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Early enteral feeding compared with parenteral nutrition after oesophageal or oesophagogastric resection and reconstruction

Published online by Cambridge University Press:  08 March 2007

S. Gabor ,
H. Renner ,
V. Matzi ,
B. Ratzenhofer ,
J. Lindenmann ,
O. Sankin ,
H. Pinter ,
A. Maier ,
J. Smolle  and
F. M. Smolle-Jüttner
S. Gabor*
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
H. Renner
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
V. Matzi
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
B. Ratzenhofer
Affiliation:
Department of Anesthesiology, University of Medicine Graz, Auenbruggerplatz 29, A-8036, Graz, Austria
J. Lindenmann
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
O. Sankin
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
H. Pinter
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
A. Maier
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
J. Smolle
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
F. M. Smolle-Jüttner
Affiliation:
Department of Surgery, Division of Thoracic and Hyperbaric Surgery and
*
*Corresponding author: Dr S. Gabor, fax +43 316 385 4679, email [email protected]
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Abstract

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After resective and reconstructive surgery in the gastrointestinal tract, oral feeding is traditionally avoided in order to minimize strain to the anastomoses and to reduce the inherent risks of the postoperatively impaired gastrointestinal motility. However, studies have given evidence that the small bowel recovers its ability to absorb nutrients almost immediately following surgery, even in the absence of peristalsis, and that early enteral feeding would preserve both the integrity of gut mucosa and its immunological function. The aim of this study was to investigate the impact of early enteral feeding on the postoperative course following oesophagectomy or oesophagogastrectomy, and reconstruction. Between May 1999 and November 2002, forty-four consecutive patients (thirty-eight males and six females; mean age 62, range 30–82) with oesophageal carcinoma (stages I–III), who had undergone radical resection and reconstruction, entered this study (early enteral feeding group; EEF). A historical group of forty-four patients (thirty-seven males and seven females; mean age 64, range 41–79; stages I–III) resected between January 1997 and March 1999 served as control (parenteral feeding group; PF). The duration of both postoperative stay in the Intensive Care Unit (ICU) and the total hospital stay, perioperative complications and the overall mortality were compared. Early enteral feeding was administered over the jejunal line of a Dobhoff tube. It started 6 h postoperatively at a rate of 10 ml/h for 6 h with stepwise increase until total enteral nutrition was achieved on day 6. In the controls oral enteral feeding was begun on day 7. If compared to the PF group, EEF patients recovered faster considering the duration of both stay in the ICU and in the hospital. There was a significant difference in the interval until the first bowel movements. No difference in overall 30 d mortality was identified. A poor nutritional status was a significant prognostic factor for an increased mortality. Early enteral feeding significantly reduces the duration of ICU treatment and total hospital stay in patients who undergo oesophagectomy or oesophagogastrectomy for oesophageal carcinoma. The mortality rate is not affected.

Keywords

Early enteral feedingOesophagusImmunonutritionParenteral nutritionNutrition
Type
Research Article
Information
British Journal of Nutrition , Volume 93 , Issue 4 , April 2005 , pp. 509 - 513
Copyright
Copyright © The Nutrition Society 2005

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