Understanding and Application of Enteral Nutrition Support_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHENBo , XIONGMao-ming ,  MENGXiang-ling

Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China;

Corresponding author：

MENGXiang-ling, Email: anyimxl@163.com

Keywords：

Enteral nutrition; Undernutrition; Nutrition support; Clinical outcome

DOI：

10.7507/1007-9424.20160199

Video：

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Objective To summarize the application of enteral nutrition support in hospitalized patients. Methods The related literatures about enteral nutrition support in recent years were reviewed. Results The rates of malnutrition and nutritional risk were still high in patients. Enteral nutrition support could improve the condition and result of these cases in better clinical outcome, such as shorten hospitalization time and reduced the cost of hospital expenditure. Enteral nutritional support included both oral supplementation and tube-feeding techniques. Artificial nutrition may be provided by nasal tube (nasogastric or nasojejunal tube) or surgically placed tube (gastrostomy, jejunostomy, percutaneous endoscopic gastrostomy or percutaneous endoscopic gastrostomy-jejunostomy). More attention should be paid to the issues relating to feeding intolerance, including abdominal distension, diarrhea, reflux, and aspiration, especially for postoperative patients with early enteral nutrition support. Conclusion Enteral nutrition support requires highly individually and specialized tailored management.

Citation： CHENBo, XIONGMao-ming, MENGXiang-ling. Understanding and Application of Enteral Nutrition Support. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(6): 756-760. doi: 10.7507/1007-9424.20160199 Copy

