Brief Article
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World J Gastroenterol. Sep 21, 2013; 19(35): 5889-5896
Published online Sep 21, 2013. doi: 10.3748/wjg.v19.i35.5889
Effect of early enteral combined with parenteral nutrition in patients undergoing pancreaticoduodenectomy
Xin-Hua Zhu, Ya-Fu Wu, Yu-Dong Qiu, Chun-Ping Jiang, Yi-Tao Ding
Xin-Hua Zhu, Ya-Fu Wu, Yu-Dong Qiu, Chun-Ping Jiang, Yi-Tao Ding, Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu Province, China
Author contributions: Zhu XH performed the literature review and part of the surgical procedure, and prepared the manuscript; Wu YF performed part of the surgical procedure and offered help with manuscript preparation and literature review; Qiu YD performed part of the surgical procedure, collected clinical data and did statistical analysis; Jiang CP helped collect clinical data and performed part of the surgical procedure; Ding YT instructed the manuscript preparation, and performed part of the surgical procedure.
Supported by Grants from Jiangsu Provincial Government, China, No. ZX200605
Correspondence to: Yi-Tao Ding, MD, Professor, Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, No. 321, Zhongshang Road, Nanjing 210008, Jiangsu Province, China. drzhuxh@163.com
Telephone: +86-25-83304616 Fax: +86-25-83317016
Received: May 23, 2013
Revised: July 17, 2013
Accepted: August 4, 2013
Published online: September 21, 2013
Abstract

AIM: To investigate the effect of early enteral nutrition (EEN) combined with parenteral nutritional support in patients undergoing pancreaticoduodenectomy (PD).

METHODS: From January 2006, all patients were given EEN combined with parenteral nutrition (PN) (EEN/PN group, n = 107), while patients prior to this date were given total parenteral nutrition (TPN) (TPN group, n = 67). Venous blood samples were obtained for a nutrition-associated assessment and liver function tests on the day before surgery and 6 d after surgery. The assessment of clinical outcome was based on postoperative complications. Follow-up for infectious and noninfectious complications was carried out for 30 d after hospital discharge. Readmission within 30 d after discharge was also recorded.

RESULTS: Compared with the TPN group, a significant decrease in prealbumin (PAB) (P = 0.023) was seen in the EEN/PN group. Total bilirubin (TB), direct bilirubin (DB) and lactate dehydrogenase (LDH) were significantly decreased on day 6 in the EEN/PN group (P = 0.006, 0.004 and 0.032, respectively). The rate of grade I complications, grade II complications and the length of postoperative hospital stay in the EEN/PN group were significantly decreased (P = 0.036, 0.028 and 0.021, respectively), and no hospital mortality was observed in our study. Compared with the TPN group (58.2%), the rate of infectious complications in the EEN/PN group (39.3%) was significantly decreased (P = 0.042). Eleven cases of delayed gastric emptying were noted in the TPN group, and 6 cases in the EEN/PN group. The rate of delayed gastric emptying and hyperglycemia was significantly reduced in the EEN/PN group (P = 0.031 and P = 0.040, respectively).

CONCLUSION: Early enteral combined with PN can greatly improve liver function, reduce infectious complications and delayed gastric emptying, and shorten postoperative hospital stay in patients undergoing PD.

Keywords: Enteral nutrition, Parenteral nutrition, Pancreaticoduodenectomy, Complications, Metabolism

Core tip: On the basis of our experience and the findings of previous studies, we investigated the effect of early enteral nutrition combined with parenteral nutritional support in patients undergoing pancreaticoduodenectomy enrolled in a retrospective controlled clinical trial. The results of this study showed that early enteral nutritional support combined with parenteral nutrition can greatly improve nutritional status and liver function, decrease the incidence of infectious complications and delayed gastric emptying, and shorten the length of postoperative hospital stay.