The role of exclusive enteral nutrition in the pre-operative optimisation of adult patients with Crohn's disease: A systematic review

Ayeshah Gordon-Dixon; Jessica Gore-Rodney; Rumneek Hampal; Rose Ross; Anur Miah; Amanda Rodrigues Amorim Adegboye; Caris E. Grimes

doi:10.1016/j.clnesp.2021.09.723

The role of exclusive enteral nutrition in the pre-operative optimisation of adult patients with Crohn's disease: A systematic review

Ayeshah Gordon-Dixon
, Jessica Gore-Rodney
, Rumneek Hampal
, Rose Ross
, Anur Miah
, Amanda Rodrigues Amorim Adegboye
, Caris E. Grimes

Medway NHS Foundation Trust
University College London
Kingston Hospital NHS Foundation Trust

Research output: Contribution to journal › Article › peer-review

13 Citations (Scopus)

329 Downloads (Pure)

Abstract

Summary Aim To conduct a systematic review in order to bring together the current knowledge about the use of exclusive enteral nutrition (EEN) in the pre-operative optimisation of adult patients with Crohn's disease undergoing intestinal resection. Methods We searched Pubmed, Cochrane Library, ClinicalTrials.gov and the EU clinical trial register to identify experimental and observational studies on the effect of pre-operative EEN on nutritional and clinical outcomes of patients undergoing surgery. Methodological quality was assessed using the Downs and Black checklist. Results Seven studies were included in the final analysis. Of these 5 were retrospective cohort studies and 2 were retrospective case-control studies. There were 4 ongoing RCTs, however they have not reported data to analyse. Overall the 7 retrospective studies, support that with EEN; body mass index (BMI) does not increase, C-reactive protein decreases (CRP), albumin usually increases and haemoglobin does not significantly change. There were fewer infectious complications in patients who had taken EEN. There was a trend towards fewer stomas but only one of the studies was powered enough to demonstrate significance. There was no significant difference in recurrence rates of Crohn's disease at 12 months in any of the studies. Quality of the studies were either medium or poor. Conclusion The current data on the use of EEN in pre-operative optimisation is of poor quality and underpowered to demonstrate significance. Randomised controlled trials are needed to demonstrate whether or not EEN can improve outcomes and reduce stoma formation in adult patients undergoing intestinal resection.

Original language	English
Pages (from-to)	99-105
Number of pages	7
Journal	Clinical Nutrition ESPEN
Volume	46
Early online date	12 Oct 2021
DOIs	https://doi.org/10.1016/j.clnesp.2021.09.723
Publication status	Published - Dec 2021

Bibliographical note

© 2021, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/

Copyright © and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders.

This document is the author’s post-print version, incorporating any revisions agreed during the peer-review process. Some differences between the published version and this version may remain and you are advised to consult the published version if you wish to cite from it.

Keywords

Crohn's disease
Surgical resection
Enteral nutrition
Complications
Nutrition

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10.1016/j.clnesp.2021.09.723

Post-printAccepted author manuscript, 1.1 MBLicence: CC BY-NC-ND

Cite this

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title = "The role of exclusive enteral nutrition in the pre-operative optimisation of adult patients with Crohn's disease: A systematic review",

abstract = "Summary Aim To conduct a systematic review in order to bring together the current knowledge about the use of exclusive enteral nutrition (EEN) in the pre-operative optimisation of adult patients with Crohn's disease undergoing intestinal resection. Methods We searched Pubmed, Cochrane Library, ClinicalTrials.gov and the EU clinical trial register to identify experimental and observational studies on the effect of pre-operative EEN on nutritional and clinical outcomes of patients undergoing surgery. Methodological quality was assessed using the Downs and Black checklist. Results Seven studies were included in the final analysis. Of these 5 were retrospective cohort studies and 2 were retrospective case-control studies. There were 4 ongoing RCTs, however they have not reported data to analyse. Overall the 7 retrospective studies, support that with EEN; body mass index (BMI) does not increase, C-reactive protein decreases (CRP), albumin usually increases and haemoglobin does not significantly change. There were fewer infectious complications in patients who had taken EEN. There was a trend towards fewer stomas but only one of the studies was powered enough to demonstrate significance. There was no significant difference in recurrence rates of Crohn's disease at 12 months in any of the studies. Quality of the studies were either medium or poor. Conclusion The current data on the use of EEN in pre-operative optimisation is of poor quality and underpowered to demonstrate significance. Randomised controlled trials are needed to demonstrate whether or not EEN can improve outcomes and reduce stoma formation in adult patients undergoing intestinal resection.",

keywords = "Crohn's disease, Surgical resection, Enteral nutrition, Complications, Nutrition",