1.	Mueller C, Compher C, Ellen DM, et al. A.S.P.E.N. clinical guide-lines: nutrition screening, assessment, and intervention in adults. JPEN J Parenter Enteral Nutr, 2011, 35(1): 16-24.
2.	Tucker A, Ybarra J, Bingham A, et al. American society for paren-teral and enteral nutrition (a.s.p.e.N.) standards of practice for nutrition support pharmacists. Nutr Clin Pract, 2015, 30(1): 139-146.
3.	Osland EJ, Ali A, Isenring E, et al. Australasian society for parenteral and enteral nutrition guidelines for supplementation of trace elements during parenteral nutrition. Asia Pac J Clin Nutr, 2014, 23(4): 545-554.
4.	Klek S, Hermanowicz A, Dziwiszek G, et al. Home enteral nutrition reduces complications, length of stay, and health care costs: results from a multicenter study. Am J Clin Nutr, 2014, 100(2): 609-615.
5.	Byrne TA, Wilmore DW, Iyer K, et al. Growth hormone, glutamine, and an optimal diet reduces parenteral nutrition in patients with short bowel syndrome: a prospective, randomized, placebo-contro-lled, double-blind clinical trial. Ann Surg, 2005, 242(5): 655-661.
6.	Ohta K, Omura K, Hirano K, et al. The effects of an additive small amount of a low residual diet against total parenteral nutrition-induced gut mucosal barrier. Am J Surg, 2003, 185(1): 79-85.
7.	Elke G, Kuhnt E, Ragaller M, et al. Enteral nutrition is associated with improved outcome in patients with severe sepsis. Med Klin Intensivmed Notfmed, 2013, 108(3): 223-233.
8.	Yuan Y, Ren J, Gu G, et al. Early enteral nutrition improves outcomes of open abdomen in gastrointestinal fistula patients complicated with severe sepsis. Nutr Clin Pract, 2011, 26(6): 688-694.
9.	Ikegami T, Shirabe K, Yoshiya S, et al. Bacterial sepsis after living donor liver transplantation: the impact of early enteral nutrition. J Am Coll Surg, 2012, 214(3): 288-295.
10.	于健春. “序贯疗法”优化手术后早期肠内营养. 中华临床营养杂志, 2011, 19(3): 140-143.
11.	Heyland DK, Stephens KE, Day AG, et al. The success of enteral nutrition and ICU-acquired infections: a multicenter observational study. Clin Nutr, 2011, 30(2): 148-155.
12.	Weijs TJ, Berkelmans GH, Nieuwenhuijzen GA, et al. Routes for early enteral nutrition after esophagectomy. A systematic review. Clin Nutr, 2015, 34(1): 1-6.
13.	ASGE Training Committee 2013-2014; Enestvedt BK, Jorgensen J, et al. Endoscopic approaches to enteral feeding and nutrition core curriculum. Gastrointest Endosc, 2014, 80(1): 34-41.
14.	Wan B, Fu H, Yin J. Early jejunal feeding by bedside placement of a nasointestinal tube significantly improves nutritional status and reduces complications in critically ill patients versus enteral nutrition by a nasogastric tube. Asia Pac J Clin Nutr, 2015, 24(1): 51-57.
15.	Akashi Y, Hiki N, Nunobe S, et al. Safe management of anastomotic leakage after gastric cancer surgery with enteral nutrition via a nasointestinal tube. Langenbecks Arch Surg, 2012, 397(5): 737-744.
16.	Hermanowicz A, Matuszczak E, Komarowska M, et al. Laparoscopy-assisted percutaneous endoscopic gastrostomy enables enteral nutri-tion even in patients with distorted anatomy. World J Gastroenterol, 2013, 19(43): 7696-7700.
17.	Trotti A, Bellm LA, Epstein JB, et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol, 2003, 66(3): 253-262.
18.	Zopf Y, Maiss J, Konturek P, et al. Predictive factors of mortality after PEG insertion: guidance for clinical practice. JPEN J Parenter Enteral Nutr, 2011, 35(1): 50-55.
19.	Corry J, Poon W, McPhee N, et al. Prospective study of percutaneous endoscopic gastrostomy tubes versus nasogastric tubes for enteral feeding in patients with head and neck cancer undergoing (chemo) radiation. Head Neck, 2009, 31(7): 867-876.
20.	Kreymann KG, Berger MM, Deutz NE, et al. ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr, 2006, 25(2): 210-223.
