Document Detail


Systematic review of five feeding routes after pancreatoduodenectomy.
MedLine Citation:
PMID:  23354970     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Current European guidelines recommend routine enteral feeding after pancreato-duodenectomy (PD), whereas American guidelines do not. The aim of this study was to determine the optimal feeding route after PD.
METHODS: A systematic search was performed in PubMed, Embase and the Cochrane Library. Included were studies on feeding routes after PD that reported length of hospital stay (primary outcome).
RESULTS: Of 442 articles screened, 15 studies with 3474 patients were included. Data on five feeding routes were extracted: oral diet (2210 patients), enteral nutrition via either a nasojejunal tube (NJT, 165), gastrojejunostomy tube (GJT, 52) or jejunostomy tube (JT, 623), and total parenteral nutrition (TPN, 424). Mean(s.d.) length of hospital stay was shortest in the oral diet and GJT groups (15(14) and 15(11) days respectively), followed by 19(12) days in the JT, 20(15) days in the TPN and 25(11) days in the NJT group. Normal oral intake was established most quickly in the oral diet group (mean 6(5) days), followed by 8(9) days in the NJT group. The incidence of delayed gastric emptying varied from 6 per cent (3 of 52 patients) in the GJT group to 23.2 per cent (43 of 185) in the JT group, but definitions varied widely. The overall morbidity rate ranged from 43.8 per cent (81 of 185) in the JT group to 75 per cent (24 of 32) in the GJT group. The overall mortality rate ranged from 1.8 per cent (3 of 165) in the NJT group to 5.4 per cent (23 of 424) in the TPN group.
CONCLUSION: There is no evidence to support routine enteral or parenteral feeding after PD. An oral diet may be considered as the preferred routine feeding strategy after PD.
Authors:
A Gerritsen; M G H Besselink; D J Gouma; E Steenhagen; I H M Borel Rinkes; I Q Molenaar
Publication Detail:
Type:  Journal Article; Review     Date:  2013-01-25
Journal Detail:
Title:  The British journal of surgery     Volume:  100     ISSN:  1365-2168     ISO Abbreviation:  Br J Surg     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-04     Completed Date:  2013-04-18     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  589-98; discussion 599     Citation Subset:  AIM; IM    
Copyright Information:
© 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.
Affiliation:
Department of Surgery, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Enteral Nutrition / methods*
Epidemiologic Methods
Gastric Emptying
Humans
Length of Stay
Pancreatic Fistula / etiology
Pancreaticoduodenectomy*
Parenteral Nutrition, Total / methods*
Postoperative Complications / etiology
Treatment Outcome
Comments/Corrections
Comment In:
Br J Surg. 2013 Jun;100(7):980-1   [PMID:  23640673 ]
Br J Surg. 2013 Jun;100(7):981   [PMID:  23640676 ]
Chirurg. 2013 May;84(5):435   [PMID:  23564199 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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