author = "Ayeshah Gordon-Dixon and Jessica Gore-Rodney and Rumneek Hampal and Rose Ross and Anur Miah and Adegboye, \{Amanda Rodrigues Amorim\} and Grimes, \{Caris E.\}",

note = "{\textcopyright} 2021, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ Copyright {\textcopyright} and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders. This document is the author{\textquoteright}s post-print version, incorporating any revisions agreed during the peer-review process. Some differences between the published version and this version may remain and you are advised to consult the published version if you wish to cite from it. ",

year = "2021",

month = dec,

doi = "10.1016/j.clnesp.2021.09.723",

language = "English",

volume = "46",

pages = "99--105",

journal = "Clinical Nutrition ESPEN",

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T1 - The role of exclusive enteral nutrition in the pre-operative optimisation of adult patients with Crohn's disease

T2 - A systematic review

AU - Gordon-Dixon, Ayeshah

AU - Gore-Rodney, Jessica

AU - Hampal, Rumneek

AU - Ross, Rose

AU - Miah, Anur

AU - Adegboye, Amanda Rodrigues Amorim

AU - Grimes, Caris E.

N1 - © 2021, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ Copyright © and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders. This document is the author’s post-print version, incorporating any revisions agreed during the peer-review process. Some differences between the published version and this version may remain and you are advised to consult the published version if you wish to cite from it.

PY - 2021/12

Y1 - 2021/12

N2 - Summary Aim To conduct a systematic review in order to bring together the current knowledge about the use of exclusive enteral nutrition (EEN) in the pre-operative optimisation of adult patients with Crohn's disease undergoing intestinal resection. Methods We searched Pubmed, Cochrane Library, ClinicalTrials.gov and the EU clinical trial register to identify experimental and observational studies on the effect of pre-operative EEN on nutritional and clinical outcomes of patients undergoing surgery. Methodological quality was assessed using the Downs and Black checklist. Results Seven studies were included in the final analysis. Of these 5 were retrospective cohort studies and 2 were retrospective case-control studies. There were 4 ongoing RCTs, however they have not reported data to analyse. Overall the 7 retrospective studies, support that with EEN; body mass index (BMI) does not increase, C-reactive protein decreases (CRP), albumin usually increases and haemoglobin does not significantly change. There were fewer infectious complications in patients who had taken EEN. There was a trend towards fewer stomas but only one of the studies was powered enough to demonstrate significance. There was no significant difference in recurrence rates of Crohn's disease at 12 months in any of the studies. Quality of the studies were either medium or poor. Conclusion The current data on the use of EEN in pre-operative optimisation is of poor quality and underpowered to demonstrate significance. Randomised controlled trials are needed to demonstrate whether or not EEN can improve outcomes and reduce stoma formation in adult patients undergoing intestinal resection.

AB - Summary Aim To conduct a systematic review in order to bring together the current knowledge about the use of exclusive enteral nutrition (EEN) in the pre-operative optimisation of adult patients with Crohn's disease undergoing intestinal resection. Methods We searched Pubmed, Cochrane Library, ClinicalTrials.gov and the EU clinical trial register to identify experimental and observational studies on the effect of pre-operative EEN on nutritional and clinical outcomes of patients undergoing surgery. Methodological quality was assessed using the Downs and Black checklist. Results Seven studies were included in the final analysis. Of these 5 were retrospective cohort studies and 2 were retrospective case-control studies. There were 4 ongoing RCTs, however they have not reported data to analyse. Overall the 7 retrospective studies, support that with EEN; body mass index (BMI) does not increase, C-reactive protein decreases (CRP), albumin usually increases and haemoglobin does not significantly change. There were fewer infectious complications in patients who had taken EEN. There was a trend towards fewer stomas but only one of the studies was powered enough to demonstrate significance. There was no significant difference in recurrence rates of Crohn's disease at 12 months in any of the studies. Quality of the studies were either medium or poor. Conclusion The current data on the use of EEN in pre-operative optimisation is of poor quality and underpowered to demonstrate significance. Randomised controlled trials are needed to demonstrate whether or not EEN can improve outcomes and reduce stoma formation in adult patients undergoing intestinal resection.

KW - Crohn's disease

KW - Surgical resection

KW - Enteral nutrition

KW - Complications

KW - Nutrition

UR - https://www.scopus.com/pages/publications/85117823152

U2 - 10.1016/j.clnesp.2021.09.723

DO - 10.1016/j.clnesp.2021.09.723

M3 - Article

SN - 2405-4577

VL - 46

SP - 99

EP - 105

JO - Clinical Nutrition ESPEN

JF - Clinical Nutrition ESPEN

ER -

The role of exclusive enteral nutrition in the pre-operative optimisation of adult patients with Crohn's disease: A systematic review

Abstract

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Keywords

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