Nasoenteric Tube Research Articles

The usefulness of a pectoralis major myocutaneous flap in preventing salivary fistulae after salvage total laryngectomy

Salvage laryngectomy in patients treated with organ preservation protocols is associated with high rates of postoperative complications. The use of non-irradiated tissue flaps in pharyngeal reconstruction could reduce the incidence of these complications.Objective: This study aims to evaluate the usefulness of the pectoralis major myocutaneous flap in preventing salivary fistulae during the postoperative period of salvage total laryngectomy (TL).Materials and Method: This retrospective study enrolled 31 patients operated between April of 2006 and May of 2011. All patients had advanced cancer at the time of the salvage procedure and had been treated with chemoradiotherapy or radiotherapy alone. Pharyngeal reconstruction was performed using pectoralis major myocutaneous flap in 19 cases (61%); primary wound closure occurred in 12 patients (39%).Results: Salivary fistulae occurred in 16% of the patients who received the flap and in 58% of the patients with primary closure of the pharynx (p < 0.02). No statistically significant differences were noted between the groups with respect to the mean time for fistula formation, reintroduction of an oral diet, or use of a nasoenteric tube for feeding.Conclusion: The pectoralis major myocutaneous flap was found to reduce the incidence of salivary fistulae in salvage laryngectomy procedures.

Complicated adult right-sided Bochdalek hernia with Chilaiditi's syndrome: a case report.

An extremely rare adult case that underwent surgery for ileus caused by Bochdalek hernia associated with Chilaiditi’s syndrome is presented. A 65-year-old woman complaining of upper abdominal pain presented to our hospital. Abdominal plain radiography showed increased intestinal gas, and computed tomography (CT) showed the transverse colon located above the right lobe of the liver, representing Chilaiditi’s sign. She was diagnosed as having ileus and treated with decompression therapy by a nasoenteric tube. After hospitalization, the patient developed dyspnea, and CT showed intestinal herniation into the right thoracic cavity. She was diagnosed as having strangulated ileus caused by Bochdalek hernia. An emergent laparotomy was performed, and it showed a hole of 5 cm in diameter at the right hemi-diaphragm. The transverse colon was incarcerated through the hole, it was pulled back to the abdominal cavity, and a right hemicolectomy was performed because of necrotic changes. A small part of the liver was also herniated into the right thoracic cavity, and it was returned to the abdominal cavity. The defect in the diaphragm was closed by direct suture. Although the patient developed an abscess in the thoracic cavity postoperatively, she improved with antibiotic therapy and was discharged 2 months after the operation.

Profile, recommendation criteria, and outcome of gastrostomy tube insertions in a pediatric teaching hospital

Objective: To describe the profile of patients undergoing a gastrostomy, the recommendations and outcome of this insertion in a Pediatric Teaching Hospital. Method: This was a retrospective, quantitative, and descriptive study that researched the records of patients who underwent a gastrostomy between January 2010 and December 2012. Results: The diseases and conditions most frequent were chronic infantile encephalopathy (77.5%), pneumonia (67.5%), seizures (57.5%), and malnutrition (42.5%). Although most patients presented a history of dysphagia (62.5%), oral feeding was observed most frequently as the most common form of nutrition, before the gastrostomy insertion (42.5%), followed by nasoenteric tube (40%). The introduction of nutrition by gastrostomy was successful and occurred an average of 2.82 (± 1.19) days after insertion. Six months after their gastrostomy, 80% of patients continued feeding only through this access tube and only 2.5% had removed the gastrostomy; 45% of the participants had gastrostomy complications, with extravasation of gastric material (15%) and local inflammation (15%) being the most frequent. Conclusion: The profile of patients undergoing gastrostomy is mostly of individuals with neurological and respiratory diseases, without respiratory support, of the male gender, and feeding by oral cavity or nasoenteric tube for a prolonged period. The main recommendation criteria were dysphagia and neurological diseases. Regarding the outcome, the introduction of nutrition by gastrostomy was successful; most individuals remained with this long-term nutritional support and the most common complications were gastric material extravasation and local inflammations

Acute pancreatitis.

