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Early Enteral Nutrition Within 24 h of Intestinal Surgery Versus Later Commencement of Feeding: A Systematic review and Meta-analysis



We set out to evaluate early commencement of post-operative enteral nutrition versus traditional management in patients undergoing gastrointestinal surgery.


Electronic databases were searched, references lists were scanned and authors contacted for additional information. We looked for randomised controlled trials comparing early commencement of feeding (within 24 h) with no feeding in patients undergoing gastrointestinal surgery. Primary endpoints were wound infections, intra-abdominal abscesses, pneumonia, anastomotic leakage, mortality, length of hospital stay and complications of feeding. Data were combined to estimate the common relative risk of post-operative complications and associated 95% confidence intervals.


Thirteen trials, with a total of 1,173 patients, fulfilled our inclusion criteria. Mortality was reduced with early post-operative feeding. Early post-operative feeding increased vomiting. The direction of effect is suggestive of a reduction of risk of post-surgical complications and reduced length of hospital stay.


There is no obvious advantage in keeping patients ‘nil by mouth’ following gastrointestinal surgery. Early enteral nutrition is associated with reduced mortality, though the mechanism is not clear. This review supports the notion that early commencement of enteral feeding may be of benefit.

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We would like to thank the authors who provided additional data: R Beier-Holgersen, B Stewart, S Wexner, JE Fischer, MF Brennan and H Ortiz. We would also like to thank the following manufacturers of enteral feeds for assisting in the collection of data: Nutricia Ltd, Fresenius Kabi Ltd, Novartis Nutrition UK Ltd, Ross Products, Clintec Nutrition Ltd, Nestlé (Clinical Nutrition), SHS International and Mead Johnson Nutrition.

Guarantor of the article

Stephen J Lewis

Specific author contributions

Search strategies were developed and primary trials were evaluated using a data extraction form developed by HKA and SJL. HKA, SJL and ST were all involved in data extracting, interpretation and drafting the review.

Financial support

Danish Institute for Health Technology Assessment

Potential competing interests

SJL and ST have received financial support for clinical trials from Numico Research, Wageningen, The Netherlands.

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Correspondence to Stephen J. Lewis.

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Lewis, S.J., Andersen, H.K. & Thomas, S. Early Enteral Nutrition Within 24 h of Intestinal Surgery Versus Later Commencement of Feeding: A Systematic review and Meta-analysis. J Gastrointest Surg 13, 569–575 (2009).

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  • Early
  • Enteral
  • Nutrition
  • Post-operative