Comparison of enteral nutrition with combined enteral and parenteral nutrition in post-pancreaticoduodenectomy patients: a pilot study

Abstract

Background: Many clinical studies have demonstrated that early postoperative enteral nutrition (EN) improved the postroperative course. Post-pancreaticoduodenectomy (PD), patients tend to suffer from postoperative nausea, abdominal distention, and diarrhoea, causing difficulty in the introduction of EN. In this pilot study, we investigated the appropriate nutritional mode post-pancreatic surgery.

Methods: Between October 2006 and March 2007 2 postoperative nutritional methods were implemented in 17 patients in a prospective single-centere study. Eight patients received only enteral nutrition (EN group) and 9 patients received enteral nutrition combined with parenteral nutrition (EN + PN group).

Results: There were no differences in the patient characteristics and postoperative morbidity between the 2 groups. The rate of discontinuance of enteral feeding was significantly high in the EN group, and the duration of enteral feeding was significantly longer in the EN + PN group. The central venous line was retained for a significantly longer period in the EN + PN group, but there was no difference in the frequency of catheter-related infection between the 2 groups.

Conclusion: EN combined with PN is more adequate for patients after pancreatic surgery.

Figure 1

Schedules of postoperative nutrition. The infusion of 500 ml of 5% liquid glucose commenced within 12 h of surgery and enteral feeding was started on POD 2 in both groups. All patients in both groups reached the maximum volume of total caloric intake (derived using Harris-Benedict equation), on POD 4. In the EN group, the total volume of EN was 600 kcal/day on POD 2 and 1000 kcal/day on POD 3 with PPN. In the EN + PN group, EN started at 200 kcal/day and was increased every 2 days to a maximum volume of 600 kcal/day from POD 6. The patients received PPN until POD 3 or TPN from POD 4 to compensate for the caloric shortage. Oral intake started on POD 7. TPN was stopped when oral intake was over 500 kcal/day and enteral nutrition was stopped when oral intake was over 1000 kcal/day. EN: enteral nutrition, PPN: peripheral parenteral nutrition, TPN: total parenteral nutrition, OI: oral intake.

Figure 2

Comparison of nutritional parameters. Mean values of prealbumin and transferrin in the EN (square) and EN + PN (triangle) groups. The error bars represent the standard error of the mean (SEM).

Figure 3

Comparison of immunological parameters. Mean values of IgG, IgM, and IgA in the EN (square) and EN + PN (triangle) groups. The error bars represent the SEM; * signifies p < 0.05.

Figure 4

Comparison of biochemical parameters. Mean values of ALT, lactate, and ChE in the EN (square) and EN + PN (triangle) groups. The error bars represent the SEM; * signifies p < 0.05.