21.	Mehta NM. Early enteral nutrition in the PICU: should we trust our gut?. Pediatr Crit Care Med, 2015, 16(8): 786-789.
22.	Martindale RG, Warren M. Should enteral nutrition be started in the first week of critical illness?. Curr Opin Clin Nutr Metab Care, 2015, 18(2): 202-206.
23.	Kozeniecki M, Fritzshall R. Enteral nutrition for adults in the hospital setting. Nutr Clin Pract, 2015, 30(5): 634-651.
24.	Kang Y, Kim S, Kim SY, et al. Effect of short-term partial enteral nutrition on the treatment of younger patients with severe Crohn’s disease. Gut Liver, 2015, 9(1): 87-93.
25.	Jiang W, Lv X, Xu X, et al. Early enteral nutrition for upper digestive tract malformation in neonate. Asia Pac J Clin Nutr, 2015, 24(1): 38-43.
26.	Kolaček S. Enteral nutrition. World Rev Nutr Diet, 2013, 108: 86-90.
27.	Lee JS, Kwok T, Chui PY, et al. Can continuous pump feeding reduce the incidence of pneumonia in nasogastric tube-fed patients? A randomized controlled trial. Clin Nutr, 2010, 29(4): 453-458.
28.	Stoll B, Puiman PJ, Cui L, et al. Continuous parenteral and enteral nutrition induces metabolic dysfunction in neonatal pigs. JPEN J Parenter Enteral Nutr, 2012, 36(5): 538-550.
29.	Zhao J, Dong JN, Gong JF, et al. Impact of enteral nutrition on energy metabolism in patients with Crohn’s disease. World J Gastroenterol, 2015, 21(4): 1299-1304.
30.	Manba N, Koyama Y, Kosugi S, et al. Is early enteral nutrition initiated within 24 hours better for the postoperative course in esophageal cancer surgery?. J Clin Med Res, 2014, 6(1): 53-58.
31.	Mikhailov TA, Kuhn EM, Manzi J, et al. Early enteral nutrition is associated with lower mortality in critically ill children. JPEN J Parenter Enteral Nutr, 2014, 38(4): 459-466.
32.	Chen W, Zhang Z, Xiong M, et al. Early enteral nutrition after total gastrectomy for gastric cancer. Asia Pac J Clin Nutr, 2014, 23(4): 607-611.
33.	Chambrier C, Barnoud D. How to feed complicated patients after surgery: what’s new?. Curr Opin Crit Care, 2014, 20(4): 438-443.
34.	Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med, 2001, 29(12): 2264-2270.
35.	El Nakeeb A, Fikry A, El Metwally T, et al. Early oral feeding in patients undergoing elective colonic anastomosis. Int J Surg, 2009, 7(3): 206-209.
36.	Hur H, Kim SG, Shim JH, et al. Effect of early oral feeding after gastric cancer surgery: a result of randomized clinical trial. Surgery, 2011, 149(4): 561-568.
37.	Beier-Holgersen R, Brandstrup B. Influence of postoperative enteral nutrition on cellular immunity. A random double-blinded placebo controlled clinical trial. Int J Colorectal Dis, 2012, 27(4): 513-520.
38.	Lobo DN, Williams RN, Welch NT, et al. Early postoperative jejunostomy feeding with an immune modulating diet in patients undergoing resectional surgery for upper gastrointestinal cancer: a prospective, randomized, controlled, double-blind study. Clin Nutr, 2006, 25(5): 716-726.
39.	冯立, 王峰, 董培德, 等. 胃癌患者根治术后早期肠内营养的临床疗效观察. 中国普外基础与临床杂志, 2014, 21(3): 325-329.
40.	伍映鑫, 夏霖, 王勇, 等. 胃癌患者术前应用含ω-3不饱和脂肪酸的肠内营养制剂的临床效果观察. 中国普外基础与临床杂志, 2015, 22(3): 312-316.
41.	Rayes N, Seehofer D, Theruvath T, et al. Effect of enteral nutrition and synbiotics on bacterial infection rates after pylorus-preserving pancreatoduodenectomy: a randomized, double-blind trial. Ann Surg, 2007, 246(1): 36-41.
42.	McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr, 2009, 33(3): 277-316.
43.	Scurlock C, Mechanick JI. Early nutrition support in the intensive care unit: a US perspective. Curr Opin Clin Nutr Metab Care, 2008, 11(2): 152-155.
44.	Singer P, Berger MM, van den Berghe G, et al. ESPEN guidelines on parenteral nutrition: intensive care. Clin Nutr, 2009, 28(4): 387-400.
45.	Leier H. Does gum chewing help prevent impaired gastric motility in the postoperative period?. J Am Acad Nurse Pract, 2007, 19(3): 133-136.

