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EDITORIALS: D B A Silk and N Menzies Gow Postoperative starvation after gastrointestinal surgery BMJ 2001; 323: 761-762 [Full text]

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Early enteral Feeding: do we need further randomised trials?

Mathur Pawan   (14 December 2001)

Early enteral Feeding: do we need further randomised trials? 14 December 2001
Mathur Pawan, Surgical SpR West Middlesex University Hospital, TW7 6AF Send response to journal: Re: Early enteral Feeding: do we need further randomised trials?	Dear Editor We read with interest the articles by Silk & Gow (1) and Lewis et al (2). These papers serve to highlight the benefits of early enteral feeding in intestinal surgery and are welcome. In addition, they conclude that this benefit should be tested in a randomised setting. We have retrospectively analysed the impact of early feeding in a variety of colorectal operations in our unit. We found a significant difference both in ‘time to discharge’ and complications in patients who were fed early as compared to late. On the basis of this study we formulated a protocol for a randomised trial which we presented to a local surgical forum. Interestingly the overwhelming opinion of the group (including surgeons, intensivists, biochemists and nursing staff) was that it would be unethical to deny the patients randomised to late feeding, the benefits of early enteral nutrition. The concept of early enteral feeding is widely accepted by most Intensivists and Nutritionists, but still remains a subject of controversy in surgical fields. The concept challenges traditional surgical teaching with the usual perceived risk being an increased risk of aspiration and anastomotic dehiscence despite a body of evidence showing otherwise (2). Although we are in a culture of evidence based medicine, in our unit we feel it is unreasonable to question the benefit of early feeding and are instead optimising the schedule of administration. Clearly in order for widespread acceptance of early feeding in intestinal surgery further randomised data is required. However, is it justifiable to undertake these studies when there is eviedence showing it is beneficial? P Mathur Surgical SpR JJ Smith Surgical SpR S Ramesh Consultant Colorectal Surgeon P M Dawson Consultant Colorectal Surgeon Colorectal Surgical Unit, West Middlesex University Hospital, Twickenham Road, Isleworth, Middlesex TW7 6AF 1) DBA Silk & N Menzies. Postoperative starvation after gastrointestinal surgery. BMJ 2001; 323: 761-2. 2) Lewis SJ, Egger M, Sylvester PA, Thomas S. Early enteral feeding versus ‘nil by mouth’ after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 2001; 323: 773-6.