Preoperative Enteral Nutrition Research Articles

P724 Long-term outcomes of exclusive enteral nutrition in the peri-operative period for Crohn’s disease: A seven year follow-up study

Abstract Background Exclusive enteral nutrition (EEN) is a recommended first-line treatment for Crohn’s disease flares in the paediatric population. Its use has yet to translate widely to the adult population. There is growing evidence for the use of EEN in the pre-operative setting to downstage the disease process and improve short term surgical outcomes. Little is known in this context regarding the long term effects of pre-operative EEN. Our study reports on follow up data for a cohort of patients who underwent surgery following pre-optimisation with EEN compared to those who did not. We assessed long term complications, disease recurrence and disease control as our key outcomes. Methods We carried out a seven year follow up study of the patients included in a retrospective, matched cohort trial conducted in a single, tertiary care, inflammatory bowel disease centre, in the UK. Patients pre- optimised with EEN prior to surgery were compared to a matched control cohort. Results Median follow up period was seven and six years for EEN and control groups respectively. Patients in the EEN group were more likely to be on maintenance medical therapy compared to control (73.47% vs 46.67%, p=0.005), however, admission rates and clinical recurrence rates were similar between groups (32.65% vs 24.66%, p=0.33 and 71.43% vs 65.58%, p=0.42). There was a moderate difference in complication rates beyond six months in favour of the EEN group (5.55% vs 17.80%, p=0.08). EEN patients were more likely to need further surgery however, this observation was not sustained when surgery for peri-anal disease was excluded (22.45% vs 13.69%, p=0.21) Conclusion Pre-optimising patients with EEN prior to Crohn’s disease surgery may improve short term surgical outcomes, it is unlikely to improve long term disease outcomes, based on results from this study.

High risk of necrotising enterocolitis in term-born neonates with CHD delivered by caesarean section: a case-control study.

Necrotising enterocolitis is linked with altered intestinal microbiota, and caesarean birth is associated with imbalance of newborn intestinal microbiome. We aimed to investigate the role of delivery mode (vaginal or caesarean) and gestational age in the development of necrotising enterocolitis among term-born neonates (≥ 37 weeks) with CHD. Case-control study. We studied all newborns with CHD who underwent cardiac surgery during the neonatal (≤ 28 days of age) period, between 2007 and 2017. Totally, 60 cases of necrotising enterocolitis were matched (by year of birth and type of congenital heart lesion) with 180 controls (1:3 ratio). Multivariable conditional logistic regression was used to assess the study question. The overall prevalence of necrotising enterocolitis was 6.3% in term-born newborns with CHD. Neonates with a left-ventricular outflow tract lesion or single ventricle lesion accounted for 55% (n = 33) of cases. 62% (n = 37) cases were in the modified Bell's stage 2 or more for necrotising enterocolitis classification. In multivariable modelling, gestational age at birth was not associated with the development of necrotising enterocolitis [adjusted odds ratio per week increase, 95% confidence interval: 1.20 (0.90-1.60)]. Birth by caesarean delivery (compared to vaginal) was strongly associated with development of necrotising enterocolitis [adjusted odds ratio (95% confidence interval): 2.64 (1.31-5.29)]. We failed to identify an association between preoperative enteral nutrition and necrotising enterocolitis. This study showed a high risk of necrotising enterocolitis in newborns with critical CHD born via caesarean. This information is important given the high prevalence of planned birth by caesarean in newborns with CHD.

DOP89 Impact of biologics on the risk of early postoperative complications in Crohn’s disease: a French nationwide study

