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Effect of lower esophageal gastric tube implantation in postoperative enteral nutritional support in patients with laryngeal cancer: A study protocol for a randomized controlled trial.
Xiao, H, Liu, J, Liu, S, Chen, X
Medicine. 2020;(16):e19771
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Abstract
BACKGROUND For a long time, postoperative nutritional support for laryngeal cancer patients has depended on the gastric tube for enteral nutrition. Silica gel gastric tube is often used in clinical practice; however, the gastric tube placed in the conventional depth often leads to various complications in the stomach, thus damaging the nutritional status of patients and leading to the poor prognosis. METHODS/DESIGN A total of 80 patients with laryngeal cancer in otolaryngology, head and neck surgery department of Deyang people's hospital from May 2020 to April 2022 will be selected and randomly divided into control group and experimental group according to the numerical table. Patients in the control group will receive conventional gastric tube placement, with a depth of 45 to 55 cm, which can extract gastric juice. B-ultrasound accurately positioned the gastric tube in the stomach instead of the cardia, and postoperative nasal feeding nutrition will be provided. In the experimental group, the gastric tube will be pulled out 10 cm after conventional placement and no gastric juice will be extracted. B-ultrasonography verified that the gastric tube will be located below the esophagus or above the cardia, and routine nasal feeding will be performed postoperatively. Analysis for comfort and prognosis were performed by general comfort questionnaire and various index including height, body mass index, albumin value, electrolyte, wound healing, pharyngeal fistula. DISCUSSION In this study, visual simulation scale and general comfort questionnaire developed by Kolaba, an American comfort nursing specialist, were used to evaluate the comfort level of the 2 groups of patients, including pain, acid reflux, upper abdominal burning sensation, and hiccup. Objective indexes such as height, body mass index, albumin value, electrolyte, wound healing, and pharyngeal fistula were used to evaluate the prognosis of the 2 groups of patients. The visual simulation scale can preliminarily judge the subjective feelings of patients. TRIAL REGISTRATION It has been registered at http://www.chictr.org.cn/listbycreater.aspx (Identifier: ChiCTR2000030378), Registered February 29, 2020.
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Exclusive enteral nutritional therapy can relieve inflammatory bowel stricture in Crohn's disease.
Hu, D, Ren, J, Wang, G, Li, G, Liu, S, Yan, D, Gu, G, Zhou, B, Wu, X, Chen, J, et al
Journal of clinical gastroenterology. 2014;(9):790-5
Abstract
GOALS To examine the efficiency of exclusive enteral nutrition (EEN) in relieving inflammatory bowel stricture in patients with Crohn's disease (CD). BACKGROUND Patients with CD usually develop bowel strictures due to transmural edema of intestinal wall, which can potentially be managed with conservative medical treatment. Previous studies showed that EEN therapy could induce clinical remission through its anti-inflammation effect. METHODS We achieved a prospective observational study. CD patients with inflammatory bowel stricture were preliminarily differentiated from a fibrous one, and further treated with EEN therapy for 12 weeks. Demographics and clinical variables were recorded. Nutritional (body mass index, albumin, pre-albumin, transferrin, etc.), inflammatory (C-reactive protein, erythrocyte sedimentation rate, white blood cell, etc.), and radiologic parameters (bowel wall thickness, luminal diameter, and luminal cross-sectional area) were evaluated at baseline, week 4, and week 12, respectively. RESULTS Between May 2012 and January 2013, 65 patients with CD were preliminarily diagnosed with inflammatory bowel stricture and 6 patients were further excluded. Among the remaining 59 cases, 50 patients (84.7%) finished the whole EEN treatment, whereas the other 9 patients (15.3%) gained progressive bowel obstruction resulting in surgery. Intention-to-treat analyses showed that 48 patients (81.4%) achieved symptomatic remission, 35 patients (53.8%) achieved radiologic remission, and 42 patients (64.6%) achieved clinical remission. Among those patients who complete the whole EEN therapy, inflammatory, nutritional, and radiologic parameters improved significantly compared with baseline. Of note, the average luminal cross-sectional area at the site of stricture increased approximately 331% at week 12 (195.7 ± 18.79 vs. 59.09 ± 10.64 mm, P<0.001). CONCLUSIONS EEN therapy can effectively relieve inflammatory bowel stricture in CD, which replenishes roles of enteral nutrition in the treatment of CD. Further studies are expected to investigate the underlying mechanisms of this effect in the future.
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Application of perioperative immunonutrition for gastrointestinal surgery: a meta-analysis of randomized controlled trials.
Zheng, Y, Li, F, Qi, B, Luo, B, Sun, H, Liu, S, Wu, X
Asia Pacific journal of clinical nutrition. 2007;:253-7
Abstract
The aim of this study was to evaluate clinical and economic validity of perioperative immunonutrition and effect on postoperative immunity in patients with gastrointestinal cancers. Immunonutrition diet supplemented two or more of nutrients including glutamine, arginine, omega-3 polyunsaturated fatty acids and ribonucleic acids. A meta-analysis of all relevant clinical randomized controlled trials (RCTs) was performed. The trials compared perioperative immunonutrition diet with standard diet. We extracted RCTs from electronic databases: Cochrane Library, MEDLINE, EMBASE, SCI and assessed methodological quality of them according handbook for Cochrane reviewer in June 2006. Statistical analysis was performed by RevMan4.2 software. Thirteen RCTs involving 1269 patients were included. The combined results showed that immunonutrition had no significant effect on postoperative mortality (OR =0.91, p= 0.84). But it had positive effect on postoperative infection rate (OR =0.41, p<0.00001), length of hospital stay (WMD=-3.48, p<0.00001). Furthermore, it improved immune function by increasing total lymphocytes (WMD=0.40, p<0.00001), CD4 levels (WMD=11.39, p<0.00001), IgG levels (WMD=1.07, p=0.0005) and decreasing IL6 levels (WMD=-201.83, p<0.00001). At the same time, we did not found significant difference in CD8, IL2 and CRP levels . There were no serious side effects and two trials found low hospital cost. In conclusion, perioperative diet adding immunonutrition is effective and safe to decrease postoperative infection and reduce length of hospital stay through improving immunity of postoperative patients as compared with the control group. Further prospective study is required in children or critical patients with gastrointestinal surgery.