PROSPECTIVE, RANDOMIZED TRIAL ON THE EFFECT OF CYCLIC VERSUS CONTINUOUS ENTERAL NUTRITION ON POSTOPERATIVE GASTRIC FUNCTION AFTER PYLORUS-PRESERVING PANCREATICODUODENECTOMY

Objective The effect of a cyclic versus a continuous enteral feeding p rotocol on postoperative delayed gastric emptying, start of normal die t, and hospital stay was assessed in patients undergoing pylorus-prese rving pancreatoduodenectomy (PPPD). Summary Background Data Delayed ga stric emptying occurs in approximately 30% of patients after PPPD and causes prolonged hospital slay. Enteral nutrition through a catheter j ejunostomy is used to provide postoperative nutritional support. Enter al infusion of fats and proteins activates neurohumoral feedback mecha nisms and therefore can potentially impair gastric emptying and prolon g postoperative gastroparesis. Methods From September 1995 to December 1996, 72 consecutive patients underwent PPPD at the Academic Medical Center, Amsterdam. Fifty-seven patients were included and randomized f or either continuous (CON) jejunal nutrition (0-24 hr; 1500 kCal/24 hr ) or cyclic (CYC) enteral nutrition (6-24 hr; 1125 kCal/18 hr). Both g roups had an equal caloric load of 1 kCal/min. The following parameter s were assessed: days of nasogastric intubation, days of enteral nutri tion, days until normal diet was tolerated orally, and hospital stay. On postoperative day 10, plasma cholecystokinin (CCK) levels were meas ured during both feeding protocols. Results Nasogastric intubation was 9.1 days in the CON group (n = 30) and 6.7 days in the CYC group (n = 27) (not statistically significant). First day of normal diet was ear lier for the CYC group (15.7 vs. 12.2 days, p < 0.05). Hospital stay w as shorter in the CYC group (21.4 vs. 17.5 days, p < 0.05). CCK levels were lower in CYC patients, before and after feeding, compared with C ON patients (p < 0.05). Conclusions Cyclic enteral feeding after PPPD is associated with a shorter period of enteral nutrition, a faster ret urn to a normal diet, and a shorter hospital stay. Continuously high C CK levels could be a cause of prolonged time until normal diet is tole rated in patients on continuous enteral nutrition. Cyclic enteral nutr ition is therefore the feeding regimen of choice in patients after PPP D.