Abstract Background While the effect of anti-TNFs on postoperative outcomes in patients with Crohn’s disease (CD) has been widely studied, the impact of vedolizumab and ustekinumab on the risk of postoperative complications remains poorly known. Methods All consecutive patients who underwent intestinal resection for CD between July 2014 and April 2022 within 22 French centers were included in a retrospective cohort. The risk of early post-operative complications (≤30days) in patients exposed to biologics was compared to patients not exposed by logistic regression and propensity score-matched analysis adjusted for age, previous intestinal resection, corticosteroids or immunosuppressants exposure, disease activity, presence of abscess, urgent surgery and initial stoma (preoperative contra-indication to anastomosis). Results Among the 1201 patients included, respectively 491 (41%), 76 (6.3%) and 57 (4.7%) were exposed to anti-TNFs, ustekinumab, or vedolizumab within six months before surgery. A total of 317 (26.4%) patients had at least one complication of which 123 (38%) were considered as severe (DINDO III/IV). New surgery was necessary in 69 (5.7%) patients and secondary stoma in 23 (1.9%). Three deaths were observed (0.25%). The rates of overall complications in patients not exposed to biologics, exposed to anti-TNFs, ustekinumab or vedolizumab were respectively 26.1%, 25.1%, 34.7% and 29.8%. The risks of intra-abdominal infectious complications in these four groups were respectively 13.5%, 11.1%, 13.3% and 8.8%. In multivariate analysis, age [OR, 1.02 (1.01-1.04); p=0.004], disease activity [OR, 8.36 (1.79 – 149); p=0.037], the presence of an abscess [OR, 2.01 (1.25-3.20); p=0.004] and initial stoma [OR, 1.70 (1.10 –2.61); p=0.016] were significantly associated with intra-abdominal infectious complications. Conversely, preoperative enteral nutrition [OR, 0.12 (0.01 -0.59); p=0.040] was associated with a reduction in this risk. Exposure to anti-TNFs [OR, 0.80 (0.51-1.24); p=0.31], ustekinumab [OR, 1.17 (0.39-3.51); p=0.78] and vedolizumab [OR, 1.28 (0.32-5.17); p=0.72] within the 3 months before surgery were not associated with the risk of intra-abdominal infectious complications. Similar results were observed in patients exposed to these treatments in the month before surgery. Conclusion In this large cohort, a quarter of patients operated on for CD presented an early postoperative complication and 10% a severe complication. Preoperative exposure to anti-TNFs, vedolizumab or ustekinumab was not associated with an increased risk of early postoperative complications. Preoperative enteral nutrition was associated with a reduced risk of intra-abdominal infectious complication.

Role of perioperative nutritional status and enteral nutrition in predicting and preventing post-operative complications in patients with Crohn's disease.

Perioperative immune-nutritional status is correlated with post-operative outcomes. This study aimed to evaluate whether pre-operative nutritional status could predict post-operative complications in patients with Crohn's disease (CD) and whether pre-operative enteral nutrition (EN) can prevent post-operative complications. This retrospective cohort study analyzed the electronic health records of 173 patients diagnosed with CD in Ruijin Hospital, Shanghai, China, between August 2015 and May 2021: 122 patients had pre-operative nutritional support while 51 patients underwent surgery without pre-operative nutritional support. The pre-operative nutritional status, disease activity index, disease-related data, frequency of multiple surgery, operative data, and post-operative characters in each group were compared to determine whether the nutritional support and status could significantly affect post-operative outcome. One-to-one propensity score matching (PSM) was performed to limit demographic inequalities between the two groups. After PSM, no statistically significant differences were found in pre-operative patient basic characteristics between the two groups of 47 patients (98 patients in all) included in this study. Overall, 21 patients developed 26 post-operative complications. In terms of pre-operative nutritional status, the level of serum albumin (ALB), pre-albumin (pre-ALB), and hemoglobin (Hb) in the nutrition group were statistically higher than that in the control group. We also observed a statistically significant decrease in post-operative complications, need for emergency surgery, and staged operations, while the rate of laparoscopic surgery was higher in the nutrition group compared to the non-nutritional group. Post-operative complications were related to pre-operative nutritional condition, which indicated that EN may improve the nutritional status and reduced the rate of post-operative complications. Pre-operative nutritional status is correlated with post-operative outcomes while EN plays a positive role in preventing the post-operative complications. EN is useful for improving the pre-operative nutritional status and reducing the post-operative adverse events for CD patients undergoing surgery.

Nutritional care in patients undergoing laparoscopic/minimally invasive surgeries for gastrointestinal tumours.

