Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature.
BACKGROUND
Although previous studies recommend the use of enteral nutrition (EN), the benefit of EN after elective gastrointestinal surgery has not been comprehensively demonstrated as through a meta-analysis. Our aim is to determine whether enteral nutrition is more beneficial than parenteral nutrition.


METHODS
A search was conducted on Medline, Web of Science, the Cochrane Library electronic databases, and bibliographic reviews. The trials were based on randomization, gastrointestinal surgery, and the reporting of at least one of the following end points: any complication, any infectious complication, mortality, wound infection and dehiscence, anastomotic leak, intraabdominal abscess, pneumonia, respiratory failure, urinary tract infection, renal failure, any adverse effect, and duration of hospital stay.


RESULTS
Twenty-nine trials, which included 2,552 patients, met the criteria. EN was beneficial in the reduction of any complication (relative risk (RR), 0.85; 95% confidence interval (CI), 0.74-0.99; P = 0.04), any infectious complication (RR, 0.69; 95% CI, 0.56-0.86; P = 0.001), anastomotic leak (RR, 0.67; 95% CI, 0.47-0.95; P = 0.03), intraabdominal abscess (RR, 0.63; 95% CI, 0.41-0.95; P = 0.03), and duration of hospital stay (weighted mean difference, -0.81; 95% CI, -1.25-0.38; P = 0.02). There were no clear benefits in any of the other complications.


CONCLUSIONS
The present findings would lead us to recommend the use of EN rather than PN when possible and indicated.
Mazaki
Takero
T
Department of Surgery, Nihon University School of Medicine, Nihon University Nerima-Hikarigaoka Hospital, 2-11-1 Hikarigaoka, Nerima-ku, Tokyo 179-0072, Japan. tmazaki@med.nihon-u.ac.jp
Ebisawa
Kiyoko
K
D017558:Elective Surgical Procedures; D004750:Enteral Nutrition; D041981:Gastrointestinal Tract / Q000601:surgery*; D006801:Humans; D010288:Parenteral Nutrition; D011182:Postoperative Care; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome