An Elemental Diet Reduces Chylous Ascites of Patients Undergoing Pancreatoduodenectomy in the Setting of Early Enteral Feeding

Author:

Matsumura Masaru1,Mise Yoshihiro2,Takemura Nobuyuki1,Ono Yoshihiro1,Sato Takafumi1,Ito Hiromichi1,Inoue Yosuke1,Takahashi Yu1,Saiura Akio2

Affiliation:

1. Department of Hepatobiliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake Hospital, 3-8-31 Ariake, Koto-ku

2. Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.

Abstract

Objectives The elemental diet (ED) is a formula to support nutritional status without increasing chylous burden. This study evaluates the efficacy of early ED feeding after pancreatoduodenectomy (PD). Materials and Methods A prospective phase II study of consecutive patients who underwent PD with early ED feeding was conducted. Patient backgrounds, surgical outcomes, and ED feeding tolerability were compared with a historical cohort of 74 PD patients with early enteral feeding of a low residue diet (LRD). Results The ED group comprised 104 patients. No patient in the ED group discontinued enteral feeding because of chylous ascites (CAs), whereas 17.6% of the LRD group experienced refractory CAs that disrupted further enteral feeding. The CAs rate was significantly decreased in the ED group compared with the LRD group (3.9% and 48.7%, respectively; P < 0.001). There was no significant difference in the incidence of major complications (ED: 17.3%, LRD: 18.9%; P = 0.844). Postoperative prognostic nutritional index was similar between the 2 groups (P = 0.764). In multivariate analysis, enteral feeding formula, and sex were independent risk factors for CAs (LRD: P < 0.001, odds ratio, 22.87; female: P = 0.019, odds ratio, 2.78). Conclusions An ED reduces postoperative CAs of patients undergoing PD in the setting of early enteral feeding.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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1. Elemental Diet as a Therapeutic Modality: A Comprehensive Review;Digestive Diseases and Sciences;2024-07-13

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