The introduction of minimally invasive surgeries for gastrointestinal tumours has been associated with many favourable postoperative outcomes and a reduced impact on nutritional status. The literature review begins by discussing the impact of minimally invasive procedures on the nutritional status of patients with gastrointestinal tumours, followed by indications for enteral nutrition (EN) in this population, including preoperative nutritional support and postoperative nutritional support. The review then examines the evidence that favours the use of EN in this population, including studies demonstrating improved outcomes with preoperative EN and reduced postoperative complications with postoperative EN. It also discusses potential strategies for improving outcomes with EN, such as early initiation of feeding and individualized nutrition plans. Overall, current evidence shows that EN improves outcomes, reduces complications, and enhances the quality of life. However, the optimal timing, composition of EN, and long-term outcomes are still unclear, indicating the need for future investigations.

Poor preoperative enteral nutrition would be a risk factor for readmission due to infection after liver transplantation

Poor preoperative enteral nutrition would be a risk factor for readmission due to infection after liver transplantation

Increased Rate of Serum Prealbumin Level after Preoperative Enteral Nutrition as an Indicator of Morbidity in Gastrectomy for Gastric Cancer with Outlet Obstruction.

Preoperative malnutrition is believed to contribute to increased postoperative complications. Preoperative serum prealbumin level was reported to be a predictor of nutritional status and postoperative complications after gastrointestinal surgery, including gastrectomy. Gastric outlet obstruction caused by gastric cancer leads to insufficient nutritional status. However, the impact of preoperative enteral nutrition using naso-jejunal feeding tubes for patients with gastric outlet obstruction is not fully understood. From July 2010 to June 2020, 50 patients with gastric cancer-induced outlet obstruction who underwent gastrectomy following preoperative enteral nutrition via feeding tube were included. We investigated the relationship between changes in nutritional status after preoperative enteral nutrition and postoperative complications. Postoperative complications were defined as grade ≥II based on the Clavien-Dindo classification. The median period of preoperative enteral nutrition was 10days. The median increase rate of the serum prealbumin level was 10.5% (interquartile range, 0.63-38.2%), and patients with an increase rate ≥ 10% were defined as the elevated group. Postoperative morbidity was significantly higher in the non-elevated group (P = 0.0031). Univariate and multivariate analyses showed that an increased rate of the serum prealbumin level was an independent risk factor of postoperative complications for patients with gastric outlet obstruction caused by gastric cancer (P = 0.0025 and P = 0.009, respectively). Preoperative enteral nutrition improved the serum prealbumin level of patients with gastric cancer-induced outlet obstruction, and an increased rate of prealbumin can be an indicator of sufficient preoperative enteral nutrition and decreased postoperative morbidity.

Preoperative Elemental Diet before Laparoscopic Anterior Resection in Patients with Advanced Stenotic Rectal Cancer.

Objectives: To evaluate the feasibility of our new preoperative enteral nutrition protocol using ElentalⓇ without mechanical bowel preparation (MBP) before laparoscopic anterior resection (LAR) in patients with advanced stenotic rectal cancer. Methods: Among 74 patients with advanced rectal cancer (clinical stages T3 and T4) scheduled to undergo LAR, 42 patients with stenotic rectal cancer were administered ElentalⓇ (900 kcal/day) without MBP before LAR (group S). Thirty-two patients without stenosis (group NS) did not receive preoperative nutritional support but underwent MBP. Results: Group S patients were maintained in a fasting state and received an elemental diet approximately 10 days preoperatively without severe adverse effects. The incidence of postoperative complications (Clavien-Dindo classification ≥ grade 2) was significantly lower in group S than that in group NS (adjusted odds ratio [OR]: 6.046, P = 0.008). Logistic regression analysis revealed that group NS exhibited higher risks of developing postoperative complications than those exhibited by group S (OR: 4.32, 95% confidence interval [CI]: 1.28-17.28, P = 0.018). Among preoperative characteristics, the clinical tumor stage indicated a significant intergroup difference. Thus, the clinical stage was selected as a covariate and adjusted in the logistic regression model to calculate a covariate-adjusted OR. Group NS exhibited a higher incidence of postoperative complications than group S (adjusted OR: 6.05, 95% CI: 1.58-28.35, P = 0.008). Conclusions: Administration of an elemental diet using ElentalⓇ without MBP before LAR is a feasible strategy in patients with advanced stenotic rectal cancer. Application of this research may encourage use of ElentalⓇ in the clinical setting.

