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Kim, Chung, and Kim: The Comparison between Early Enteral Nutrition and Total Parenteral Nutrition after Total Gastrectomy in Patients with Gastric Cancer: The Randomized Prospective Study
Original Article
Alimentary Tract
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 59(6): 407-413.

Published online: 20 June 2012

DOI: https://doi.org/10.4166/kjg.2012.59.6.407

The Comparison between Early Enteral Nutrition and Total Parenteral Nutrition after Total Gastrectomy in Patients with Gastric Cancer: The Randomized Prospective Study

Hye Un Kim, Jai Bock Chung1, Choong Bai Kim

Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Correspondence to: Choong Bai Kim, Department of Surgery, Yonsei University College of Medicine, 250 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82-2-2228-2100, Fax: +82-2-313-8289, cbkimmd@yuhs.ac

Received 21 May 2011       Revised 29 November 2011       Accepted 4 December 2011

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Early enteral nutrition (EEN) has benefits in reducing infectious complication, length of stay (LOS) and preserving liver function. There are few data about the effect of EEN in the patients who had total gastrectomy. The aim of this randomized and prospective study was to evaluate the effect of EEN after total gastrectomy on nutritional status, liver function, complications and LOS, compared to total parenteral nutrition (TPN) in patients with gastric cancer.

Methods

Among 56 patients with gastric cancer, 36 and 20 were randomly assigned to EEN and TPN groups, and finally 17 and 16 completed EEN and TPN schedules, respectively. The nutritional parameters, liver function, LOS and abdominal symptoms were compared between 2 groups on pre-operative day and post-operative 7th day.

Results

There was no significant difference in the nutritional parameters, liver function between EEN and TPN groups. Vomiting and abdominal distention were more frequent in EEN than TPN group (2 vs. 0 cases, p=0.485; 1 vs. 0 case, p=1.000, respectively), while increased AST, ALT and total bilirubin were more common in TPN than EEN group (4 vs. 2 cases, p=0.398; 1 vs. 0 case, p=0.485, respectively without statistical significance). LOS was shorter in EEN than TPN group without statistical significance (12 vs. 13 days, p=0.289).

Conclusions

No significant differences were found in the nutritional status parameters, liver function, complications and LOS between EEN and TPN groups on 7th day after total gastrectomy. Further large scale studies on the advantages and disadvantages of EEN after total gastrectomy are warranted.

Keywords: Early enteral nutrition, Nasojejunal feeding tube, Total gastrectomy, Length of stay, Complication

Figures and Tables

Fig. 1
Selection and drop-out of patients. The early enteral nutrition (EEN) group was finally 17 patients and the total parenteral nutrition (TPN) group was 16 patients, after the drop-out with the shown causes during study period.
kjg-59-407-g001
Fig. 2
The changes of nutritional parameters and length of stay (LOS) in early enteral nutrition (EEN) group and total parenteral nutrition (TPN) group on postoperative 7th day. AST and ALT were increased in both groups, but triglyceride (TG), transferrin, and prealbumin were decreased in both groups. There was no significant difference in any parameters and LOS.
kjg-59-407-g002
Table 1
The Comparison of Anthropological and Biochemical Parameters between EEN and TPN Groups before Nutritional Support
kjg-59-407-i001

Values are presented n, median (range), or mean±SD.

aWilcoxon rank sum test.

EEN, early enteral nutrition; TPN, total parenteral nutrition; TLC, total lymphocyte count.

Table 2
Nutritional Support for EEN Group and TPN Group until Post-operative 7th Day
kjg-59-407-i002

Both groups were supported with calculated amount (total daily calories, 25 kcal/kg/day; total daily protein, 1.5 g/kg/day). In EEN group, feeding nutrition was increased 300 kcal on every day.

Pre-op, pre-operation; POD, post-operative days; EEN, early enteral nutrition; TPN, total parenteral nutrition; PPN, partial parenteral nutrition; PGLD, post-gastrectomy liquid diet; PGSD, post-gastrectomy soft diet.

Table 3
The Changes of Nutritional Parameters in Each Group after Nutritional Support on Post-operative 7th Day
kjg-59-407-i003

Values are presented as mean±SD.

EEN, early enteral nutrition; TPN, total parenteral nutrition; TLC, total lymphocyte count.

aWilcoxon rank sum test; '-' means decrease.

Table 4
The Comparison of Nutritional Parameters and LOS between EEN and TPN Groups after Nutritional Support on Post-operative 7th Day
kjg-59-407-i004

Values are presented mean±SD or median (range).

EEN, early enteral nutrition; TPN, total parenteral nutrition; TLC, total lymphocyte count; LOS, length of stay.

aWilcoxon rank sum test.

Table 5
The Comparison of Complications between EEN and TPN Groups
kjg-59-407-i005

The complications were collected from operative day until discharge. If AST, ALT, total bilirubin, and glucose levels increased twice above upper normal value (AST 11-47 IU/L, ALT 7-50 IU/L, total bilirubin 0.3-1.1 mg/dL, glucose 60-120 mg/dL), they were defined as complication.

EEN, early enteral nutrition; TPN, total parenteral nutrition.

aFisher's exact test.

Notes

Financial support: None.

Conflict of interest: None.

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