The effects of enteral immunonutrition in upper gastrointestinal surgery

A systematic review and meta-analysis

Chee S Wong, Emad H Aly

    Research output: Contribution to journalReview article

    18 Citations (Scopus)

    Abstract

    AIM: The beneficial of immunonutrition on overall morbidity and mortality remains uncertain. We undertook a systematic review to evaluate the effects of immune-enhancing enteral nutrition (IEN) in upper gastrointestinal (GI) surgery.

    METHODS: Main electronic databases [MEDLINE via Pubmed, EMBASE, Scopus, Web of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library, and clinical trial registry (ClinicalTrial.gov)] were searched for studies reported clinical outcomes comparing standard enteral nutrition (SEN) and immunonutrition (IEN). The systematic review was conducted in accordance with the PRISMA guidelines and meta-analysis was analysed using fixed and random-effects models.

    RESULTS: Nineteen RCTs with a total of 2016 patients (1017 IEN and 999 SEN) were included in the final pooled analysis. The ratio of patients underwent oesophagectomy:gastrectomy:pancreatectomy was 2.2:1.2:1.0. IEN, when administered post-operatively, was associated with a significantly lower risk of wound infection (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.40 to 0.88; p = 0.009) and shorter length of hospital stay (MD -2.92 days, 95% CI -3.89 to -1.95; p < 0.00001). No significant differences in other post-operative morbidities of interest (e.g. anastomotic leak and pulmonary infection) and mortality between the two groups were identified.

    CONCLUSIONS: Overall, our analysis found that IEN decreases wound infection rates and reduces length of stay. It should be recommended as routine nutritional support as part of the Enhanced Recovery after Surgery (ERAS) programmes for upper GI Surgery.

    Original languageEnglish
    Pages (from-to)137-150
    Number of pages14
    JournalInternational Journal of Surgery
    Volume29
    Early online date26 Mar 2016
    DOIs
    Publication statusPublished - May 2016

    Fingerprint

    Enteral Nutrition
    Small Intestine
    Meta-Analysis
    Length of Stay
    Wound Infection
    Confidence Intervals
    Morbidity
    Anastomotic Leak
    Pancreatectomy
    Esophagectomy
    Nutritional Support
    Mortality
    Gastrectomy
    PubMed
    MEDLINE
    Libraries
    Registries
    Odds Ratio
    Clinical Trials
    Databases

    Keywords

    • Enteral Nutrition
    • Esophagectomy
    • Gastrectomy
    • Humans
    • Length of Stay
    • Pancreatectomy
    • Postoperative Care
    • Randomized Controlled Trials as Topic
    • Wound Infection
    • Journal Article
    • Meta-Analysis
    • Review

    Cite this

    The effects of enteral immunonutrition in upper gastrointestinal surgery : A systematic review and meta-analysis. / Wong, Chee S; Aly, Emad H.

    In: International Journal of Surgery , Vol. 29, 05.2016, p. 137-150.

    Research output: Contribution to journalReview article

    @article{14360e3558b74866887b79a7374fc1bf,
    title = "The effects of enteral immunonutrition in upper gastrointestinal surgery: A systematic review and meta-analysis",
    abstract = "AIM: The beneficial of immunonutrition on overall morbidity and mortality remains uncertain. We undertook a systematic review to evaluate the effects of immune-enhancing enteral nutrition (IEN) in upper gastrointestinal (GI) surgery.METHODS: Main electronic databases [MEDLINE via Pubmed, EMBASE, Scopus, Web of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library, and clinical trial registry (ClinicalTrial.gov)] were searched for studies reported clinical outcomes comparing standard enteral nutrition (SEN) and immunonutrition (IEN). The systematic review was conducted in accordance with the PRISMA guidelines and meta-analysis was analysed using fixed and random-effects models.RESULTS: Nineteen RCTs with a total of 2016 patients (1017 IEN and 999 SEN) were included in the final pooled analysis. The ratio of patients underwent oesophagectomy:gastrectomy:pancreatectomy was 2.2:1.2:1.0. IEN, when administered post-operatively, was associated with a significantly lower risk of wound infection (risk ratio (RR) 0.59, 95{\%} confidence interval (CI) 0.40 to 0.88; p = 0.009) and shorter length of hospital stay (MD -2.92 days, 95{\%} CI -3.89 to -1.95; p < 0.00001). No significant differences in other post-operative morbidities of interest (e.g. anastomotic leak and pulmonary infection) and mortality between the two groups were identified.CONCLUSIONS: Overall, our analysis found that IEN decreases wound infection rates and reduces length of stay. It should be recommended as routine nutritional support as part of the Enhanced Recovery after Surgery (ERAS) programmes for upper GI Surgery.",
    keywords = "Enteral Nutrition, Esophagectomy, Gastrectomy, Humans, Length of Stay, Pancreatectomy, Postoperative Care, Randomized Controlled Trials as Topic, Wound Infection, Journal Article, Meta-Analysis, Review",
    author = "Wong, {Chee S} and Aly, {Emad H}",
    note = "Copyright {\circledC} 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.",
    year = "2016",
    month = "5",
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    T1 - The effects of enteral immunonutrition in upper gastrointestinal surgery

