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Randomised trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection

^a Departments of Cardiothoracic Surgery and Surgery, University College London Medical School, Middlesex Hospital, London W1N 8AA, ^b Department of Medicine, University College London Medical School, Whittington Hospital, London N19 5NF, ^c Bloomsbury Institute of Intensive Care Medicine, Department of Medicine, University College London Medical School, Rayne Institute Building, London WC1E 6JJ

Correspondence to: Dr Singer.

Abstract

Objectives: To assess whether immediate postoperative enteral feeding in patients who have undergone gastrointestinal resection is safe and effective.
Design: Randomised trial of immediate postoperative enteral feeding through a nasojejunal tube v conventional postoperative intravenous fluids until the reintroduction of normal diet.
Setting: Teaching hospitals in London.
Subjects: 30 patients under the care of the participating consultant surgeon who were undergoing elective laparotomies with a view to gastrointestinal resection for quiescent, chronic gastrointestinal disease. Two patients did not proceed to resection.
Main outcome measures: Nutritional state, nutritional intake and nitrogen balance, gut mucosal permeability measured by lactulose-mannitol differential sugar absorption test, complications, and outcome.
Results: Successful immediate enteral feeding was established in all 14 patients, with a mean (SD) daily intake of 6.78 (1.57) MJ (1622 (375) kcal before reintroduction of oral diet compared with 1.58 (0.14) MJ (377 (34) kcal) for those on intravenous fluids (P<0.0001). Urinary nitrogen balance on the first postoperative day was negative in those on intravenous fluids but positive in all 14 enterally fed patients (mean (SD) -13.2 (11.6) g v 5.3 (2.7) g; P<0.005). There was no difference by day 5. There was no change in gut mucosal permeability in the enterally fed group but a significant increase from the test ratios seen before the operation in those on intravenous fluids (0.11 (0.06) v 0.15 (0.12); P<0.005). There were also fewer postoperative complications in the enterally fed group (P<0.005).
Conclusions: Immediate postoperative enteral feeding in patients undergoing intestinal resection seems to be safe, prevents an increase in gut mucosal permeability, and produces a positive nitrogen balance.

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