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Cited by 858Enhanced Recovery After SurgeryClinical Nutrition and GastroenterologyAbdominal Surgery and Complications

Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and meta-analysis of controlled trials

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Lewis, Stephen J, Egger, Matthias, Sylvester, Paul A, Thomas, Steven·2001·BMJ
DOI 10.1136/bmj.323.7316.773PMC PMC57351
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Abstract

Objective: To determine whether a period of starvation (nil by mouth) after gastrointestinal surgery is beneficial in terms of specific outcomes. Design: Systematic review and meta-analysis of randomised controlled trials comparing any type of enteral feeding started within 24 hours after surgery with nil by mouth management in elective gastrointestinal surgery. Three electronic databases (PubMed, Embase, and the Cochrane controlled trials register) were searched, reference lists checked, and letters requesting details of unpublished trials and data sent to pharmaceutical companies and authors of previous trials. Main outcome measures: Anastomotic dehiscence, infection of any type, wound infection, pneumonia, intra-abdominal abscess, length of hospital stay, and mortality. Results: Eleven studies with 837 patients met the inclusion criteria. In six studies patients in the intervention group were fed directly into the small bowel and in five studies patients were fed orally. Early feeding reduced the risk of any type of infection (relative risk 0.72, 95% confidence interval 0.54 to 0.98, P=0.036) and the mean length of stay in hospital (number of days reduced by 0.84, 0.36 to 1.33, P=0.001). Risk reductions were also seen for anastomotic dehiscence (0.53, 0.26 to 1.08, P=0.080), wound infection, pneumonia, intra-abdominal abscess, and mortality, but these failed to reach significance (P>0.10). The risk of vomiting was increased among patients fed early (1.27, 1.01 to 1.61, P=0.046). Conclusions: There seems to be no clear advantage to keeping patients nil by mouth after elective gastrointestinal resection. Early feeding may be of benefit. An adequately powered trial is required to confirm or refute the benefits seen in small trials. What is already known on this topic: Enteral feeding within 24 hours after gastrointestinal surgery is tolerated Theoretically, early enteral feeding improves tissue healing and reduces septic complications after gastrointestinal surgery What this study adds: There is no benefit in keeping patients “nil by mouth” after gastrointestinal surgery Septic complications and length of hospital stay were reduced in those patients who received early enteral feeding In patients who received early enteral feeding there were no significant reductions in incidence of anastomotic dehiscence, wound infection, pneumonia, intra-abdominal abscess, and mortality

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  • Early postoperative oral feeding does not negatively affect outcomes such as mortality, anastomotic dehiscence, resumption of bowel function, or hospital length of stay.

    “and does not negatively affect outcomes such as 1587 mortality, anastomotic dehiscence, resumption of bowel function, or hospital length of stay 1588 [209, 210].”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [210]

    The Outcomes and Abstract report no significant increase in anastomotic dehiscence or mortality with early feeding, and a shorter hospital stay. But the review pooled oral feeding with feeding directly into the small bowel; it does not establish those findings for oral feeding alone. The Length of hospital stay section suggests faster return of gastrointestinal function only as a possible explanation, not a measured outcome. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Two recent meta-analyses showed that early postoperative oral feeding is associated with significant reductions in total complications compared with traditional postoperative feeding practices.

    “Two recent meta-analyses showed that early postoperative 1585 oral feeding is associated with significant reductions in total complications compared with 1586 traditional postoperative feeding practices”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [210]

    The Outcomes section reports a significant reduction in infections of any type with early enteral feeding versus nil by mouth. It does not report a significant reduction in total complications: the Methods list separate outcomes, and the Outcomes section reports increased vomiting. The source evaluates enteral feeding, which is not necessarily oral feeding. (LLM, conf=0.88)

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Cites

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Research works printed but not linked: 32

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Cited by

Sorted by citations

Authors
Lewis, S. J., Egger, M., Sylvester, P. A., & Thomas, S.
Affiliations
  • Addenbrooke's Hospital (GB)
  • University of Bristol (GB)
  • Bristol Royal Infirmary (GB)
ORCID
Venue
BMJ
Publisher
BMJ
Published
2001-10-06
Volume
323
Issue
7316
Pages
773
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.323.7316.773
PMC
PMC57351
OpenAlex
W2080262569
Cited by
858
References
2
Citations by year
2026: 14 · 2025: 17 · 2024: 22 · 2023: 19 · 2022: 27 · 2021: 24 · 2020: 27 · 2019: 25 · 2018: 32 · 2017: 33 · 2016: 36 · 2015: 57 · 2014: 54 · 2013: 49 · 2012: 38
FWCI
4.72
Type
journal article
Language
en
Open access
Licence
www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations
  • BMJ (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Mead Johnson Nutrition
Topics
  • Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
Keywords
early enteral nutrition, gastrointestinal surgery, postoperative feeding, anastomotic leakage, postoperative infection, wound infection, pneumonia, intra-abdominal abscess, length of hospital stay, postoperative mortality, vomiting, postoperative sepsis, surgical wound healing, postoperative nutrition, postoperative analgesia
MeSH terms
Anastomosis, Surgical, Enteral Nutrition, Food Deprivation, Humans, Postoperative Period, Research Design, Risk, Digestive System Surgical Procedures, Surgical Wound Dehiscence, Surgical Wound Infection, Vomiting, Chi-Square Distribution, Randomized Controlled Trials as Topic, Unnecessary Procedures

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