title: Early Parenteral Nutrition in Patients with Biliopancreatic Mass Lesions, a Prospective, Randomized Intervention Trial.
abstract: OBJECTIVE
  Patients with biliopancreatic tumors frequently suffer from weight loss and cachexia. The in-hospital work-up to differentiate between benign and malignant biliopancreatic lesions requires repeated pre-interventional fasting periods that can aggravate this problem. We conducted a randomized intervention study to test whether routine in-hospital peripheral intravenous nutrition on fasting days (1000 ml/24 h, 700 kcal) has a beneficial effect on body weight and body composition.
  
  
  METHODS
  168 patients were screened and 100 enrolled in the trial, all undergoing in-hospital work-up for biliopancreatic mass lesions and randomized to either intravenous nutrition or control. Primary endpoint was weight loss at time of hospital discharge; secondary endpoints were parameters determined by bioelectric impedance analysis and quality of life recorded by the EORTC questionnaire.
  
  
  RESULTS
  Within three months prior to hospital admission patients had a median self-reported loss of 4.0 kg (25*th: -10.0 kg and 75*th* percentile: 0.0kg) of body weight. On a multivariate analysis nutritional intervention increased body weight by 1.7 kg (95% CI: 0.204; 3.210, p = 0.027), particularly in patients with malignant lesions (2.7 kg (95% CI: 0.71; 4.76, p < 0.01).
  
  
  CONCLUSIONS
  In a hospital setting, patients with suspected biliopancreatic mass lesions stabilized their body weight when receiving parenteral nutrition in fasting periods even when no total parenteral nutrition was required. Analysis showed that this effect was greatest in patients with malignant tumors. Further studies will be necessary to see whether patient outcome is affected as well.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02670265.
authors.affiliation: Department of Medicine A, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Krüger
authors.affiliation: Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Meffert
authors.affiliation: Department of Medicine A, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Lena J
authors.initials: LJ
authors.lastname: Vogt
authors.affiliation: Department of Medicine A, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Gärtner
authors.affiliation: Department of Medicine A, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Steveling
authors.affiliation: cts Vinzentius Krankenhaus, Landau, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kraft
authors.affiliation: Department of Medicine A, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Mayerle
authors.affiliation: Department of Medicine A, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Markus M
authors.initials: MM
authors.lastname: Lerch
authors.affiliation: Department of Medicine A, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Aghdassi
mesh_terms: D000368:Aged; D001661:Biliary Tract Neoplasms / Q000473:pathology* / Q000628:therapy*; D001823:Body Composition; D001837:Body Weights and Measures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy*; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods; D011788:Quality of Life; D061665:Time-to-Treatment; D016896:Treatment Outcome