1. Mueller C, Compher C, Ellen DM, et al. A.S.P.E.N. clinical guide-lines: nutrition screening, assessment, and intervention in adults. JPEN J Parenter Enteral Nutr, 2011, 35(1): 16-24.
2. Tucker A, Ybarra J, Bingham A, et al. American society for paren-teral and enteral nutrition (a.s.p.e.N.) standards of practice for nutrition support pharmacists. Nutr Clin Pract, 2015, 30(1): 139-146.
3. Osland EJ, Ali A, Isenring E, et al. Australasian society for parenteral and enteral nutrition guidelines for supplementation of trace elements during parenteral nutrition. Asia Pac J Clin Nutr, 2014, 23(4): 545-554.
4. Klek S, Hermanowicz A, Dziwiszek G, et al. Home enteral nutrition reduces complications, length of stay, and health care costs: results from a multicenter study. Am J Clin Nutr, 2014, 100(2): 609-615.
5. Byrne TA, Wilmore DW, Iyer K, et al. Growth hormone, glutamine, and an optimal diet reduces parenteral nutrition in patients with short bowel syndrome: a prospective, randomized, placebo-contro-lled, double-blind clinical trial. Ann Surg, 2005, 242(5): 655-661.
6. Ohta K, Omura K, Hirano K, et al. The effects of an additive small amount of a low residual diet against total parenteral nutrition-induced gut mucosal barrier. Am J Surg, 2003, 185(1): 79-85.
7. Elke G, Kuhnt E, Ragaller M, et al. Enteral nutrition is associated with improved outcome in patients with severe sepsis. Med Klin Intensivmed Notfmed, 2013, 108(3): 223-233.
8. Yuan Y, Ren J, Gu G, et al. Early enteral nutrition improves outcomes of open abdomen in gastrointestinal fistula patients complicated with severe sepsis. Nutr Clin Pract, 2011, 26(6): 688-694.
9. Ikegami T, Shirabe K, Yoshiya S, et al. Bacterial sepsis after living donor liver transplantation: the impact of early enteral nutrition. J Am Coll Surg, 2012, 214(3): 288-295.
10. 于健春. “序贯疗法”优化手术后早期肠内营养. 中华临床营养杂志, 2011, 19(3): 140-143.
11. Heyland DK, Stephens KE, Day AG, et al. The success of enteral nutrition and ICU-acquired infections: a multicenter observational study. Clin Nutr, 2011, 30(2): 148-155.
12. Weijs TJ, Berkelmans GH, Nieuwenhuijzen GA, et al. Routes for early enteral nutrition after esophagectomy. A systematic review. Clin Nutr, 2015, 34(1): 1-6.
13. ASGE Training Committee 2013-2014; Enestvedt BK, Jorgensen J, et al. Endoscopic approaches to enteral feeding and nutrition core curriculum. Gastrointest Endosc, 2014, 80(1): 34-41.
14. Wan B, Fu H, Yin J. Early jejunal feeding by bedside placement of a nasointestinal tube significantly improves nutritional status and reduces complications in critically ill patients versus enteral nutrition by a nasogastric tube. Asia Pac J Clin Nutr, 2015, 24(1): 51-57.
15. Akashi Y, Hiki N, Nunobe S, et al. Safe management of anastomotic leakage after gastric cancer surgery with enteral nutrition via a nasointestinal tube. Langenbecks Arch Surg, 2012, 397(5): 737-744.
16. Hermanowicz A, Matuszczak E, Komarowska M, et al. Laparoscopy-assisted percutaneous endoscopic gastrostomy enables enteral nutri-tion even in patients with distorted anatomy. World J Gastroenterol, 2013, 19(43): 7696-7700.
17. Trotti A, Bellm LA, Epstein JB, et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol, 2003, 66(3): 253-262.
18. Zopf Y, Maiss J, Konturek P, et al. Predictive factors of mortality after PEG insertion: guidance for clinical practice. JPEN J Parenter Enteral Nutr, 2011, 35(1): 50-55.
19. Corry J, Poon W, McPhee N, et al. Prospective study of percutaneous endoscopic gastrostomy tubes versus nasogastric tubes for enteral feeding in patients with head and neck cancer undergoing (chemo) radiation. Head Neck, 2009, 31(7): 867-876.
20. Kreymann KG, Berger MM, Deutz NE, et al. ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr, 2006, 25(2): 210-223.
