TY - JOUR
T1 - A retrospective cohort study
T2 - pre-operative oral enteral nutritional optimisation for Crohnʼs disease in a UK tertiary IBD Centre
AU - Meade, Susanna
AU - Patel, Kamal V.
AU - Luber, Raphael P.
AU - O'Hanlon, Dearbhaile
AU - Caracostea, Andra
AU - Pavlidis, Polychronis
AU - Honap, Sailish
AU - Anandarajah, Cheran
AU - Gryffin, Nyree
AU - Zeki, Sebastian
AU - Ray, Shuvra
AU - Mawdsley, Joel
AU - Samaan, Mark A.
AU - Anderson, Simon H.
AU - Darakhshan, Amir
AU - Adams, Katie
AU - Williams, Andrew
AU - Sanderson, Jeremy D.
AU - Lomer, Miranda
AU - Irving, Peter M.
N1 - 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.
PY - 2022/8
Y1 - 2022/8
N2 - 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.
AB - 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.
KW - Crohn’s disease
KW - enteral nutrition
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=85132409718&partnerID=8YFLogxK
U2 - 10.1111/apt.17055
DO - 10.1111/apt.17055
M3 - Article
C2 - 35723622
AN - SCOPUS:85132409718
SN - 0269-2813
VL - 56
SP - 646
EP - 663
JO - Alimentary Pharmacology and Therapeutics
JF - Alimentary Pharmacology and Therapeutics
IS - 4
ER -