upper gastrointestinal surgical resection

Cited by 151 publications

References 25 publications

Oesophageal cancer

Oesophageal cancer

Nutritional support and dietary interventions following esophagectomy: challenges and solutions

Retrospective cohort study of an enhanced recovery programme in oesophageal and gastric cancer surgery

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