Usefulness of semi-solid medical foods administered after percutaneous endoscopic gastrostomy

Background: Even if preoperative enteral nutrition is administered without any issues, some patients suffer from gastrointestinal symptoms (e.g., vomiting and diarrhea) after initiating gastrostomy feeding. Because of the amino acid composition and limited amount of lipids, elemental diets may reduce the risk of gastrointestinal symptoms. However, elemental diets are expensive. Semi-solid medical foods are inexpensive and more closely mimic normal physiology than elemental diets. The aim of the present study was to investigate the usefulness of semi-solid medical foods when administered after percutaneous endoscopic gastrostomy (PEG).Method: This retrospective study analyzed 91 patients who had PEG performed by the author who was the attending physician. All patients received preoperative enteral nutrition with liquid nutrients, and there were no instances of gastrointestinal symptoms before PEG tube placement. The types of nutrients administered after PEG were divided into three categories: semi-solid medical foods (n = 20), polymeric formulas (n = 26), and elemental diets (n = 45). The incidence of gastrointestinal symptoms was compared among the three groups.Results: No gastrointestinal symptoms occurred in the semi-solid medical foods group; the incidence of gastrointestinal symptoms in the semi-solid medical foods group was significantly lower than that of the polymeric formulas group [0% vs. 26.9% (7/26), p 0.05] and was similar to that of the elemental diets group [0% vs. 2.2% (1/45), p = 1].Conclusion: If preoperative enteral nutrition is administered without any issues, semi-solid medical foods are useful as nutrients administered after PEG tube placement.

Review of exclusive enteral therapy in adult Crohn’s disease

BackgroundExclusive enteral nutrition (EEN) is a potentially effective but underused therapy for Crohn’s disease (CD) in adults. It is first-line induction treatment for paediatric patients but remains a second-line or...

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

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.

Effects of different preoperative enteral nutrition feeding routes on the duration of gastrointestinal decompression after definitive surgery for small intestinal fistula.

The purpose of this study is to investigate the effects of different preoperative enteral nutrition feeding routes on the duration of gastrointestinal decompression after definitive surgery for small intestinal fistula. From January 2015 to June 2019, patients with small intestinal fistula and receiving a definitive surgery were enrolled. According to the feeding route, patients were divided into a nasointestinal tube group and a nasogastric tube group. Clinical characteristics of the two groups were analyzed, and the influence of the two route on the recovery of gastrointestinal function was evaluated. A total of 151 patients were enrolled in our study. There were 49 patients in the nasogastric tube group, and 102 patients in the nasointestinal tube group. Enteral nutrition via nasogastric feeding route had a positive effect on shortening the duration of gastrointestinal decompression (adjusted HR = 2.488, 95% CI: 1.692-3.659, P < 0.001). After propensity matching (PM), 44 patients were enrolled (22 vs 22). EN via nasogastric tube was a positive factor for getting rid of gastrointestinal decompression (adjusted HR = 3.563, 95% CI: 1.639-7.746, P = 0.001). Preoperative enteral nutrition via nasogastric route can reduce the duration of gastrointestinal decompression after definitive surgery for small intestinal fistula.

Nutrition Considerations in Inflammatory Bowel Disease.

The purpose of this article is to provide an updated review of the definition, prevalence, causes, and clinical management of malnutrition in inflammatory bowel disease (IBD). Prevalence of malnutrition in IBD is estimated to be between 6.1% and 69.7% depending on the definition used, the type of IBD, the clinical setting, and whether the IBD is active or in remission. Whereas older definitions of malnutrition have been found to be correlated with mortality and length of hospital stay, the more recent European Society for Clinical Nutrition and Metabolism (ESPEN) 2015 and the Global Leadership Initiative on Malnutrition (GLIM) definitions provide significantly different prevalence estimates of malnutrition when applied to the same patient population, and further work is needed to validate these two definitions against clinical outcomes. In patients with IBD with identified malnutrition, oral nutrition supplementation, enteral nutrition, or parenteral nutrition should be started. In malnourished patients with Crohn's disease undergoing surgery, preoperative enteral nutrition has been demonstrated to reduce the rate of postoperative complications. Overall, patients with IBD are at significant risk for malnutrition and should be screened for malnutrition by using a validated screening tool. The management of malnutrition in IBD is complex, and studies are often limited in their size or their ability to demonstrate an improvement in clinical outcomes based on specific nutrition-related interventions. Future studies particularly regarding the validation of new screening tools and perioperative management of malnutrition may provide insight into the standardization of diagnosis and management of malnutrition in IBD.