To summarize recent data on classification systems, cause, risk factors, severity prediction, nutrition, and drug treatment of acute pancreatitis. Comparison of the Revised Atlanta Classification and Determinant Based Classification has shown heterogeneous results. Simvastatin has a protective effect against acute pancreatitis. Young black male, alcohol, smoldering symptoms, and subsequent diagnosis of chronic pancreatitis are risk factors associated with readmissions after acute pancreatitis. A reliable clinical or laboratory marker or a scoring system to predict severity is lacking. The PYTHON trial has shown that oral feeding with on demand nasoenteric tube feeding after 72 h is as good as nasoenteric tube feeding within 24 h in preventing infections in predicted severe acute pancreatitis. Male sex, multiple organ failure, extent of pancreatic necrosis, and heterogeneous collection are factors associated with failure of percutaneous drainage of pancreatic collections. The newly proposed classification systems of acute pancreatitis need to be evaluated more critically. New biomarkers are needed for severity prediction. Further well designed studies are required to assess the type of enteral nutritional formulations for acute pancreatitis. The optimal minimally invasive method or combination to debride the necrotic collections is evolving. There is a great need for a drug to treat the disease early on to prevent morbidity and mortality.

Electromagnetic Sensor-Guided Enteral Access Systems: A Literature Review.

Enteral feeding is the nutritional support of choice for acutely ill patients with functional gastrointestinal tracts who are unable to swallow. Several benefits including reduced mortality and length of hospital stay have been associated with early initiation of enteral feeding. However, misplacement of conventional nasoenteric tubes is relatively common and can result in complications including pneumothorax. In addition, the need to confirm the position by X-ray can delay the start of using the tube. Eliminating these delays can help patients start feeding, and minimise the adverse impact on initiating hydration and medication. The purpose of this review was to critically examine whether electromagnetic sensor-guided enteral access systems (EMS-EAS) can help overcome the challenges of conventional nasoenteric feeding tube placement and confirmation. The Royal Society of Medicine’s library performed two searches on Medline (1946–March 2014) and Embase (1947–March 2014) covering all papers on Cortrak or electromagnetic or magnetic guidance systems for feeding tubes in adults. Results from the literature search found an agreement between the radiographic and EMS-EAS confirmation of placement. EMS-EAS virtually eliminated the risk of misplacement and pneumothorax was not reported. In addition, studies showed a small decrease in the number of X-rays with EMS-EAS and a reduced average time to start feeding compared with blind placement. This review suggests that EMS-EAS reduces several complications associated with the misplacement of nasoenteric feeding tubes, and that there could be considerable improvements in mortality, morbidity, patient experience and cost if EMS-EAS is used instead of conventional methods.

Naso‐enteric Tube Placement: A Review of Methods to Confirm Tip Location, Global Applicability and Requirements

The insertion of a tube through the nose and into the stomach or beyond is a common clinical procedure for feeding and decompression. The safety, accuracy and reliability of tube insertion and methods used to confirm the location of the naso-enteric tube (NET) tip have not been systematically reviewed. The aim of this study is to review and compare these methods and determine their global applicability by end-user engagement. A systematic literature review of four major databases was performed to identify all relevant studies. The methods for NET tip localization were then compared for their accuracy with reference to a gold standard method (radiography or endoscopy). The global applicability of the different methods was analysed using a house of quality matrix. After applying the inclusion and exclusion criteria, 76 articles were selected. Limitations were found to be associated with the 20 different methods described for NET tip localization. The method with the best combined sensitivity and specificity (where n > 1) was ultrasound/sonography, followed by external magnetic guidance, electromagnetic methods and then capnography/capnometry. The top three performance criteria that were considered most important for global applicability were cost per tube/disposable, success rate and cost for non-disposable components. There is no ideal method for confirming NET tip localisation. While radiography (the gold standard used for comparison) and ultrasound were the most accurate methods, they are costly and not universally available. There remains the need to develop a low-cost, easy-use, accurate and reliable method for NET tip localization.

Electromagnetic guided bedside or endoscopic placement of nasoenteral feeding tubes in surgical patients (CORE trial): study protocol for a randomized controlled trial.