21. Mehta NM. Early enteral nutrition in the PICU: should we trust our gut?. Pediatr Crit Care Med, 2015, 16(8): 786-789.
22. Martindale RG, Warren M. Should enteral nutrition be started in the first week of critical illness?. Curr Opin Clin Nutr Metab Care, 2015, 18(2): 202-206.
23. Kozeniecki M, Fritzshall R. Enteral nutrition for adults in the hospital setting. Nutr Clin Pract, 2015, 30(5): 634-651.
24. Kang Y, Kim S, Kim SY, et al. Effect of short-term partial enteral nutrition on the treatment of younger patients with severe Crohn’s disease. Gut Liver, 2015, 9(1): 87-93.
25. Jiang W, Lv X, Xu X, et al. Early enteral nutrition for upper digestive tract malformation in neonate. Asia Pac J Clin Nutr, 2015, 24(1): 38-43.
26. Kolaček S. Enteral nutrition. World Rev Nutr Diet, 2013, 108: 86-90.
27. Lee JS, Kwok T, Chui PY, et al. Can continuous pump feeding reduce the incidence of pneumonia in nasogastric tube-fed patients? A randomized controlled trial. Clin Nutr, 2010, 29(4): 453-458.
28. Stoll B, Puiman PJ, Cui L, et al. Continuous parenteral and enteral nutrition induces metabolic dysfunction in neonatal pigs. JPEN J Parenter Enteral Nutr, 2012, 36(5): 538-550.
29. Zhao J, Dong JN, Gong JF, et al. Impact of enteral nutrition on energy metabolism in patients with Crohn’s disease. World J Gastroenterol, 2015, 21(4): 1299-1304.
30. Manba N, Koyama Y, Kosugi S, et al. Is early enteral nutrition initiated within 24 hours better for the postoperative course in esophageal cancer surgery?. J Clin Med Res, 2014, 6(1): 53-58.
31. Mikhailov TA, Kuhn EM, Manzi J, et al. Early enteral nutrition is associated with lower mortality in critically ill children. JPEN J Parenter Enteral Nutr, 2014, 38(4): 459-466.
32. Chen W, Zhang Z, Xiong M, et al. Early enteral nutrition after total gastrectomy for gastric cancer. Asia Pac J Clin Nutr, 2014, 23(4): 607-611.
33. Chambrier C, Barnoud D. How to feed complicated patients after surgery: what’s new?. Curr Opin Crit Care, 2014, 20(4): 438-443.
34. Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med, 2001, 29(12): 2264-2270.
35. El Nakeeb A, Fikry A, El Metwally T, et al. Early oral feeding in patients undergoing elective colonic anastomosis. Int J Surg, 2009, 7(3): 206-209.
36. Hur H, Kim SG, Shim JH, et al. Effect of early oral feeding after gastric cancer surgery: a result of randomized clinical trial. Surgery, 2011, 149(4): 561-568.
37. Beier-Holgersen R, Brandstrup B. Influence of postoperative enteral nutrition on cellular immunity. A random double-blinded placebo controlled clinical trial. Int J Colorectal Dis, 2012, 27(4): 513-520.
38. Lobo DN, Williams RN, Welch NT, et al. Early postoperative jejunostomy feeding with an immune modulating diet in patients undergoing resectional surgery for upper gastrointestinal cancer: a prospective, randomized, controlled, double-blind study. Clin Nutr, 2006, 25(5): 716-726.
39. 冯立, 王峰, 董培德, 等. 胃癌患者根治术后早期肠内营养的临床疗效观察. 中国普外基础与临床杂志, 2014, 21(3): 325-329.
40. 伍映鑫, 夏霖, 王勇, 等. 胃癌患者术前应用含ω-3不饱和脂肪酸的肠内营养制剂的临床效果观察. 中国普外基础与临床杂志, 2015, 22(3): 312-316.
41. Rayes N, Seehofer D, Theruvath T, et al. Effect of enteral nutrition and synbiotics on bacterial infection rates after pylorus-preserving pancreatoduodenectomy: a randomized, double-blind trial. Ann Surg, 2007, 246(1): 36-41.
42. McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr, 2009, 33(3): 277-316.
43. Scurlock C, Mechanick JI. Early nutrition support in the intensive care unit: a US perspective. Curr Opin Clin Nutr Metab Care, 2008, 11(2): 152-155.
44. Singer P, Berger MM, van den Berghe G, et al. ESPEN guidelines on parenteral nutrition: intensive care. Clin Nutr, 2009, 28(4): 387-400.
45. Leier H. Does gum chewing help prevent impaired gastric motility in the postoperative period?. J Am Acad Nurse Pract, 2007, 19(3): 133-136.

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