Crohn’s disease: better outcomes with EEN before laparoscopic surgery

  • Ge X & al.
  • Int J Surg
  • 21 Mar 2019

  • International Clinical Digest
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Takeaway

  • In a retrospective analysis of patients with Crohn’s disease (CD) undergoing laparoscopic surgery, preoperative exclusive enteral nutrition (EEN) was associated with fewer postoperative complications.

Why this matters

  • About 80% of patients with CD require bowel surgery.
  • This population is frequently malnourished, and malnutrition has been linked to postoperative morbidity and mortality.
  • Few data exist on EEN before laparoscopic surgery.

Key results

  • 29.2% (35) of patients had complications; 21 complications were major.
  • EEN vs non-EEN: 
    • Complications: 17.8% vs 36.0% (P=.033).
    • Surgical-site infections: 8.9% vs 24.0% (P=.038).
    • Endoscopic recurrence at 6 months: 11.9% vs 28.4% (P=.044).
  • No between-group differences in clinical recurrence.
  • EEN predicted (lower risk for) endoscopic recurrence: OR, 0.328 (95% CI, 0.113-0.949; P=.040).

Study design

  • Retrospective analysis of prospectively collected data at Sir Run Run Shaw Hospital, Hangzhou, China (n=120).
  • Participants underwent elective laparoscopic bowel resection for CD. 
  • All were advised to use EEN via nasogastric tube for 4 weeks before surgery; 45 did so.
  • Those who did not worked with nutritionists and received similar calorie and protein levels.
  • Outcome: postoperative complications; recurrence.
  • Funding: National Natural Science Foundation of China, Zhejiang Natural Science Foundation.

Limitations

  • Small, nonrandomized, single-center study; risk for residual confounding.
  • Non-EEN group several years older, on average.

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