BackgroundGastroparesis is common in surgical patients and frequently leads to the need for enteral tube feeding. Nasoenteral feeding tubes are usually placed endoscopically by gastroenterologists, but this procedure is relatively cumbersome for patients and labor-intensive for hospital staff. Electromagnetic (EM) guided bedside placement of nasoenteral feeding tubes by nurses may reduce patient discomfort, workload and costs, but randomized studies are lacking, especially in surgical patients. We hypothesize that EM guided bedside placement of nasoenteral feeding tubes is at least as effective as endoscopic placement in surgical patients, at lower costs.Methods/DesignThe CORE trial is an investigator-initiated, parallel-group, pragmatic, multicenter randomized controlled non-inferiority trial. A total of 154 patients admitted to gastrointestinal surgical wards in five hospitals, requiring nasoenteral feeding, will be randomly allocated to undergo EM guided or endoscopic nasoenteral feeding tube placement. Primary outcome is reinsertion of the feeding tube, defined as the insertion of an endoscope or tube in the nose/mouth and esophagus for (re)placement of the feeding tube (e.g. after failed initial placement or dislodgement or blockage of the tube). Secondary outcomes include patient-reported outcomes, costs and tube (placement) related complications.DiscussionThe CORE trial is designed to generate evidence on the effectiveness of EM guided placement of nasoenteral feeding tubes in surgical patients and the impact on costs as compared to endoscopic placement. The trial potentially offers a strong argument for wider implementation of this technique as method of choice for placement of nasoenteral feeding tubes.Trial registrationDutch Trial Register: NTR4420, date registered 5-feb-2014Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0633-1) contains supplementary material, which is available to authorized users.

How to manage indwelling feeding tubes in critically ill dogs and cats

Introduction Although not many veterinary research articles are available to prove the benefits of enteral nutrition in critically ill veterinary patients, it is widely accepted that providing nutrition improves outcome in these patients. In many cases patients do not voluntarily consume adequate levels of energy and feeding tubes are used to facilitate feeding. These include naso-enteric tubes, oesophagostomy tubes, gastrostomy tubes and jejunostomy tubes. This article gives a brief overview of the practical use and management of enteral feeding tubes and the technique for placement of naso-enteric tubes.

Metoclopramide for post-pyloric placement of naso-enteral feeding tubes.

Enteral nutrition by feeding tube is a common and efficient method of providing nutritional support to prevent malnutrition in hospitalised patients who have adequate gastrointestinal function but who are unable to eat. Gastric feeding may be associated with higher rates of food aspiration and pneumonia than post-pyloric naso-enteral tubes. Thus, enteral feeding tubes are placed directly into the small intestine rather than the stomach, and the use of metoclopramide, a prokinetic agent, has been recommended to achieve post-pyloric placement, but its efficacy is controversial. Moreover, metoclopramide may include adverse reactions, which with high doses or prolonged use may be serious and irreversible. To determine the effect of intravenous metoclopramide on post-pyloric placement of the naso-enteral tube in adults. Trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 10) which includes the CUGPD group's specialised register of trials, MEDLINE (1996 to 21 October 2014), EMBASE (1988 to 21 October 2014), LILACS (2005 to 21 October 2014) We did not confine our search to English language publications. Searches in all databases were updated originally in January 2005, then in November 2008 and again in October 2014. No new studies were found in 2008 or in 2014. We selected randomised controlled trials of adults needing enteral nutrition, who received intravenous or intramuscular metoclopramide to aid placement of transpyloric naso-enteral feeding tubes, compared to placebo or no intervention. We used standard methodological procedures expected by The Cochrane Collaboration. All analyses were performed according to the intention-to-treat method. We present risk ratios (RR) with 95% confidence intervals (CI). Four studies, with a total of 204 participants were included and analysed. The trials compared metoclopramide with placebo (two trials) or with no intervention (two trials). Metoclopramide was investigated at doses of 10 mg (two trials) and 20 mg (two trials). There was no statistically significant difference between metoclopramide versus placebo or no intervention administered to promote tube placement (RR 0.82, 95% CI 0.61 to 1.10). Metoclopramide at doses of 10 mg (RR 0.82, 95% CI 0.60 to 1.11) and 20 mg (RR 0.62, 95% CI 0.15 to 2.62) were equally ineffective in facilitating post-pyloric intubation when compared with placebo or no intervention. In this review, we found only four studies that fitted our inclusion criteria. These were small, underpowered studies, in which metoclopramide was given at doses of 10 mg and 20 mg. Our analysis showed that metoclopramide did not assist post-pyloric placement of naso-enteral feeding tubes.Ideally randomised clinical trials should be performed that have a significant sample size, administering metoclopramide against control, however, given the lack of efficacy revealed by this review it is unlikely that further studies will be performed.

