Do patients fed enterally post–gastrointestinal surgery experience more complications when fed a fiber-enriched feed compared with a standard feed? A systematic review

The role of enteral feeding with fiber-enriched feeds in minimizing infections, shortening length of hospital stay (LOHS), and preventing or treating feeding complications has been widely researched. However, there is limited evidence to evaluate the role of fiber-enriched enteral feeding in gastrointestinal surgery patients postoperatively. This systematic review aims to identify the role of fiber-enriched enteral feeds on postoperative feeding complications of diarrhea, nausea and vomiting, abdominal distension, flatulence, cramps, LOHS, and infection rates after gastrointestinal surgery. A systematic literature search was conducted using MEDLINE, CINAHL, and Cochrane Library. Manual reference lists were searched on identified studies and the SCOPUS database. Randomized controlled trials (RCTs) conducted on any gastrointestinal surgery type that included enteral nutrition with high-fiber enteral feeds and/or fiber supplements were included. All studies included were screened for risk of bias with Cochrane's risk-of-bias tool, and data were extracted with Cochrane Collaboration's data extraction tool. In total, 3 RCTs out of 231 screened citations including fiber-enriched feeds and probiotics were included in this review. No significant effect on LOHS or postoperative infections was found. No safety risks were identified. Limited, low-quality evidence suggests fiber-enriched feeds may minimize diarrhea incidence. The effects of fiber-enriched feeds postoperatively in gastrointestinal surgery remain under-researched. Studies evaluating fiber and probiotics were low quality and at high risk of bias because of the misreporting of outcomes and the lack of detailed outlines of probiotic strains utilized. However, fiber-enriched enteral feeding appears safe, may yield benefits, and is recommended in stable gastrointestinal surgical patients.