Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy.Variation in practices during the perioperative period exists including the type of nutrition started,the del...Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy.Variation in practices during the perioperative period exists including the type of nutrition started,the delivery route,and its timing.Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery,which can affect their ability to regain or maintain weight.Methods of feeding after an esophagectomy include total parenteral nutrition,nasoduodenal/nasojejunal tube feeding,jejunostomy tube feeding,and oral feeding.Recent evidence suggests that early oral feeding is associated with shorter LOS,faster return of bowel function,and improved quality of life.Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe,feasible,and cost-effective,albeit with limited data.However,data on anastomotic leaks is mixed,and some studies suggest that the incidence of leaks may be higher with early oral feeding.This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach.No definitive data is currently available to definitively answer this question,and further studies should look at how these early feeding regimens vary by surgical technique.This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.展开更多
ObjectiveTo compare the effects of oral intake and nasogastric tube(NG)feeding on nutritional status,complications and survival during neoadjuvant chemoradiotherapy for esophageal squamous-cell carcinoma(ESCC)patients...ObjectiveTo compare the effects of oral intake and nasogastric tube(NG)feeding on nutritional status,complications and survival during neoadjuvant chemoradiotherapy for esophageal squamous-cell carcinoma(ESCC)patients.MethodsA total of 61 ESCC cases treated with neoadjuvant chemoradiotherapy from December 2018 to March 2020 were enrolled,including(38 in oral intake group,and 22 in NG feeding group.Disease characteristics and baseline nutritional markers were collected in both groups.Nutritional status,complication and completion rate of chemoradiotherapy in both groups were evaluated.ResultsCompared with the oral intake group,patients in the NG feeding group had a later T stage(P=0.027)and clinical stage(P=0.014).The levels of energy intake(P=0.033),serum prealbumin(P<0.001),albumin(P=0.017)and hemoglobin(P=0.015)before treatment in NG group were significantly lower than those in oral intake group.Furthermore,patient-generated subjective global assessment(PG-SGA)score(P=0.016)and the levels of serum C-reactive protein(P=0.014)of NG feeding group were significantly higher than those of oral intake group.However,at the end of treatment,PG-SGA scores were increased in oral intake group and decreased in NG feeding group.In addition,the NG feeding group had a lower incidence of grade≥2 esophagitis(P=0.037),and higher completion rate of chemotherapy compared with oral intake group(P=0.034).Meanwhile,the proportion of parenteral nutrition(P=0.008)and anti-inflammatory(P=0.022)treatment in NG feeding group was significantly lower than that in oral intake group.Although patients in the NG feeding group had a worse prognosis,there were no statistically significant differences in overall survival(OS)and progression-free survival(PFS)between the two groups(P>0.05).ConclusionsAs a safe and effective enteral nutrition approach to improving nutrition,nasogastric tube feeding could increase treatment completion rate and reduce the incidence of≥grade 2 esophagitis reaction during neoadjuvant chemoradiotherapy.展开更多
文摘Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy.Variation in practices during the perioperative period exists including the type of nutrition started,the delivery route,and its timing.Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery,which can affect their ability to regain or maintain weight.Methods of feeding after an esophagectomy include total parenteral nutrition,nasoduodenal/nasojejunal tube feeding,jejunostomy tube feeding,and oral feeding.Recent evidence suggests that early oral feeding is associated with shorter LOS,faster return of bowel function,and improved quality of life.Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe,feasible,and cost-effective,albeit with limited data.However,data on anastomotic leaks is mixed,and some studies suggest that the incidence of leaks may be higher with early oral feeding.This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach.No definitive data is currently available to definitively answer this question,and further studies should look at how these early feeding regimens vary by surgical technique.This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.
文摘ObjectiveTo compare the effects of oral intake and nasogastric tube(NG)feeding on nutritional status,complications and survival during neoadjuvant chemoradiotherapy for esophageal squamous-cell carcinoma(ESCC)patients.MethodsA total of 61 ESCC cases treated with neoadjuvant chemoradiotherapy from December 2018 to March 2020 were enrolled,including(38 in oral intake group,and 22 in NG feeding group.Disease characteristics and baseline nutritional markers were collected in both groups.Nutritional status,complication and completion rate of chemoradiotherapy in both groups were evaluated.ResultsCompared with the oral intake group,patients in the NG feeding group had a later T stage(P=0.027)and clinical stage(P=0.014).The levels of energy intake(P=0.033),serum prealbumin(P<0.001),albumin(P=0.017)and hemoglobin(P=0.015)before treatment in NG group were significantly lower than those in oral intake group.Furthermore,patient-generated subjective global assessment(PG-SGA)score(P=0.016)and the levels of serum C-reactive protein(P=0.014)of NG feeding group were significantly higher than those of oral intake group.However,at the end of treatment,PG-SGA scores were increased in oral intake group and decreased in NG feeding group.In addition,the NG feeding group had a lower incidence of grade≥2 esophagitis(P=0.037),and higher completion rate of chemotherapy compared with oral intake group(P=0.034).Meanwhile,the proportion of parenteral nutrition(P=0.008)and anti-inflammatory(P=0.022)treatment in NG feeding group was significantly lower than that in oral intake group.Although patients in the NG feeding group had a worse prognosis,there were no statistically significant differences in overall survival(OS)and progression-free survival(PFS)between the two groups(P>0.05).ConclusionsAs a safe and effective enteral nutrition approach to improving nutrition,nasogastric tube feeding could increase treatment completion rate and reduce the incidence of≥grade 2 esophagitis reaction during neoadjuvant chemoradiotherapy.
文摘目的探讨间歇经口至食管管饲(intermittent oro-esophageal tube feeding,IOE)在急性卒中合并吞咽障碍患者中的应用效果。方法本研究为前瞻性随机对照研究,连续纳入2018年1月-2020年9月南京大学医学院附属鼓楼医院急诊科收治的急性卒中合并吞咽障碍患者,使用分层随机化方式将患者分为鼻饲组和IOE组。采用洼田饮水试验和标准吞咽功能评价量表(standardized swallowing assessment,SSA)分别在入院时及出院时对患者吞咽障碍进行评估,同时记录患者BMI、血红蛋白(hemoglobin,Hb)、血清白蛋白(albumin,ALB)及血清前白蛋白(prealbumin,PA)的变化,住院期间吸入性肺炎、消化性溃疡、便秘、腹泻、呕吐及口鼻黏膜破损的发生情况,以及住院天数等,比较两组上述指标的差异。结果符合纳入标准并进行分析的患者共126例,鼻饲组62例,IOE组64例。出院时IOE组吞咽功能临床疗效评级1级和2级的患者比例高于鼻饲组,但差异无统计学意义;IOE组SSA评分改善优于鼻饲组(24.88±3.07分vs 28.87±3.04分,P<0.001)。营养状况方面,出院时IOE组ALB(37.40±4.40 g/L vs 35.31±3.32 g/L,P=0.003)、PA(0.28±0.04 g/L vs 0.24±0.03 g/L,P<0.001)及Hb(127.60±6.93 g/L vs 124.76±6.69 g/L,P=0.021)均显著优于鼻饲组;IOE组患者吸入性肺炎(4.69%vs 22.58%,P=0.007)、呕吐(3.13%vs 25.81%,P=0.001)及口鼻黏膜破损(0 vs 17.74%,P=0.001)的发生率及住院天数(中位数15 d vs 17 d,P=0.029)也显著低于鼻饲组。结论 IOE可改善急性卒中合并吞咽障碍患者的吞咽功能,在提供良好营养支持的同时可降低吸入性肺炎、呕吐及口鼻黏膜破损的发生,值得临床推广。
