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A randomised control trial of early enteral nutrition v. conventional management in patients undergoing major resection for upper gastrointestinal cancer: a comparison of fluid management

Published online by Cambridge University Press:  23 July 2009

R. C. Barlow  and
M. C. A. Puntis
R. C. Barlow
Affiliation:
Department of Surgery, Cardiff and Vale NHS Trust, Cardiff CF14 4AX, UK
M. C. A. Puntis
Affiliation:
Department of Surgery, Cardiff and Vale NHS Trust, Cardiff CF14 4AX, UK
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Abstract

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Abstract
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Proceedings of the Nutrition Society , Volume 68 , Issue OCE1: OCE Malnutrition Matters, Joint BAPEN and Nutrition Society, 4–5 November 2008, Harrogate , 2009 , E10
Copyright
Copyright © The Authors 2009

Studies have shown that optimal fluid administration is essential in post-operative surgical management(Reference Holte, Sharrock and Kehlet1, Reference Lobo2). Oedema is associated with delayed wound healing, cardiac and respiratory complications and delayed gastrointestinal motility. Problems with the management of fluid balance were highlighted in a survey(Reference Lobo3), which concluded that often peri-operative fluid management was suboptimal in the UK.

The aim of the present study was to compare the fluid management of patients who received early enteral nutrition (EEN) or conventional (CON) post-operative management, i.e. nil by mouth. Length of hospital stay, post-operative morbidity and mortality, volume of fluid delivered, cumulative fluid balance and development of oedema were recorded, in addition to other endpoints.

A total of 120 patients (median age 64 (range 35–82) years, sixty oesophageal, thirty-three gastric, twenty-eight pancreatic cancer) were recruited across three National Health Service Trusts over a 3-year period. There were two randomisation groups: group A (EEN) received EEN, commenced within 12 h of leaving the operating theatre; group B (CON) were ‘nil by mouth’ with hydration maintained with intravenous (IV) fluids, until deemed safe by the operating surgeon to commence oral diet and fluids.

There were no significant differences in serum albumin concentration between the two groups. The incidence of oedema was higher in the CON group. This was not surprising as the CON group had a higher mean cumulative fluid balance than the EEN group. However, the difference was not sufficient to reflect the marked differences. It may be that the EEN modulated the inflammatory response and affected the rennin–angiotensin II system(Reference Desborough4) to modify fluid handling in the EEN group.

To conclude, EEN patients had improved fluid balance when compared with the CON group, this was reflected by a reduction in oedema, improved gastrointestinal transit and fewer complications in the EEN group.

References

1. Holte, K, Sharrock, N & Kehlet, H (2002) Br J Anaesth 89, 622–632.CrossRefGoogle Scholar
2. Lobo, DN (2001) Clin Nutr 20, 125–130.CrossRefGoogle Scholar
3. Lobo, DN (2002) Ann R Coll Surg Engl 84, 156–160.Google Scholar
4. Desborough, J (2000) Br J Anaesth 85, 109–117.CrossRefGoogle Scholar