RANDOMIZED TRIAL OF SAFETY AND EFFICACY OF IMMEDIATE POSTOPERATIVE ENTERAL FEEDING IN PATIENTS UNDERGOING GASTROINTESTINAL RESECTION

Objectives-To assess whether immediate postoperative enteral feeding i n patients who have undergone gastrointestinal resection is safe and e ffective. Design-Randomised trial of immediate postoperative enteral f eeding through a nasojejunal tube v conventional postoperative intrave nous fluids until the reintroduction of normal diet. Setting-Teaching hospitals in London. Subjects-30 patients under the care of the partic ipating consultant surgeon who were undergoing elective laparotomies w ith a view to gastrointestinal resection for quiescent, chronic gastro intestinal disease. Two patients did not proceed to resection. Main ou tcome measures-Nutritional state, nutritional intake and nitrogen bala nce, gut mucosal permeability measured by lactulose-mannitol different ial sugar absorption test, complications, and outcome. Results-Success ful immediate enteral feeding was established in all 14 patients, with a mean (SD) daily intake of 6.78 (1.57) MJ (1622 (375) kcal before re introduction of oral diet compared with 1.58 (0.14) MJ (377 (34) kcal) for those on intravenous fluids (P<0.0001). Urinary nitrogen balance on the first postoperative day was negative in those on intravenous fl uids but positive in all 14 enterally fed patients (mean (SD) -13.2 (1 1.6) g v 5.3 (2.7) g; P<0 005). There was no difference by day 5. Ther e was no change in gut mucosal permeability in the enterally fed group but a significant increase from the test ratios seen before the opera tion in those on intravenous fluids (0.11 (0.06) v 0.15 (0.12); P<0.00 5). There were also fewer postoperative complications in the enterally fed group (P< 0.005). Conclusions-Immediate postoperative enteral fee ding in patients undergoing intestinal resection seems to be safe, pre vents an increase in gut mucosal permeability, and produces a positive nitrogen balance.