Abstracts
1997 Digestive Disease Week

Prospective randomized study on the effect of cyclic versus continuous enteral nutrition after pylorus-preserving pancreatoduodenectomy.

MI van Berge Henegouwen*, ThM van Gulik*, TM Moojen*, LMA Akkermans§, H Obertop*, DJ Gouma*. Departments of Surgery, *Academic Medical Centre, Amsterdam, and §University Hospital Utrecht, Netherlands.

Delayed gastric emptying occurs in around 30 % after pylorus-preserving pancreatoduodenectomy (PPPD) and causes prolonged hospital stay. Postoperative continuous enteral infusion of fats and proteins through a catheter jejunostomy may impair gastric emptying by continuous entero-gastric enhibitory mechanisms and thus prolong postoperative gastric stasis. Cyclic nutrition might prevent this and therefore we studied the effect of two different enteral feeding regimens in patients after PPPD.

From September 1995 to September 1996, 53 patients underwent PPPD (overall mortality 0 %). 39 patients were included and randomized for either continuous (CON) jejunal nutrition (00-24 hrs) or cyclic (CYC) enteral nutrition (06-24 hrs). Both groups had an equal caloric load/minute of 1.1 kCal/min. The following parameters were assessed: days of nasogastric intubation, days of enteral nutrition, days until normal diet and hospital stay. A sub-analysis was performed in patients in whom feeding protocol was not stopped due to technical problems or abdominal complications.

Nasogastric intubation was 5 days in the CON-group (n=19) and 4 days in the CYC-group (n=20) (NS). Number of days of enteral nutrition was 8 days for both the CON- and the CYC-group (NS). First day of normal diet was earlier for the CYC-groups: 11 vs 9 days (P<0.05). Hospital stay was shorter in the CYC-group: 18 vs 14 days (P<0.05). In 13 patients feeding protocol was stopped. In the remaining 26 patients (CON, n=13; CYC, n=13) the CYC-group had less days of enteral nutrition: 12 vs 8 days (P<0.05), a shorter period until normal diet: 11 vs 8 days (P<0.05) and a shorter hospital stay: 17.5 vs 14 days (P<0.05).

Conclusions: Cyclic enteral feeding after PPPD induces a faster return to a normal diet, a shorter period of enteral nutrition and a shorter hospital stay. Postoperative intra abdominal complications were not related to the positive clinical effect of cyclic enteral nutrition in these patients.