    T2 - A systematic review and meta-analysis

    AU - Wong, Chee S

    AU - Aly, Emad H

    N1 - Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

    PY - 2016/5

    Y1 - 2016/5

    N2 - AIM: The beneficial of immunonutrition on overall morbidity and mortality remains uncertain. We undertook a systematic review to evaluate the effects of immune-enhancing enteral nutrition (IEN) in upper gastrointestinal (GI) surgery.METHODS: Main electronic databases [MEDLINE via Pubmed, EMBASE, Scopus, Web of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library, and clinical trial registry (ClinicalTrial.gov)] were searched for studies reported clinical outcomes comparing standard enteral nutrition (SEN) and immunonutrition (IEN). The systematic review was conducted in accordance with the PRISMA guidelines and meta-analysis was analysed using fixed and random-effects models.RESULTS: Nineteen RCTs with a total of 2016 patients (1017 IEN and 999 SEN) were included in the final pooled analysis. The ratio of patients underwent oesophagectomy:gastrectomy:pancreatectomy was 2.2:1.2:1.0. IEN, when administered post-operatively, was associated with a significantly lower risk of wound infection (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.40 to 0.88; p = 0.009) and shorter length of hospital stay (MD -2.92 days, 95% CI -3.89 to -1.95; p < 0.00001). No significant differences in other post-operative morbidities of interest (e.g. anastomotic leak and pulmonary infection) and mortality between the two groups were identified.CONCLUSIONS: Overall, our analysis found that IEN decreases wound infection rates and reduces length of stay. It should be recommended as routine nutritional support as part of the Enhanced Recovery after Surgery (ERAS) programmes for upper GI Surgery.

    AB - AIM: The beneficial of immunonutrition on overall morbidity and mortality remains uncertain. We undertook a systematic review to evaluate the effects of immune-enhancing enteral nutrition (IEN) in upper gastrointestinal (GI) surgery.METHODS: Main electronic databases [MEDLINE via Pubmed, EMBASE, Scopus, Web of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library, and clinical trial registry (ClinicalTrial.gov)] were searched for studies reported clinical outcomes comparing standard enteral nutrition (SEN) and immunonutrition (IEN). The systematic review was conducted in accordance with the PRISMA guidelines and meta-analysis was analysed using fixed and random-effects models.RESULTS: Nineteen RCTs with a total of 2016 patients (1017 IEN and 999 SEN) were included in the final pooled analysis. The ratio of patients underwent oesophagectomy:gastrectomy:pancreatectomy was 2.2:1.2:1.0. IEN, when administered post-operatively, was associated with a significantly lower risk of wound infection (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.40 to 0.88; p = 0.009) and shorter length of hospital stay (MD -2.92 days, 95% CI -3.89 to -1.95; p < 0.00001). No significant differences in other post-operative morbidities of interest (e.g. anastomotic leak and pulmonary infection) and mortality between the two groups were identified.CONCLUSIONS: Overall, our analysis found that IEN decreases wound infection rates and reduces length of stay. It should be recommended as routine nutritional support as part of the Enhanced Recovery after Surgery (ERAS) programmes for upper GI Surgery.

    KW - Enteral Nutrition

    KW - Esophagectomy

    KW - Gastrectomy

    KW - Humans

    KW - Length of Stay

    KW - Pancreatectomy

    KW - Postoperative Care

    KW - Randomized Controlled Trials as Topic

    KW - Wound Infection

    KW - Journal Article

    KW - Meta-Analysis

    KW - Review

    U2 - 10.1016/j.ijsu.2016.03.043

    DO - 10.1016/j.ijsu.2016.03.043

    M3 - Review article

    VL - 29

    SP - 137

    EP - 150

    JO - International Journal of Surgery

    JF - International Journal of Surgery

    SN - 1743-9159

    ER -