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Enteral versus Parenteral Nutrition after Gastrointestinal Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials in the English Literature

  • original article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Although previous studies recommend the use of enteral nutrition (EN), the benefit of EN after elective gastrointestinal surgery has not been comprehensively demonstrated as through a meta-analysis. Our aim is to determine whether enteral nutrition is more beneficial than parenteral nutrition.

Methods

A search was conducted on Medline, Web of Science, the Cochrane Library electronic databases, and bibliographic reviews. The trials were based on randomization, gastrointestinal surgery, and the reporting of at least one of the following end points: any complication, any infectious complication, mortality, wound infection and dehiscence, anastomotic leak, intraabdominal abscess, pneumonia, respiratory failure, urinary tract infection, renal failure, any adverse effect, and duration of hospital stay.

Results

Twenty-nine trials, which included 2,552 patients, met the criteria. EN was beneficial in the reduction of any complication (relative risk (RR), 0.85; 95% confidence interval (CI), 0.74–0.99; P = 0.04), any infectious complication (RR, 0.69; 95% CI, 0.56–0.86; P = 0.001), anastomotic leak (RR, 0.67; 95% CI, 0.47–0.95; P = 0.03), intraabdominal abscess (RR, 0.63; 95% CI, 0.41–0.95; P = 0.03), and duration of hospital stay (weighted mean difference, −0.81; 95% CI, −1.25–0.38; P = 0.02). There were no clear benefits in any of the other complications.

Conclusion

The present findings would lead us to recommend the use of EN rather than PN when possible and indicated.

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Abbreviations

EN:

enteral nutrition

PN:

parenteral nutrition

GI:

gastrointestinal

TPN:

total parenteral nutrition

PPN:

peripheral parenteral nutrition

RR:

relative risk

CI:

confidence interval

χ2 :

chi-squared

RCT:

randomized controlled trial

WMD:

weighted mean difference

GALT:

gut-associated lymphoid tissue

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Acknowledgments

We would like to thank the authors who provided additional data: Drs. F Bozzetti,13 M Braga,27,28,62 C Feo,30 AM Keele,45 L Mack,33 R Page,34 JV Peter,22 N Rayes36 and J Reynolds38.

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  1. Department of Surgery, Nihon University School of Medicine, Nihon University Nerima-Hikarigaoka Hospital, 2-11-1 Hikarigaoka, Nerima-ku, Tokyo, 179-0072, Japan

    Takero Mazaki & Kiyoko Ebisawa

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  1. Takero Mazaki
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Correspondence to Takero Mazaki.

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The preliminary report of this work was presented in the poster session of the 46th Annual Meeting of the Society for Surgery of the Alimentary Tract at the Digestive Disease Week in Chicago on May 2005.

There are no sources of support, including grants, fellowships, and gifts of materials.

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Mazaki, T., Ebisawa, K. Enteral versus Parenteral Nutrition after Gastrointestinal Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials in the English Literature. J Gastrointest Surg 12, 739–755 (2008). https://doi.org/10.1007/s11605-007-0362-1

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