Incidence of surgical infection and risk factors in colorectal surgery - A prospective cohort study.

The objective was to measure the incidence of surgical site infection (SSI) and identify risk factors, in patients undergoing elective surgery of the colon and rectum. A prospective cohort study was performed from January 2017 to December 2018. A total of 130 patients were studied. The cumulative incidence of SSI was 12.3%. The 56.25% were superficial wound infections and the 31.25%, organ-space infection. The risk factors significantly associated with SSI were the non-administration of pre-operative oral nutrition, diabetes mellitus, heart disease, symptomatic state at the diagnosis of colorectal cancer (CRC), and ≥ 2 altered nutritional biochemical parameters at diagnosis. After multivariate , risk factors associated with SSI were: non-administration of preoperative enteral nutrition (odds ratio [OR] = 0.27; 95% confidence interval [CI]: 0.07-1.0), DM (OR = 3.0; 95% CI: 0.9-9.9), the heart disease (OR = 4.6; 95% CI: 1.1-18.6), and laparoscopic surgery (OR = 0.28; 95% CI: 0.08-0.97). The average stay was higher in patients with a diagnosis of SSI (11.9 vs. 9.2 days). Independent risk factors for SSI in CRC were the non-administration of pre-operative enteral nutrition, the existence of heart disease, and open surgery.

Effect of preoperative nutrition therapy type and duration on short-time outcomes in gastric cancer patient with gastric outlet obstruction.

ObjectiveTo avoid perioperative complications caused malnutrition, nutrition therapy is necessary in gastric outlet obstruction (GOO) patients. Compared to parenteral nutrition (PN), enteral nutrition (EN) is associated with many advantages. This study aimed to investigate whether preoperative EN has beneficial clinical effects compared to preoperative PN in gastric cancer patients with GOO undergoing surgery.MethodsAccording to the methods of preoperative nutrition therapy, 143 patients were divided into EN group (n=42) and PN group (n=101) between January 2013 and December 2017 at the Chinese People’s Liberation Army General Hospital. Multiple logistic regression models were used to assess the association between the methods of preoperative nutrition therapy and postoperative day of flatus passage. The generalized additive model and two-piecewise linear regression model were used to calculate the inflection point of the preoperative nutritional therapy time on the postoperative day of flatus passage in the PN group.ResultsEN shortened the postoperative day of flatus passage in gastric cancer patients with GOO, which is a protective factor, especially in patients who underwent non-radical operations and the postoperative day of flatus passage reduced when the preoperative PN therapy was up to 3 d and a longer PN therapy (>3 d) did not accelerate the postoperative recovery of gastrointestinal functions.ConclusionsPreoperative EN therapy would benefit gastric cancer patients with GOO by accelerating postoperative recovery. For patients with absolute obstruction, no more than 3-day PN therapy is recommended if patients can tolerate general anesthesia and surgery.

Risk Factors for Gastrointestinal Symptoms post Enteral Nutrition Initiation via a Gastrostomy Tube

