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Early oral feeding after pancreatoduodenectomy: a systematic review and meta-analysis

Lookup NU author(s): Sanjay PandanaboyanaORCiD


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© 2022 International Hepato-Pancreato-Biliary Association Inc. Background: The effect of early oral feeding (EOF) after pancreatoduodenectomy (PD) upon perioperative complications and outcomes is unknown, therefore the aim of this systematic review and meta-analysis was to investigate the effect of EOF on clinical outcomes after PD, such as postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE) and length of stay (LOS). Methods: A systematic review and meta-analysis was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance and assimilated evidence from studies reporting outcomes for patients who received EOF after PD compared to enteral tube feeding (EN) or parenteral nutrition (PN). Results: Four studies reported outcomes after EOF compared to EN/PN after PD and included 553 patients. Meta-analyses showed no difference in rates of CR-POPF (OR 0.74; 95%CI 0.44–1.24; p = 0.25) or DGE (Grade B/C) (OR 0.83; 95%CI 0.31–2.21; p = 0.70). LOS was significantly shorter in the EOF group compared to the EN/PN group (Mean Difference −3.40 days; 95% −6.11-0.70 days; p = 0.01). Conclusion: Current available evidence suggests that EOF after PD is not associated with increased risk of DGE, does not exacerbate POPF and appears to reduce length of stay.

Publication metadata

Author(s): Halle-Smith JM, Pande R, Powell-Brett S, Pathak S, Pandanaboyana S, Smith AM, Roberts KJ

Publication type: Review

Publication status: Published

Journal: HPB

Year: 2022

Pages: Epub ahead of print

Online publication date: 26/04/2022

Acceptance date: 12/04/2022

ISSN (print): 1365-182X

ISSN (electronic): 1477-2574

Publisher: Elsevier B.V.


DOI: 10.1016/j.hpb.2022.04.005