Table 2.
Characteristics, aims, methods, indications for and data regarding preoperative exclusive enteral nutrition, and main conclusions of the articles under review
| Authors, country, and year of publication | Study design and time frame | Prospective Data base | Aims | Inclusion criteria | Indications for pre-op EEN | EEN/ no-EEN patients, n | Type of EEN | Duration of EEN | Route of administration | Tolerance to EEN | Main results |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Liet al.[57], China, 2015 | Retro spective cohort (01-2001 to 03-2014) | Yes | To evaluate the effect of pre-op EEN on 30-day post-op outcomes in CD pts | Abdominal surgery | Withdrawal of immunosuppression | 219/561 | Elemental* | Up to 8 weeks | NGT | Yes | Pre-op EEN was an independent protective factor against post-op infectious and non-infectious complications, significantly increased the drug-free interval, and decreased the emergent surgery, stoma, anastomotic leak, and reoperation rates |
| Heerasinget al.[58], UK, 2017 | Retro- spective cohort (2008 to 2015) | No | To evaluate if pre-op EEN could provide a bridge to surgery to reduce post-op complications and CD recurrence rate | Stricturing and penetrating complications | Dietitian prescription | 38/76 | Polymeric TGF-β2 enriched †* | 6.3 weeks (mean) | PO | Yes | Pre-op EEN led to less inflammation and shorter operative time, protected against anastomotic leak and/or abscesses, and even avoided surgery in some pts |
| Beaupelet al. [59], France, 2017 | Retro- spective cohort (06-2011 to 03-2015) | Yes | To assess whether EEN enriched with TGF-β2 could reduce 30-day post-op complications after surgery in high-risk§CD pts | Elective ileocecal or ileocolic resection | High-risk§ pts | 35§/21 | Polymeric TGF-β2 enriched † | 21.6 days (median) | PO − 34 pts; NGT − 1 pt | All but 1 pt | No prognostic factors for post-op global and abdominal complications identified; TGF-β2-enriched EEN could limit the deleterious effects of high-risk factors for post-op complications |
| Zhuet al. [60], China, 2017 | Retro- spective cohort (01-2011 to 06-2015) | No | To assess the value of EEN on 2-year surgery rate and on 30-day post-op morbidity in pts with percutaneously undrainable >1 cm intra-abdominal abscesses | Recurrent or not improving abscesses, and/or fistulae and/or bowel obstruction | Compliance/ tolerance to EEN | 46/28 | Elemental* | 39 days (median) | NGT | Yes | Pre-op EEN was an independent factor against surgery and significantly increased serum albumin, improved pts' inflammatory status, decreased IASCs, and led to a shorter post-op hospitalization |
pre-op, preoperative; EEN, exclusive enteral nutrition; pt(s), patient(s); post-op, postoperative; CD, Crohn's disease; NGT, nasogastric tube; TGF-β2, transforming growth factor beta-2; PO, per os; IASCs, intraabdominal septic complications.
Peptisorb Liquid® (Nutricia, Amsterdam, The Netherlands) – semi-elemental, 17.6 g carbohydrates, 1.7 g lipids, and 4 g protein/100 mL, 1 kcal/mL.
Modulen IBD® (Nestlé, Vevey, Switzerland) – polymeric TGF-β2 enriched, 54 g carbohydrates, 23 g lipids, and 18 g protein/100 mL, 1 kcal/mL.
High-risk patients: obstructive symptoms and/or penetrating CD and/or corticosteroid therapy and/or weight loss >10%.