title: Prospective, randomized trial on the effect of cyclic versus continuous enteral nutrition on postoperative gastric function after pylorus-preserving pancreatoduodenectomy.
abstract: OBJECTIVE
  The effect of a cyclic versus a continuous enteral feeding protocol on postoperative delayed gastric emptying, start of normal diet, and hospital stay was assessed in patients undergoing pylorus-preserving pancreatoduodenectomy (PPPD).
  
  
  BACKGROUND
  Delayed gastric emptying occurs in approximately 30% of patients after PPPD and causes prolonged hospital stay. Enteral nutrition through a catheter jejunostomy is used to provide postoperative nutritional support. Enteral infusion of fats and proteins activates neurohumoral feedback mechanisms and therefore can potentially impair gastric emptying and prolong postoperative gastroparesis.
  
  
  METHODS
  From September 1995 to December 1996, 72 consecutive patients underwent PPPD at the Academic Medical Center, Amsterdam. Fifty-seven patients were included and randomized for either continuous (CON) jejunal nutrition (0-24 hr; 1500 kCal/24 hr) or cyclic (CYC) enteral nutrition (6-24 hr; 1125 kCal/18 hr). Both groups had an equal caloric load of 1 kCal/min. The following parameters were assessed: days of nasogastric intubation, days of enteral nutrition, days until normal diet was tolerated orally, and hospital stay. On postoperative day 10, plasma cholecystokinin (CCK) levels were measured during both feeding protocols.
  
  
  RESULTS
  Nasogastric intubation was 9.1 days in the CON group (n = 30) and 6.7 days in the CYC group (n = 27) (not statistically significant). First day of normal diet was earlier for the CYC group (15.7 vs. 12.2 days, p < 0.05). Hospital stay was shorter in the CYC group (21.4 vs. 17.5 days, p < 0.05). CCK levels were lower in CYC patients, before and after feeding, compared with CON patients (p < 0.05).
  
  
  CONCLUSIONS
  Cyclic enteral feeding after PPPD is associated with a shorter period of enteral nutrition, a faster return to a normal diet, and a shorter hospital stay. Continuously high CCK levels could be a cause of prolonged time until normal diet is tolerated in patients on continuous enteral nutrition. Cyclic enteral nutrition is therefore the feeding regimen of choice in patients after PPPD.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: M I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.forename: L M
authors.initials: LM
authors.lastname: Akkermans
authors.forename: T M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: A A
authors.initials: AA
authors.lastname: Masclee
authors.forename: T M
authors.initials: TM
authors.lastname: Moojen
authors.forename: H
authors.initials: H
authors.lastname: Obertop
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000328:Adult; D000368:Aged; D002766:Cholecystokinin / Q000097:blood; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007441:Intubation, Gastrointestinal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D010191:Pancreatic Polypeptide / Q000097:blood; D016577:Pancreaticoduodenectomy; D011184:Postoperative Period; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D010191:Pancreatic Polypeptide; D002766:Cholecystokinin