Enteral versus parenteral nutrition after total gastrectomy

Enteral versus parenteral nutrition after total gastrectomy

P.33 NlJmTIoNAFrgRIwIAL~ mImALVmSUsP~ F. Penuimkx,A. Heylen,M. Lybeer, P. Frost(Departnmtof Castroenterological Surgery, University of Leuven,Belgium...

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NlJmTIoNAFrgRIwIAL~ mImALVmSUsP~ F. Penuimkx,A. Heylen,M. Lybeer, P. Frost(Departnmtof Castroenterological Surgery, University of Leuven,Belgiumand Department of ClinicalPathology, CentralMickllesex Hospital, London,U.K.). Aftertotalgastrectany with esophageal anastcmsis,oral foodintakeis forbidden untilall riskof anastamticleakagehas passed,usuallyafterone to two meks. Sincefoodintakewilluotbenonaal for a furtherweek or so, evenmostwell-nourished patients will sufferpostoperative protein-caloric malnutrition unlessscm fom of alternative feedingis instituted.The paxpxe of thisstudyis to comparethe nutritional effects,safety,simplicity at-dcostof an elemental diet (Vivonex UN, NorwichEaton),and equivalent totalparenteral nutrition in 2 cmparablegroupsof 10 patients following totalgastrectany for adenocarcinms.Enteralnutrition (kX)was delivered via a needle catheterjejurmtaq at a levelcorresponding to 85 an helm Treitz'ligamentami parenteral nutrition (PN)via a centralvenousline. Nutritionstarted6 hrs afteroperation in each g-coup.The PN group was givena variable mixtureof Vamin-glucose, Intra-lipid 20% (KabiVitrm)ard glucose30 to 50% Graveml) in orderto be infusediso-nitrogenously aml iso-calorically as much as possible, according to the DJ scheme. Effective caloricintakewas alwaysidentical to the prescribed amountsin the FW group. In the m group ouly 83% of the globalaumnt of prescribed enteralfeedcouldbe administered due to osmticallyimduced abdominal crampsand diarrhoea.Nevertheless, the &XJ treatment groupsdid not differsignificantly with respectto changesof the antropmetric ~aeeters, exceptthe mid-upperarm circmference(-1.6an in EN vs -0.4cm in IW group;~(0.05). The evolution of the man daily nitrogenbslancewas caqmrablein bothgroups. No significant differences relatedto protein synthesis, liverfunction tests,hamglobin, totallymphocyte countard delayedhypersensitivity skintestswere observed.No patientexperienced catheter ccmplications. The costratiowas 1 versus2 in the advantage of m. This studyprovesthatit is possibleto preventmlnutritionaftermajorabdminal surgeryby an enteralfeedingregimenevenwhen Dl is to bs administered at a levelfar belowIreitz'Ligament.



ENl’ERU NUIRITIM. J. Ghisolfi, C. Lapalu-Tracm, 0. Couvaras, JP. Olives, MI. Boyer,

JP. Thouvenot (Groupe d’Etudes en Nutrition Infantile - CHJPurpan 31059 Toulouse C6dex France.) The metabolic effects of a taurine-supplented dietary formula in infants on the synthesis and the conjugaticm of bile acids remain uncertain. 16 children, received an artificial nutrition necessitated by a digestive disease. At the beginning of the present study, they were 6 to 16 wks-old, in good nutritional state, witkut malabsorption, protein-losing enteropathy, liver or infectious disease signs. They had the same semi-elemental defined fornula diets adapted to their requirements. The infants received at least 8 days this diet without taurine, followed immediately by 8 to 21 days of the same regimen supplementedby taurine (36 to 45 umol/kg/2+ h). Bile swles ware obtained by duodenal tube, after at least 8 days of diet without i taurine (Pl ; n-10)) and 8 dqS CP2; n-lo), 15 to 20 days (P3 ; n-6) of a taurine supplementeddiet. Total bile acid IN), taurocholic acid (TA), taurochenodeoxycholic acid (I’CRA), taurodeoxycholic acid acid YTW ,glycocholic acid (GA),glycocbenoaeaxycholit acid (CXIIA),glycodeoxy&lic (GCA)and unconjugated bile acid (UN) contxmtration$weremeasuredby enzymaticmethods after thin-layer chraaatography (a~l/l). The glyco and tauro conjugates ratio (G/T) was evaluated. The following results were obtained (m Z Sar). TBA



Pl 1222 1,1+0,2 0,8+0,1 P2 1623 1,4f0,4 1,5*0,5 P3 2Ot6 2,2*_0,5 l,l+-0,2 k Altigh a clear increase supplenrentaticn, the t-test, nificant differences, except

TCA 0,2fO,l 0,3+-0,l 0,4t0,1

GA 5,2+-l,l 6,0+-l,4 8,6+,2,4

ax4 2,4+-0,s 3,1+-0,9 3,8*10,9

GCA 0,2+,0,1 0,5+-0,l 0,6tO,l

lJB4 1,l+-0,2 1,6tO,4 1,8%I,3

G/T 4,4+-0,8 3,220,s 3,4+-0,3

of total and conjugated bile acids was noted after taurine with our present ntanberof subjects, did not show a sigfor TM (Pl/P2). 113