Early enteral feeding by naso-enteric tube in patients with perforation peritonitis

Background: This study was conducted to assess the feasibility, benefits and complications of early naso-enteral feeding in a patient undergone laparotomy for perforation peritonitis. Methods: This is a randomized prospective study of one year duration. Patients were randomly put into Test Group (TG) and Control Group (CG). In test group naso-enteric tube was placed intra-operatively by nasal route and advances to duodenum or jejunum. This tube was used for feeding. Another ryles tube was also placed through other nostril in stomach (naso-gastric) for decompression. In post-operative period test group was started early enteral feeding (24 hours after surgery) via naso-enteral tube placed intra-operatively. Control group patients were managed with the conventional regimen of intravenous fluid administration and started oral feed once they passed flatus. The groups were compared for incidence of complications, biochemical measurements, nutritional status, duration of hospital stay and mortality. Results: Thirty-seven (80.43%) patients well tolerated early naso-enteral feeding. In test group average time for appearance of bowel sounds, passage of flatus and passage of motion was 2.28 ± 0.68 days, 2.78 ± 0.59 days and 3.52 ± 0.69 days respectively while in control group it was 2.73 ± 1.06 days, 3.30 ± 1.40 days and 4.18 ± 1.74 days respectively. The difference was significant between two groups (P <0.05). In our study, three (6.5%) patients had wound infection in test group while it is six (13.63%) in control group. Average hospital stay in test group was 8.54 ± 2.91 days while it was11.10 ± 3.40 days in control group (P <0.05). Average Ryles tube aspirate was significantly lower in post-operative days in test group patients as compared to control group (P <0.05). Average protein and calorie intake post-operatively was comparatively higher in test group as compare to control group patients and was found significant (P <0.05). Conclusions: Early post-operative naso-enteral feeding (24 hours after surgery) after laparotomy for perforation peritonitis is well tolerated, safe, effective in decreases septicemic and other complications and improved wound healing, leading to shorter hospital stay and beneficial to patients.

Role of ultrasonography in detection of the localization of the nasoenteric tube

In this study, we aimed to determine the success rate of nasoenteric tube (NET) insertion into the postpyloric area by ultrasonography (USG) and compare it with the commonly used method, direct abdominal radiography.

Nutrition in Acute Pancreatitis: Have We Come Full Circle?

Current guidelines recommend early use of a nasoenteric tube with polymeric or semi-elemental formulas as the standard of care in patients with acute pancreatitis that is predicted to be severe (Am J Gastroenterol 2013; 108:1400). The early use of enteral nutrition has been considered important to stabilize the gut mucosal barrier and prevent bacterial translocation, thus reducing the risk for serious infections and death. …

Early versus On-Demand Nasoenteric Tube Feeding in Acute Pancreatitis

BackgroundEarly enteral feeding through a nasoenteric feeding tube is often used in patients with severe acute pancreatitis to prevent gut-derived infections, but evidence to support this strategy is limited. We conducted a multicenter, randomized trial comparing early nasoenteric tube feeding with an oral diet at 72 hours after presentation to the emergency department in patients with acute pancreatitis.MethodsWe enrolled patients with acute pancreatitis who were at high risk for complications on the basis of an Acute Physiology and Chronic Health Evaluation II score of 8 or higher (on a scale of 0 to 71, with higher scores indicating more severe disease), an Imrie or modified Glasgow score of 3 or higher (on a scale of 0 to 8, with higher scores indicating more severe disease), or a serum C-reactive protein level of more than 150 mg per liter. Patients were randomly assigned to nasoenteric tube feeding within 24 hours after randomization (early group) or to an oral diet initiated 72 hours after presentation (on-demand group), with tube feeding provided if the oral diet was not tolerated. The primary end point was a composite of major infection (infected pancreatic necrosis, bacteremia, or pneumonia) or death during 6 months of follow-up.ResultsA total of 208 patients were enrolled at 19 Dutch hospitals. The primary end point occurred in 30 of 101 patients (30%) in the early group and in 28 of 104 (27%) in the on-demand group (risk ratio, 1.07; 95% confidence interval, 0.79 to 1.44; P=0.76). There were no significant differences between the early group and the on-demand group in the rate of major infection (25% and 26%, respectively; P=0.87) or death (11% and 7%, respectively; P=0.33). In the on-demand group, 72 patients (69%) tolerated an oral diet and did not require tube feeding.ConclusionsThis trial did not show the superiority of early nasoenteric tube feeding, as compared with an oral diet after 72 hours, in reducing the rate of infection or death in patients with acute pancreatitis at high risk for complications. (Funded by the Netherlands Organization for Health Research and Development and others; PYTHON Current Controlled Trials number, ISRCTN18170985.)

