title: Feeding patients with preoperative symptoms of gastric outlet obstruction after pancreatoduodenectomy: Early oral or routine nasojejunal tube feeding?
abstract: BACKGROUND
  Early oral feeding is currently considered the optimal routine feeding strategy after pancreatoduodenectomy (PD). Some have suggested that patients with preoperative symptoms of gastric outlet obstruction (GOO) who undergo PD have such a high risk of developing delayed gastric emptying that these patients should rather receive routine postoperative tube feeding. The aim of this study was to determine whether clinical outcomes after PD in these patients differ between postoperative early oral feeding and routine tube feeding.
  
  
  METHODS
  We analyzed a consecutive multicenter cohort of patients with preoperative symptoms of GOO undergoing PD (2010-2013). Patients were categorized into two groups based on the applied postoperative feeding strategy (dependent on their center's routine strategy): early oral feeding or routine nasojejunal tube feeding.
  
  
  RESULTS
  Of 497 patients undergoing PD, 83 (17%) suffered from preoperative symptoms of GOO. 49 patients received early oral feeding and 29 patients received routine tube feeding. Time to resumption of adequate oral intake (primary outcome; 14 vs. 12 days, p = 0.61) did not differ between these two feeding strategies. Furthermore, overall complications and length of stay were similar in both groups. Of the patients receiving early oral feeding, 24 (49%) ultimately required postoperative tube feeding. In patients with an uncomplicated postoperative course, early oral feeding was associated with shorter time to adequate oral intake (8 vs. 12 days, p = 0.008) and shorter hospital stay (9 vs. 13 days, p < 0.001).
  
  
  CONCLUSIONS
  Also in patients with preoperative symptoms of GOO, early oral feeding can be considered the routine feeding strategy after PD.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: arjagerritsen@gmail.com.
authors.forename: Arja
authors.initials: A
authors.lastname: Gerritsen
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Roos A W
authors.initials: RAW
authors.lastname: Wennink
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Olivier R C
authors.initials: ORC
authors.lastname: Busch
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Inne H M
authors.initials: IHM
authors.lastname: Borel Rinkes
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Geert
authors.initials: G
authors.lastname: Kazemier
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: I Quintus
authors.initials: IQ
authors.lastname: Molenaar
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl.
authors.forename: Marc G H
authors.initials: MGH
authors.lastname: Besselink
mesh_terms: D000328:Adult; D000368:Aged; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D005260:Female; D017219:Gastric Outlet Obstruction / Q000175:diagnosis / Q000628:therapy*; D018589:Gastroparesis / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007441:Intubation, Gastrointestinal; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D057234:Preoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Delayed gastric emptying; Early oral feeding; Enteral nutrition; Gastric outlet obstruction; Pancreatoduodenectomy; Tube feeding