Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent ME7 5NY, UK.
University College London, Gower Street, Bloomsbury, London WC1E 6BT, UK.
Clin Nutr ESPEN. 2021 Dec;46:99-105. doi: 10.1016/j.clnesp.2021.09.723. Epub 2021 Oct 12.
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.
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.
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.
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.
进行系统评价，以汇集目前关于克罗恩病成人患者肠道切除术术前肠内营养（EEN）的使用知识，以优化患者。
我们在 Pubmed、Cochrane 图书馆、ClinicalTrials.gov 和欧盟临床试验登记处搜索了关于术前 EEN 对手术患者营养和临床结局影响的实验和观察性研究。使用 Downs 和 Black 清单评估方法学质量。
最终分析纳入了 7 项研究。其中 5 项为回顾性队列研究，2 项为回顾性病例对照研究。有 4 项正在进行的 RCT，但尚未报告可分析的数据。总的来说，7 项回顾性研究支持 EEN 治疗后体重指数（BMI）不会增加，C 反应蛋白（CRP）降低，白蛋白通常增加，血红蛋白没有明显变化。接受 EEN 的患者感染并发症较少。接受 EEN 的患者造口术较少，但只有一项研究的效力足以证明这一点。在任何研究中，克罗恩病的 12 个月复发率均无显著差异。研究质量要么中等，要么较差。
目前关于术前 EEN 优化的使用的数据质量较差，且缺乏证明其意义的效力。需要进行随机对照试验，以证明 EEN 是否可以改善接受肠道切除术的成年患者的结局并减少造口术的形成。