Background: Percutaneous endoscopic gastrostomy (PEG) facilitates long-term enteral nutrition. However, parenteral nutrition prior to PEG tube placement can cause impaired gastrointestinal function. Additionally, upon initiation of enteral feeding via a PEG tube, some patients suffer from gastrointestinal symptoms (e.g., vomiting, diarrhea), which reduce their quality of life and increase the nursing workload.Method: This retrospective study included 155 patients upon whom the author performed PEG as the attending physician. Enteral nutrition was started through the PEG tube on the third day after its placement. The following characteristics were analyzed: age, gender, indications for PEG, preoperative enteral nutrition, administered liquid nutrients, daily dosage of nutrients, serum albumin levels, serum alanine aminotransferase levels, serum creatinine levels, serum hemoglobin levels, and vomiting or diarrhea within seven days after the initiation of PEG feeding. A logistic regression model was used to identify the risk factors contributing to gastrointestinal symptoms, and three variables were sequentially introduced into the model—preoperative non-enteral nutrition, hypoalbuminemia, and administration of non-elemental diets.Results: Vomiting and diarrhea occurred in 10 and 15 patients, respectively. There were significant differences in administered nutrients and serum albumin levels between patients with and without gastrointestinal symptoms. Multivariate analysis revealed that the adjusted odds ratios for administration of non-elemental diets and serum albumin level ≤3.2 g/dL were 8.05 (95% confidence interval (CI): 2.66–24.4; p 0.001) and 3.81 (95% CI: 1.33–10.9; p 0.05), respectively.Conclusion: The administration of non-elemental diets and a serum albumin level ≤3.2 g/dL were significant risk factors.

The effects of nutritional support on selected laboratory parameters in patients with colorectal cancer undergoing surgical resection of the colon.

The benefit of the nutritional support provided to patients with colorectal cancer who have undergone the planned resection of the colon in relation to the laboratory markers of nutrition was examined. And it is currently being discussed, that pre-operative optimization of nutritional status reduces the incidence of post-operative complications in cancer patients and regulates selected laboratory parameters. This was a retrospective study where the treatment group (n = 52) received the enteral nutritional support 21 days prior to the scheduled surgery and the other group was formed of patients without preoperative enteral nutrition (n = 52). Laboratory parameters (CRP, leukocytes, albumin, total proteins) were monitored for at least one month before the planned surgery and just before the operation, and the effect of supplemental enteral nutrition on selected laboratory parameters between these two groups was compared. In a group of patients with enteral nutrition, serum albumin levels increased significantly, while CRP was significantly reduced during preoperative enteral nutrition (albumin S-ALB from 35.42 to 37.48, p = 0.0008, C reactive protein from 26.5 to 14.092, p = 0.0007). Nutritional support 21 days prior to surgery in oncological patients resulted in an improvement in laboratory parameters compared to the group of patients without nutritional enteric support. Malnutrition in patients who are candidates for major surgical intervention is a risk factor for postoperative morbidity and mortality. However, further studies are required to verify the effectiveness of this early nutritional intervention on medium and long-term clinical parameters in different types of cancer.

Effect of Preoperative Nutritional Risk Screening and Enteral Nutrition Support in Accelerated Recovery after Resection for Esophageal Cancer

Patients with esophageal cancer are often accompanied by malnutrition, especially in patients with obvious swallowing tract. Many studies have shown that preoperative nutritional support can reduce postoperative complications, but there are few studies comparing preoperative enteral nutrition with intravenous nutrition. The aim of the study was to compare the effects of the two nutritional support path in esophageal cancer patients undergoing surgery. We used the nutritional risk screening 2002 (NRS2002) for preoperative nutritional risk screening in patients with esophageal cancer treated at our department between April 2016 and March 2019. A total of 56 patients with an NRS2002 score ≥ 3 and with apparent difficulty swallowing received preoperative parenteral nutrition (PN; n = 29) or enteral nutrition (EN; n = 27). Both groups received 7 day of nutritional support before surgery. Nutritional indicators were measured on preoperative day 7, preoperative day 1, and postoperative day 7. The baseline characteristics, perioperative condition, nutritional status, and postoperative complications of the two groups were compared and analysed. There was no significant difference in baseline characteristics and perioperative nutrition indicators between two groups. Postoperative hospital stay and the costs of nutrition support were significantly reduced in the EN group compared with PN group (P = 0.000). The times of first passing gas and bowel movement were shorter in the EN group compared with PN group (P = 0.001). The incidence of gastrointestinal complications was lower in the EN group compared with PN group (P = 0.039). For esophageal cancer patients with an NRS2002 score ≥ 3 and apparent difficulty swallowing, preoperative EN with a gastric tube is safe and easy to perform. Preoperative EN can shorten the recovery time of gastrointestinal function, reduce the incidence of gastrointestinal complications, finally accelerate postoperative recovery.

Poor preoperative enteral nutrition would be a risk factor for readmission due to infection after liver transplantation.

