title: Early enteral 5% glucose infusion maintains the epidermal growth factor levels in the jejunal flap used for pharyngo-oesophageal reconstruction.
abstract: BACKGROUND
  Free jejunal flap reconstruction is the main treatment for patients after pharyngo-oesophagectomy. Flaps are unavoidably subjected to ischaemia and reperfusion (I/R) during preparation. Enteral nutrition has been shown to improve the recovery of injured intestine, although the precise underlying mechanism remains unclear. This study was aimed to determine whether early enteral 5% glucose infusion is beneficial for the recovery of flap. Further, the possibility that enteral glucose infusion induces altered mucosal responses was evaluated.
  
  
  METHODS
  Patients, who underwent free jejunal flap reconstructions after pharyngo-oesophagectomy, were enrolled. An externalised monitor loop was made to observe the viability of flap and to collect intestinal fluid. Control patients (n = 11) received peripheral parenteral nutrition for seven post-operation days. For early enteral-fed patients (n = 12), in addition to fluid infusion, administration of 5% glucose (25 ml h(-1)) via a jejunostomy tube was initiated 6h after surgery. Blood, flap fluid and mucosal specimens were harvested. Plasma and flap luminal levels of interleukin (IL)-6, IL-10, epidermal growth factor (EGF) and secretory immunoglobulin A (sIgA) were measured. Further, mucosal morphology was examined.
  
  
  RESULTS
  There were no significant differences in either plasma or luminal concentrations of IL-6, IL-10 and sIgA at different time points between groups. The luminal EGF level in the control group reduced markedly from the 3rd postoperative day, contrasting with a well-maintained level in the early enteral-fed group. No significant difference in mucosal histology between groups was observed.
  
  
  CONCLUSIONS
  Early enteral glucose infusion does not significantly benefit the ischaemia-reperfusion-injured flap; however, it does preserve EGF levels in the flap lumen.
authors.affiliation: Department of Plastic Surgery, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan, ROC.
authors.forename: Guan-Ming
authors.initials: GM
authors.lastname: Feng
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chen
authors.forename: Tzu-Ming
authors.initials: TM
authors.lastname: Chang
authors.forename: Lih-Min
authors.initials: LM
authors.lastname: Tsai
mesh_terms: D000328:Adult; D004750:Enteral Nutrition / Q000379:methods*; D004815:Epidermal Growth Factor / Q000097:blood*; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007582:Jejunostomy; D007583:Jejunum / Q000637:transplantation*; D008297:Male; D010611:Pharyngectomy / Q000009:adverse effects; D019651:Plastic Surgery Procedures / Q000379:methods*; D015427:Reperfusion Injury / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D004815:Epidermal Growth Factor; D005947:Glucose