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A retrospective cohort study: pre-operative oral enteral nutritional optimisation for Crohnʼs disease in a UK tertiary IBD Centre

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Susanna Meade, Kamal V. Patel, Raphael P. Luber, Dearbhaile O'Hanlon, Andra Caracostea, Polychronis Pavlidis, Sailish Honap, Cheran Anandarajah, Nyree Gryffin, Sebastian Zeki, Shuvra Ray, Joel Mawdsley, Mark A. Samaan, Simon H. Anderson, Amir Darakhshan, Katie Adams, Andrew Williams, Jeremy D. Sanderson, Miranda Lomer, Peter M. Irving

Original languageEnglish
Pages (from-to)646-663
Number of pages18
JournalAlimentary Pharmacology and Therapeutics
Volume56
Issue number4
DOIs
Accepted/In press2022
PublishedAug 2022

Bibliographical note

Funding Information: SM has received speaker fees from FalkPharma and an educational grant from Pfizer. KP has received honoraria for educational meetings and speaker fees from Abbvie, Janssen, Takeda, DrFalk, PredictImmune and Ferring. KP has received Advisory Board fees from Abbvie, Galapagos and Janssen. RPL has received educational grants from Ferring, Pfizer and Vifor Pharma. PMI: AbbVie, Celgene, Falk Pharma, Ferring MSD, Janssen, Pfizer, Takeda, Tillotts, Sandoz, Shire, Warner Chilcott ‐ Speaking/education, intermittent (last 3 years). SH has received lecture fees from Pfizer, Janssen and Takeda. DOH, AC, PP, CA, NG, SZ, SR, JM, MAS, SHA, KA, AD, AW, JDS, ML none declared. Publisher Copyright: © 2022 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.

King's Authors

Abstract

Background: Low-quality evidence suggests that pre-operative exclusive enteral nutrition (E/EN) can improve postoperative outcomes in patients with Crohn's disease (CD). It is not standard practice in most centres. Aims: To test the hypothesis that pre-operative EN in patients undergoing ileal/ileocolonic surgery for CD is associated with improved postoperative outcome. Methods: We performed a single centre retrospective observational study comparing surgical outcomes in patients receiving pre-operative EN (≥600 kcal/day for ≥2 weeks) with those who received no nutritional optimisation. Consecutive adult patients undergoing ileal/ileocolonic resection from 2008 to 2020 were included. The primary outcome was postoperative complications <30 days. Secondary outcomes included EN tolerance, specific surgical complications, unplanned stoma formation, length of stay, length of bowel resected, readmission and biochemical/anthropometric changes. Results: 300 surgeries were included comprising 96 without nutritional optimisation and 204 optimised cases: oral EN n = 173, additional PN n = 31 (4 of whom had received nasogastric/nasojejunal EN). 142/204 (69.6%) tolerated EN. 125/204 (61.3%) initiated EN in clinic. Patients in the optimised cohort were younger at operation and diagnosis, with an increased frequency of penetrating disease and exposure to antibiotics or biologics, and were more likely to undergo laparoscopic surgery. The optimised cohort had favourable outcomes on multivariate analysis: all complications [OR 0.29; 0.15–0.57, p < 0.001], surgical complications [OR 0.41; 95% CI 0.20–0.87, p = 0.02], non-surgical complications [OR 0.24 95% CI 0.11–0.52, p < 0.001], infective complications [OR 0.32; 95% CI 0.16–0.66, p = 0.001]. Conclusions: Oral EN was reasonably well tolerated and associated with a reduction in 30-day postoperative complications. Randomised controlled trials are required to confirm these findings.

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