Risk factors for ventilator-associated pneumonia in infants and children: a cross-sectional cohort study.

The epidemiology of ventilator-associated pneumonia is well described for adults, but little information is available on risk factors for this disease in children. To identify predisposing factors for ventilator-associated pneumonia in children. A cross-sectional prospective cohort study of 96 patients in a 9-bed pediatric intensive care unit was performed. Variables examined were demographic characteristics, inpatient care, medications, nutrition, invasive procedures, and characteristics of mechanical ventilation. Data were analyzed by using Pearson χ(2) analysis, Fisher exact and Mann-Whitney tests, odds ratios, and forward stepwise logistic regression. Occurrence of ventilator-associated pneumonia correlated positively with use of nasoenteral tubes (odds ratio, 5.278; P < .001), intermittent administration of nutritional formula (odds ratio, 6.632; P = .005), emergency reintubation (odds ratio, 2.700; P = .02), use of vasoactive drugs (odds ratio, 5.108; P = .009), duration of mechanical ventilation (P < .001), and length of stay in the pediatric intensive care unit (P < .001) and in the hospital (P = .01). Use of vasoactive drugs, presence of a nasoenteral tube, and duration of stay in the pediatric intensive care unit were independent risk factors for ventilator-associated pneumonia.

Early Nasoenteral Tube (NET) is Associated With Higher Mortality Compared to Early PEG Tube in Stroke Patients Admitted With Dysphagia in the United States

Introduction: A recent Cochrane review concluded that survival may be better if feeding is started early in stroke patients admitted with dysphagia and that there is no clear advantage of PEG over NET. Our aim is to use the nationwide inpatient sample (NIS) database to compare the hospital outcomes of early NET vs. early PEG tube among stroke patients with dysphagia. Methods: NIS database was queried for the time period 2007-2011 using the ICD-9-CM coding system for adult (≥18 years) patients admitted with stroke and dysphagia who received either an NET or a PEG within one week of admission. Patients who had a NET followed by a PEG were excluded from the NET group. Patient factors included age, gender, race, type of insurance, Charlson comorbidity index and severity of illness (APRDRG). Hospital factors included teaching status, location, bed size, and region. The outcome measures included mortality, aspiration pneumonia, length of stay (LOS), and disposition to skilled facilities (skilled nursing facility, intermediate care, or other facilities excluding short term hospitals). Results: A total of 34,530 patients who were admitted with stroke and dysphagia had an early feeding tube. An early PEG was placed in 32,533 (94.22%) patients and an early NET in 1,997 (5.78%) patients. Univariate logistic regression analysis: the early NET cohort had higher odds of aspiration pneumonia (23.65% vs. 18.13%; p<0.005) and death (12.37% vs. 3.87%; p<0.0001) compared to early PEG cohort. The odds of being transferred to skilled facilities were higher in early PEG cohort (82.12% vs. 70.78%; p<0.0001) compared to early NET cohort. Multivariate analysis: controlling for significant variables revealed that the odds of death in patients with early NET were 3.72 times that of patients with early PEG (95% confidence interval [CI] 2.56-5.40). Moreover, in early PEG patients the odds of transfer to skilled facilities were 1.85 times those of early NET patients (95% CI 1.41-2.38). Conclusion: When compared to early PEG tube placement, early NET placement in stroke patients with dysphagia is associated with higher mortality. The significance of these results highlights the necessity for a large randomized controlled trial.

Enteral ecoimmunonutrition reduced enteral permeability and serum ghrelin activity in severe cerebral stroke patients with lung infection.

The study analyzed how enteral ecoimmunonutrition, which comprises probiotics, glutamine, fish oil, and Enteral Nutritional Suspension (TPF), can impact on the enteral permeability and serum Ghrelin activity in severe cerebral stroke patients with lung infection. Among 190 severe cerebral stroke patients with tolerance to TPF, they were randomized into control and treatment groups after antibiotics treatment due to lung infections. There were 92 patients in the control group and 98 patients in treatment group. The control group was treated with TPF and the treatment group was treated with enteral ecoimmunonutrition, which comprises probiotics, glutamine, fish oil, and Enteral Nutritional Suspension. All patients received continuous treatments through nasoenteral or nasogastric tubes. 7, 14, and 21 days after the treatments, the enteral tolerance to nutrition was observed in both groups. The tests included abdominal pain, bloating, diarrhea, and lactulose/mannitol (L/M) ratio. Serum Ghrelin levels were determined by ELISA. The incidence of abdominal pain, bloating, diarrhea was lower in the treatment group and enteral tolerance to nutrition was also superior to the control group. No difference in serum Ghrelin level was observed between the control and treatment groups with enteral intolerance to nutrition. However, in patients with enteral tolerance to nutrition, the treatment group showed lower enteral nutrition and lower enteral permeability compared to the control group. In severe cerebral stroke patients with lung infection, enteral ecoimmunonutrition after antibiotics treatment improved enteral tolerance to nutrition and reduced enteral permeability; meanwhile, it lowered the serum Ghrelin activity, which implied the high serum Ghrelin reduces enteral permeability.

