Abstract
We examined gastric outlet obstruction (GOO) patients who received two weeks of strengthening pre-operative enteral nutrition therapy (pre-EN) through a nasal–jejenal feeding tube placed under a gastroscope to evaluate the feasibility and potential benefit of pre-EN compared to parenteral nutrition (PN). In this study, 68 patients confirmed to have GOO with upper-gastrointestinal contrast and who accepted the operation were randomized into an EN group and a PN group. The differences in nutritional status, immune function, post-operative complications, weight of patients, first bowel sound and first flatus time, pull tube time, length of hospital stay (LOH), and cost of hospitalization between pre-operation and post-operation were all recorded. Statistical analyses were performed using the chi square test and t-test; statistical significance was defined as p < 0.05. The success rate of the placement was 91.18% (three out of 31 cases). After pre-EN, the levels of weight, albumin (ALB), prealbumin (PA), and transferrin (TNF) in the EN group were significantly increased by pre-operation day compared to admission day, but were not significantly increased in the PN group; the weights in the EN group were significantly increased compared to the PN group by pre-operation day and day of discharge; total protein (TP), ALB, PA, and TNF of the EN group were significantly increased compared to the PN group on pre-operation and post-operative days one and three. The levels of CD3+, CD4+/CD8+, IgA, and IgM in the EN group were higher than those of the PN group at pre-operation and post-operation; the EN group had a significantly lower incidence of poor wound healing, peritoneal cavity infection, pneumonia, and a shorter first bowel sound time, first flatus time, and post-operation hospital stay than the PN group. Pre-EN through a nasal–jejunum feeding tube and placed under a gastroscope in GOO patients was safe, feasible, and beneficial to the nutrition status, immune function, and gastrointestinal function, and sped up recovery, while not increasing the cost of hospitalization.
Highlights
Gastric outlet obstruction (GOO) is a mechanical gastric emptying dysfunction which is mainly caused by a distal gastric cancer invasion helicobacter tube and scarring after gastroduodenal ulcer healing [1]
The inclusion and exclusion criteria were: (1) aged between 18 and 80; (2) the focal disease could be cured surgically; (3) patients had not received pre-operative radiation or chemotherapy treatments; (4) no serious liver, kidney, heart, or lung function insufficiencies in cases where patients could not tolerate surgery; (5) cases where surgery was refused were excluded; and (6) all patients were randomized into an enteral nutrition group (EN group) and a parenteral nutrition group (PN group)
Cases where the tube placement failed were included in the PN group, and the success rate of the placement was 91.18%
Summary
Gastric outlet obstruction (GOO) is a mechanical gastric emptying dysfunction which is mainly caused by a distal gastric cancer invasion helicobacter tube and scarring after gastroduodenal ulcer healing [1]. As the disease progresses, vomiting and abdominal distension are increasingly severe, and result in eating problems, which result in dystrophy, water and electrolyte balance disorders [3], and an increase in stomach edema and the degree of gastric outlet obstruction. Often, coupled with this are long-term nutrient consumption problems, caused by most types of gastric cancer; the vast majority of GOO patients have different degrees of malnutrition. Removal of the obstruction is the primary goal in the treatment of GOO patients, and the main method of treatment is surgery [4]. Edema of the stomach and malnutrition lead to a decrease in the immune system, Nutrients 2017, 9, 373; doi:10.3390/nu9040373 www.mdpi.com/journal/nutrients
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