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Does preoperative enteral nutrition reduce the incidence of surgical complications in patients with Crohn’s disease? A case‐matched study
Author(s) -
Yamamoto T.,
Nakahigashi M.,
Shimoyama T.,
Umegae S.
Publication year - 2020
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.14922
Subject(s) - medicine , parenteral nutrition , incidence (geometry) , surgery , colectomy , crohn's disease , complication , enteral administration , abscess , anastomosis , gastroenterology , elemental diet , enterocutaneous fistula , fistula , disease , ulcerative colitis , physics , optics
Aim Currently, the notion that preoperative optimization with enteral nutrition (EN) reduces the incidence of complication after surgery in Crohn’s disease (CD) patients is being debated. This case‐matched study was to evaluate the impact of preoperative EN on surgical outcomes in patients with CD. Method Twenty‐four patients received EN therapy with an elemental diet (1800–2400 kcal/day) for at least 2 weeks before the planned surgery (EN group). A further 24 patients who underwent surgery without receiving preoperative EN or parenteral nutrition formed a control group based on four matched criteria: age (≤/>40 years), the use of preoperative medications (corticosteroids/azathioprine/biologics), disease behaviour (inflammatory/stricturing/penetrating) and main surgical procedure (ileal resection/ileocolonic resection/colectomy). The incidence of complications observed within 30 days after surgery was compared between the two groups. Septic complications were defined as anastomotic leak, intra‐abdominal abscess, entero‐cutaneous fistula or wound infection. Results In the EN group, the median serum albumin level significantly increased, while C‐reactive protein (CRP) significantly decreased during the preoperative EN (albumin, from 3.0 mg/dl to 3.1 mg/dl, P = 0.04; CRP, from 3.05 mg/dl to 2.52 mg/dl, P = 0.02). The incidence of postoperative septic complications was significantly lower in the EN group compared with the control group (4% vs 25%, P = 0.04). The occurrence rate of overall complications was lower in the EN group (21% vs 29%, P = 0.51), but not statistically significant. Conclusion In patients with CD, preoperative optimization with EN reduced the overall rate of postoperative complications and significantly decreased postoperative septic complications.