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Feeding Routes After Pancreatoduodenectomy

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Diet and Nutrition in Critical Care

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Abstract

Delayed gastric emptying is a frequent complication after pancreatoduodenectomy and often necessitates nutritional support. Current European guidelines recommend routine enteral feeding after pancreatoduodenectomy, whereas American guidelines do not. This chapter discusses the available evidence on the optimal feeding strategy in patients after pancreatoduodenectomy.

A systematic literature search yielded 22 studies with 3,920 patients. Data on five feeding routes were extracted: oral feeding (n = 2,351); enteral nutrition via either nasojejunal tube (n = 302), gastrojejunostomy tube (n = 52), or jejunostomy tube (n = 701); and total parenteral nutrition (n = 514). The length of hospital stay was the shortest in patients receiving oral feeding. Also resumption of solid diet was established most quickly in the oral feeding group. The incidence of delayed gastric emptying varied from 5.8 % to 25.5 %, but definitions varied widely. There were no major differences in overall morbidity and mortality between the five different feeding routes.

In conclusion, there is no evidence to support routine enteral or parenteral feeding after pancreatoduodenectomy. An early oral diet may be considered as the preferred routine feeding strategy after pancreatoduodenectomy.

This work represents an edited version of a previously published systematic review (Gerritsen et al. 2013).

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Abbreviations

DGE:

Delayed gastric emptying

ERAS:

Enhanced recovery after surgery

GJT:

Gastrojejunostomy tube

ISGPS:

International study group of pancreatic surgery

JT:

Jejunostomy tube

MCT:

Medium-chain triglyceride

NJT:

Nasojejunal tube

PD:

Pancreatoduodenectomy

POD:

Postoperative day

POPF:

Postoperative pancreatic fistula

PPH:

Postpancreatectomy hemorrhage

PPPD:

Pylorus-preserving pancreatoduodenectomy

TPN:

Total parenteral nutrition

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Authors and Affiliations

  1. Department of Surgery, University Medical Center Utrecht, 85500, 3508 GA, Utrecht, The Netherlands

    Arja Gerritsen, I. Quintus Molenaar & A. Roos W. Wennink

  2. Department of Dietetics, University Medical Center Utrecht, 85500, 3508 GA, Utrecht, The Netherlands

    Elles Steenhagen

  3. Department of Gastroenterology and Hepatology, Academic Medical Center, 22660, 1100 DD, Amsterdam, The Netherlands

    Elisabeth M. H. Mathus-Vliegen

  4. Department of Surgery, Academic Medical Center, 22660, 1100 DD, Amsterdam, The Netherlands

    Arja Gerritsen, Dirk J. Gouma & H. Marc G. Besselink

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  1. Arja Gerritsen
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  2. I. Quintus Molenaar
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  3. A. Roos W. Wennink
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  4. Elles Steenhagen
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  6. Dirk J. Gouma
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  7. H. Marc G. Besselink
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Correspondence to H. Marc G. Besselink .

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Editors and Affiliations

  1. Royal Free London Hospitals, Barnet General Hospital, London, UK

    Rajkumar Rajendram

  2. Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Rajkumar Rajendram

  3. King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia

    Rajkumar Rajendram

  4. Department of Nutrition and Dietetics, Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Victor R. Preedy

  5. Department of Biomedical Sciences, Faculty of Science & Technology, University of Westminster, London, UK

    Vinood B. Patel

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Gerritsen, A. et al. (2015). Feeding Routes After Pancreatoduodenectomy. In: Rajendram, R., Preedy, V.R., Patel, V.B. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7836-2_42

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