Compared With a Nasointestinal Route, Pre-operative Enteral Nutrition via a Nasogastric Tube Reduced the Incidence of Acalculous Acute Cholecystitis After Definitive Surgery for Small Intestinal Fistula

Zheng Yao,Xin Xu,Weiliang Tian,Yunzhao Zhao,Risheng Zhao

doi:10.3389/fmed.2021.721402

Abstract

Purpose: This study aimed to investigate the difference in the efficacy of pre-operative enteral nutrition (EN) via a nasogastric tube (NGT) and pre-operative EN via a nasointestinal tube (NIT) in reducing the incidence of post-operative acalculous acute cholecystitis (AAC) after definitive surgery (DS) for small intestinal fistulas.Methods: Patients with a small intestinal fistula, who had a DS for the disease between January 2015 and March 2021, were enrolled in this study. They were divided into the NIT group and the NGT group based on the pre-operative routes of feeding they received. The clinical characteristics of the two groups were analyzed, and the incidences of post-operative AAC in the two groups were evaluated.Results: A total of 200 patients were enrolled in the study, 85 in the NGT group and 115 in the NIT group. Thirty-one patients developed post-operative AAC (8 in the NGT group and 23 in the NIT group). The incidence of post-operative AAC was 15.5%. EN via the NGT route was associated with a reduction in the incidence of post-operative AAC (adjusted HR = 0.359; 95% CI: 0.139–0.931; P = 0.035).Conclusion: Pre-operative EN via the NGT may reduce the incidence of post-operative AAC in patients who received a DS for small intestinal fistulas.

Highlights

Acute acalculous cholecystitis (AAC) is defined as an acute inflammation of the gallbladder without gallstones
This study retrospectively investigated the post-operative characteristics of patients receiving a definitive surgery (DS) for the small intestinal fistula
The nasogastric tube (NGT) group had a shorter distance from the Treitz ligament to the fistula, and a shorter total length of the small intestine than the nasointestinal tube (NIT) group did (Table 1)

Summary

Introduction

Acute acalculous cholecystitis (AAC) is defined as an acute inflammation of the gallbladder without gallstones. Comparing to the incidence of AAC in non-critically ill patients, the incidence of AAC is higher in critically ill patients [1, 2]. AAC is associated with high patient morbidity and mortality. The mortality rate is up to 50% [3,4,5]. The potential risk factors of AAC are major surgery or trauma [6], burns [7], sepsis [8], and the administration of total parenteral nutrition [9]. Bile stasis and gallbladder wall ischemia are the two possible pathophysiological processes leading to AAC [10]

Objectives

Results

Conclusion