Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
First Faculty of Medicine, Charles University, Prague, Czech Republic.
Dig Endosc. 2019 Nov;31(6):646-652. doi: 10.1111/den.13423. Epub 2019 May 24.
Oral feeding following variceal ligation in cirrhotics is usually delayed due to fear of rebleeding. Solid diet is usually further delayed (until 72 h) despite lack of evidence. We aimed to compare the impact of early versus delayed feeding on rebleeding following variceal ligation.
This was a prospective randomized controlled trial including patients undergoing variceal ligation for active esophageal variceal bleeding. Patients were randomized into two groups. In the early-feeding group, liquid diet was given after 1 h following variceal ligation and a regular solid diet was resumed after 4 h. In the delayed-feeding group, patients fasted for the first 4 h after variceal ligation, liquid diet was given until 24 h, soft diet for the next 48 h and a regular solid diet after 72 h.
There were 52 and 49 patients in the early and delayed feeding groups, respectively. Very early rebleeding rates [2 (3.84%) vs 1 (2.04%); P ≥ 0.99] and delayed rebleeding rates [2 (3.84%) vs 4 (8.16%); P = 0.75] were similar in both groups. Protein and calorie intake in the early-feeding group was significantly better and early infections in active bleeders were significantly lower compared to the delayed-feeding group. One-month mortality was similar in both groups [3 (5.76%) vs 4 (8.16%); P = 0.75].
Early feeding with a regular solid diet in conscious patients after successful variceal ligation for esophageal varices is safe, provides better nutrition and results in lower incidence of infections in bleeders compared to delayed feeding.
肝硬化患者行食管静脉曲张结扎术后通常因担心再出血而延迟进食。尽管缺乏证据，但通常会进一步延迟固体饮食（直到 72 小时）。我们旨在比较早期与延迟进食对食管静脉曲张结扎术后再出血的影响。
这是一项前瞻性随机对照试验，纳入了因活动性食管静脉曲张出血而行食管静脉曲张结扎术的患者。患者被随机分为两组。在早期喂养组中，在结扎后 1 小时给予液体饮食，并在 4 小时后恢复常规固体饮食。在延迟喂养组中，患者在结扎后前 4 小时禁食，在 24 小时内给予液体饮食，接下来的 48 小时给予软食，在 72 小时后给予常规固体饮食。
早期喂养组和延迟喂养组分别有 52 例和 49 例患者。两组早期再出血率[2（3.84%）比 1（2.04%）；P≥0.99]和迟发性再出血率[2（3.84%）比 4（8.16%）；P=0.75]相似。早期喂养组的蛋白质和卡路里摄入明显更好，活动性出血者的早期感染明显更低。两组 1 个月死亡率相似[3（5.76%）比 4（8.16%）；P=0.75]。
在成功进行食管静脉曲张结扎术治疗食管静脉曲张后，对意识清醒的患者进行常规固体饮食的早期喂养是安全的，与延迟喂养相比，可为出血者提供更好的营养，并且感染发生率更低。