BackgroundMost patients who undergo liver transplantation (LT) have advanced cirrhosis and poor nutritional status. The aim of this study was to investigate the effect of enteral nutrition (EN) on the clinical outcomes after LT.MethodsFrom 2015 to 2019, the medical records of recipient of LT at Kosin University Gospel Hospital were retrospectively reviewed.ResultsThirty-seven patients underwent LT. Nineteen patients underwent living donor liver transplantation (LDLT) and 18 patients underwent deceased donor liver transplantation (DDLT). One LDLT patient was excluded because transplantation was done within 1 month. Five DDLT patients were excluded either because they died within 1 month (n=4) or received transplantation within 1 month. (n=1). Therefore, 31 patients were analyzed. Psoas-muscle index (P=0.715) and serum albumin (P=0.111) were not statistically different between the LDLT and DDLT groups. Four patients (4/31) were readmitted because of infection. One LDLT patient was diagnosed with genitourinary infection. The three DDLT patients were diagnosed with pulmonary tuberculosis (n=1), diverticulitis (n=1), and sepsis (n=1). Readmission caused by infection was not statistically different between LDLD and DDLT patients (P=0.284). Preoperative EN <25% of the recommended amount (P=0.016) was significantly associated with readmission related to infection. In multivariate analyses, preoperative EN <25% was an independent risk factor for readmission due to infection after LT regardless of psoas-muscle index, baseline Model for End-Stage Liver Disease score, or LT type. ConclusionsPreoperative poor EN is significantly associated with readmission risk due to infection within 3 months of LT.

Preoperative enteral nutrition in adults with complicated Crohn's disease: Effect on disease outcomes and gut microbiota

ObjectivesThe use of exclusive enteral nutrition (EEN) in patients with Crohn's disease (CD) before surgical resection can reduce disease activity and improve nutritional status. The mechanism of EEN action is unclear, but it might involve modulation of the intestinal microbiota. The aim of this study was to evaluate the effects (namely changes in gut microbiota) of preoperative EEN in adults with complicated CD referred to surgery. MethodsThis was a prospective study of adult patients with CD referred to surgery. Patients with body mass index <18.5 kg/m2, weight loss >10 %, serum albumin <3 g/dL, or a combination of some or all three, received EEN for ≥2 wk. The effects of EEN on clinical (Harvey–Bradshaw Index [HBI]) and laboratory markers (C-reactive protein [CRP], serum albumin, and fecal calprotectin) and fecal microbiota were analyzed after EEN (before surgery) and 6 mo later. We used 16 S rRNA gene sequencing to determine changes in the fecal microbiota. ResultsFifteen patients were included, of whom 60% were men with a mean age of 45.4 ± 19.1 y. Of those, 10 received EEN. The median duration of preoperative EEN was 41.5 d (15–70 d). During EEN, there was a significant reduction in mean HBI (8.7 ± 1.9 versus 4.1 ± 2.4; P = 0.001) and CRP (11.7 ± 10.3 versus 0.8 ± 0.8 mg/dL; P = 0.008) and an increase in serum albumin (3.1 ± 0.6 versus 4 ± 0.6 g/dL; P = 0.022). Two patients did not require surgery after EEN. The overall microbial composition changed after EEN (Permutational analysis of variance test, P = 0.046) and there was a significant reduction in α diversity (8 ± 2.3 versus 5.2 ± 1.5; P = 0.023). EEN significantly changed the relative abundance of 11 taxonomic operational units (OTUs). At the family level, we found this was mainly due to the decrease in the Enterobacteriaceae family (7 OTUs). Six months after surgery, α diversity was not different from that before or after EEN; at this time point 6 OTUs were significantly different, mainly due to the decrease of Clostridiales order (3 OTUs). The incidence of postoperative complications and hospital length of stay were similar in EEN and immediate surgery groups, as well as clinical and endoscopic recurrence rates 6 mo after surgery. ConclusionsPreoperative EEN improved disease activity and nutritional status in patients with CD referred to surgery. Despite being malnourished, patients given EEN did not have increased postoperative complications compared with well-nourished patients. During EEN, overall microbiota composition changed and α diversity decreased. EEN did not influence postoperative recurrence and gut microbiota 6 mo after surgery.