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. 2016 Oct;12(4):2136-2144.
doi: 10.3892/etm.2016.3559. Epub 2016 Aug 1.

Effect of early enteral nutrition on patients with digestive tract surgery: A meta-analysis of randomized controlled trials

Xiao-Liang Shu  1 , Kai Kang  2 , Li-Juan Gu  1 , Yong-Sheng Zhang  3
Affiliations

Effect of early enteral nutrition on patients with digestive tract surgery: A meta-analysis of randomized controlled trials

Xiao-Liang Shu et al. Exp Ther Med. 2016 Oct.

Abstract

Postoperative early enteral nutrition (EEN) is useful for the effective recovery of patients that have undergone surgery. However, the feasibility and efficacy of EEN in patients with digestive tract surgery remain inconclusive. In the present meta-analysis, the PubMed, EMBASE, Web of Science, The Cochrane Library, China National Knowledge Infrastructure and VIP databases were searched to identify controlled trials of patients with and without EEN following digestive tract surgery between October, 1966 and December, 2014. Methodological quality assessment was carried out for each of the included studies. For estimation of the analysis indexes, relative risk (RR) was used as the effect size of the the categorical variable, while the weighted mean difference (MD) was used as the effect size of the continuous variable. The meta-analysis was conducted using RevMan 5.2 software. Eleven randomized controlled trials involving 1,095 patients were included in the meta-analysis. The results revealed that, EEN in patients with digestive tract surgery was more effective in decreasing the incidence of infectious [RR=0.50, 95% confidence interval (CI): 0.38, 0.67; P<0.01] and non-infectious complications (RR=0.72, 95% CI: 0.43, 1.22; P<0.05) and shortening the length of first bowel action (MD=-4.10, 95% CI: -5.38, -2.82; P<0.05). It also had a significant influence on increasing the serum albumin (MD=2.87, 95% CI: 1.03, 4.71; P<0.05) and serum prealbumin (MD=0.04, 95% CI: 0.02, 0.05; P<0.05) levels. In conclusion, the results of the study have shown that EEN in patients with digestive tract surgery improved the nutritional status, reduced the risk of postoperative complications, shortened the length of hospital stay and promoted the functional recovery of the digestive system.

Keywords: digestive tract; early enteral nutrition; meta-analysis; recovery; surgery.

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Figures

Figure 1.
Figure 1.
Flow chart showing the trial selection process for this study. RCT, randomized controlled trial; CNKI, China National Knowledge Infrastructure.
Figure 2.
Figure 2.
Serum total protein level in treatment [early enteral nutrition (EEN)] and control groups using the random-effects model. SD, standard deviation; CI, confidence interval.
Figure 3.
Figure 3.
Forest plot of serum albumin level in the treatment [early enteral nutrition (EEN)] and control groups using the random-effects model. SD, standard deviation; CI, confidence interval.
Figure 4.
Figure 4.
Funnel plot showing the change of serum albumin between the treatment (early enteral nutrition) and control groups. Dotted lines are pseudo 95% confidence intervals. SE, standard error; MD, mean difference.
Figure 5.
Figure 5.
Forest plot of the change of serum albumin level between the treatment [early enteral nutrition (EEN)] and control groups using the fixed-effects model. M-H, Mantel-Haenszel test; SD, standard deviation; CI, confidence interval.
Figure 6.
Figure 6.
Funnel plot of studies showing the length of first bowel action in treatment (EEN) group and control group. Dotted lines are pseudo 95% confidence intervals. SE, standard error; MD, mean difference.
Figure 7.
Figure 7.
Forest plot showing change of length of first bowel action between treatment [early enteral nutrition (EEN)] group and control group: Random-effects model. SD, standard deviation; CI, confidence interval.
Figure 8.
Figure 8.
Forest plot of the infectious complications between the treatment [early enteral nutrition (EEN)] and control groups using the fixed-effects model. M-H, Mantel-Haenszel test; SD, standard deviation; CI, confidence interval.
Figure 9.
Figure 9.
Forest plot of the non-infectious complications between the treatment [early enteral nutrition (EEN)] and control groups using the fixed-effects model. M-H: Mantel-Haenszel test; SD, standard deviation; CI, confidence interval.
Figure 10.
Figure 10.
Forest plot of the length of hospital stay between treatment [early enteral nutrition (EEN)] group and control group: random-effects model. SD, standard deviation; CI, confidence interval.
Figure 11.
Figure 11.
Funnel plot of studies mentioning the length of hospital stay between treatment (early enteral nutrition) group and control group. Dotted lines are pseudo 95% confidence intervals. SE, standard error; MD, mean difference.
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