ENTERAL VERSUS PARENTERAL-NUTRITION AFTER ESOPHAGOGASTRIC SURGERY - APROSPECTIVE RANDOMIZED COMPARISON

Background: There appears to be an emerging consensus that early posto perative nutritional support benefits the high-risk patient by decreas ing septic morbidity, maintaining immunocompetence and improving wound healing. Enteral nutrition via a feeding jejunostomy has been associa ted with serious complications, with a reported mortality rate as high as 10%, while total parenteral nutrition has also been associated wit h a wide variety of complications. Methods: Ninety-seven patients unde rgoing oesophagectomy or gastrectomy underwent pre-operative nutrition al assessment and were randomized to receive either total parenteral n utrition (47 patients) or enteral nutrition (50 patients). Results: Th ere was no significant difference in the number of catheter-related co mplications between the two groups, but 9 (45%) patients in the total parenteral nutrition group had major morbidity (potentially fatal in t wo patients) requiring active intervention. Conclusions: This study de monstrates enteral nutrition to be safe and associated with mainly rev ersible minor complications. It is probable that immediate postoperati ve enteral feeding conserves the gut's integrity. Whether this leads t o a reduction in postoperative septic complications has not been demon strated by this study although there appears to be a trend in this dir ection, supporting the concept of enteral feeding as 'primary therapy' . This can be safely, simply and economically achieved using a feeding jejunostomy placed at the time of surgery.