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Impact of Early Enteral Nutrition on Delayed Gastric Emptying and Nutritional Status After Pancreaticoduodenectomy

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Abstract

Background

Although early enteral nutrition (EEN) is an accepted practice after pancreaticoduodenectomy (PD), the impact of EEN on postoperative complications or nutritional status remains unclear. We aimed to investigate the impact of EEN on delayed gastric emptying (DGE) and nutritional status after PD.

Methods

A total of 143 patients underwent PD between January 2012 and September 2020. We excluded patients who underwent a two-stage pancreatojejunostomy, in whom the enteral tube was accidentally pulled out, or with insufficient information in their medical records. The incidence of postoperative complications was compared between patients who received EEN (EEN group, n = 21) and those who did not (control group, n = 21) after propensity score matching. Univariate and multivariate analyses were performed to identify the risk factors affecting the incidence of these complications. Nutritional status was assessed at postoperative months 1, 3, and 6.

Results

The incidence of grade B/C DGE in the EEN group was significantly lower than that in the control group (4.8% vs. 28.6%, p = 0.03). There was no significant difference in overall morbidity, incidence of any other postoperative complications, or all-grade DGE. In multivariate analysis, EEN was associated with a reduction in the incidence of grade B/C DGE (p < 0.01). In the analysis of nutritional status, EEN was significantly associated with better nutritional status at postoperative month 1.

Conclusion

EEN can lead to a lower clinically relevant DGE rate and better nutritional status in the early postoperative period in patients undergoing PD.

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Abbreviations

CI:

Confidence interval

CR-DGE:

Clinically relevant-delayed gastric empty

DGE:

Delayed gastric emptying

EEN:

Early enteral nutrition

EN:

Enteral nutrition

ISGPS:

International study group of pancreatic surgery

OR:

Odds ratio

PD:

Pancreatoduodenectomy

PNI:

Prognostic nutritional index

POM:

Postoperative month

POPF:

Postoperative pancreatic fistula

PS:

Performance status

RCT:

Randomized control trial

SSI:

Surgical site infection

WBC:

White blood cell

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Authors and Affiliations

  1. Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan

    Kiyotaka Hosoda, Akira Shimizu, Koji Kubota, Tsuyoshi Notake, Hitoshi Masuo, Takahiro Yoshizawa, Hiroki Sakai, Tomohiko Ikehara, Koya Yasukawa, Hikaru Hayashi & Yuji Soejima

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  1. Kiyotaka Hosoda
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  2. Akira Shimizu
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  3. Koji Kubota
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  4. Tsuyoshi Notake
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  5. Hitoshi Masuo
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  6. Takahiro Yoshizawa
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  7. Hiroki Sakai
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  8. Tomohiko Ikehara
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Corresponding author

Correspondence to Akira Shimizu.

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The authors declare no competing interests.

Ethical approval

This study protocol was approved by the Shinshu University Hospital Ethics Committee (approval number: 5001), and the study was conducted in accordance with the provisions of the Declaration of Helsinki.

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Hosoda, K., Shimizu, A., Kubota, K. et al. Impact of Early Enteral Nutrition on Delayed Gastric Emptying and Nutritional Status After Pancreaticoduodenectomy. World J Surg 47, 764–772 (2023). https://doi.org/10.1007/s00268-022-06844-y

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