Endoscopic Versus Bedside Electromagnetic-Guided Placement of Nasoenteral Feeding Tubes in Surgical Patients

BackgroundNasoenteral tube feeding is often required in surgical patients, mainly because of delayed gastric emptying. Bedside electromagnetic (EM)-guided tube placement by specialized nurses might offer several advantages (e.g., reduced patient discomfort and costs) over conventional endoscopic placement. The aim of this study was to compare the success rate of EM-guided to endoscopic placement of nasoenteral feeding tubes in surgical patients. Materials and MethodsA retrospective cohort study was performed in 267 adult patients admitted to two gastrointestinal surgical wards who received a nasoenteral feeding tube by EM-guidance or endoscopy. Eighteen patients were excluded because of insufficient data. Patients were categorized according to the primary tube placement method. Subgroup analysis was performed in patients with altered upper gastrointestinal anatomy. Primary endpoint was successful tube placement at or beyond the duodenojejunal flexure. ResultsA total of 249 patients were included, of which 90 patients underwent EM-guided and 159 patients underwent endoscopic tube placement. Both groups were comparable for baseline characteristics. Primary tube placement was successful in 74/90 patients (82 %) in the EM-guided group versus 140/159 patients (88 %) in the endoscopic group (P = 0.20). In patients with altered upper gastrointestinal anatomy, success rates were significantly lower in the EM-guided group (58 vs. 86 %, P = 0.004). There were no significant differences in tube-related complications such as dislodgement or tube blockage. ConclusionsBedside EM-guided placement of nasoenteral feeding tubes by specialized nurses did not differ from endoscopic placement by gastroenterologists regarding feasibility and safety in surgical patients with unaltered upper gastrointestinal anatomy.

Endoscopic approaches to enteral feeding and nutrition core curriculum

Endoscopic approaches to enteral feeding and nutrition core curriculum

Su1517 Nasal Bridles for Securing Nasoenteric Tubes: a Meta-Analysis

Nasoenteric feeding tubes are essential in patients requiring supplemental nutrition, especially in the intensive care units and situations where volitional intake is delayed. These tubes may easily become dislodged due to patient mental status, transfers, or positional changes. Traditionally, such tubes are secured in a haphazard fashion by taping the tube to the nose, forehead, and cheeks of the patient. Nasal bridles were introduced to provide a better, more reliable system to secure these tubes. This meta-analysis was performed to evaluate the effectiveness of nasal bridles in securing enteral feeding tubes and to determine if this newer strategy is better than the more commonly used alternative.

Duodéno-pancréatectomie céphalique : quelle prise en charge en postopératoire ?

Pancreaticoduodenectomy (PD) according to Whipple is a major surgical procedure which may result in exocrine pancreatic insufficiency (PI), both functional due to duodenectomy and organic due to pancreatic resection itself. These disorders may favor macronutrients maldigestion (carbohydrates, lipids, proteins) and malabsorption of micronutrients including vitamins A, D, E, K. These changes explain the persistent weight loss observed in 70–80% of patients after PD. Malnutrition and/or comorbidities may lead to early postoperative enteral nutrition via a jejunostomy or a nasoenteral tube allowing to recover a faster oral feeding and to reduce both the postoperative complications and the length of hospital stay. Pancreatic enzyme and vitamin D supplements should be routinely initiated. Long-term management should include a normal diet which may be fractioned in case of disabling functional signs. In case of chronic malnutrition, an oral nutritional supplementation should be considered, associated to/replaced by an overnight home enteral nutrition if necessary. Parenteral nutrition should not a priori be recommended. A clinical and biological nutritional long-term follow-up is further required in these patients.