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MON-LB282: Effect of Early Enteral Nutrition Supplemented with Arginine on Postoperative Course for Patients with Pancreaticoduoduodenecy
Late-breaking abstract 2 67 did not. Among those who had open surgery and those who had a left-sided colectomy, CG was associated with a marginally longer LOS (LOS in SC and CG arms, respectively, was: 7 and 8 days, SHR 0.76, 95% CI 0.59–0.99, p = 0.04 for those having open surgery; 6 and 7 days, SHR 0.65, 95% CI 0.42–0.99, p = 0.05 for those having left-sided colectomy). There were no differences between treatments within subgroups for resumption of bowel habits. Conclusion: This exploratory analysis has shown no beneficial effect of chewing gum on LOS or bowel habit within selected subgroups. This was an exploratory analysis using data from an existing RCT, and findings should be interpreted with caution. Disclosure of Interest: None declared
MON-LB281 THE ROLE OF NUTRITION THERAPY TEAM IN THE MANAGEMENT OF MALNOURISHED GASTRIC CANCER PATIENTS UNDERGOING GASTRECTOMY L. V. Joon1, M. S. Jahit1. 1Department of surgery, Sungai Buloh Hospital, selangor, Malaysia Rationale: Majority of gastric cancers patients presented in a state of malnutrition. Gastrectomy and node dissection will certainly results in intra-operative stress. Prolong malnutrition post-operatively will results in delayed overall recovery. Dedicated nutrition therapy team enhances the provision perioperative nutrition optimization. Methods: This is a retrospective analysis of peri-operative nutritional optimization in patient undergoing gastrectomy for gastric cancer. Enteral feeding was given pre-operatively. Nasoenteric tube via endoscopy was performed after surgery and feeding resumed less than 24 hours post-operatively. Caloric goal and nitrogen balance were assessed to determine the perioperative nutrition optimization. Results: Total of 97 patients underwent D2 total gastrectomy. Preoperative optimization successfully reduced the caloric gap from 864 kcal/day to 1153 kcal/day and nitrogen balanced improved from-3.57 to + 1.19. Initiation of enteral feeding less than 24 hours post-operatively managed to achieve 30% of caloric requirement. Nitrogen balance dropped post-operatively to −7.82. However with a strategy to step up the caloric and protein goal judiciously the nitrogen balance improved to −1.15 at the end of the first week. Total calorie achieved at the end of the first week was 1446 kcal/day or equivalent to 80% of the daily requirement. Conclusion: Dedicated effort by nutrition therapy team is required to assess and monitor peri-operative nutritional optimization for patient undergoing major cancer surgery. Gastrectomy and node dissection has a major impact on protein degradation. Early provision of adequate calorie and protein should be the goal in major cancer surgery. Post gastrectomy early enteral feeding is safe and feasible. References Konstantinides FN Nitrogen balance studies in clinical nutrition. Nutr Clin Pract. 1992;7(5):231–238. Vaithiswaran V et al. Effect of early enteral feeding after upper gastrointestinal surgery. Trop Gastroenterol. 2008;29(2):91–94. Blumenstein I et al. Gastroenteric tube feeding:Techniques, problems and solutions. J. World J Gastroenterol. 2014;20(26):8505–8524. Disclosure of Interest: None declared
S257 MON-LB282 EFFECT OF EARLY ENTERAL NUTRITION SUPPLEMENTED WITH ARGININE ON POSTOPERATIVE COURSE FOR PATIENTS WITH PANCREATICODUODUODENECY Y. Okamoto1, Y. Ikematsu2, M. Ogiku2, T. Ogasawara3. 1Clinical Nutritional Management, 2Surgery, 3Respiratory, Hamamatsu Medical Center, Hamamatsu, Japan Rationale: To evaluate if the administration of an enteral diet supplemented with arginine modulates postoperative responses for patients with pancreaticoduodenectomy. Methods: A prospective randomized, clinical trial was performed. Twelve patients with pancreatic cancer were randomized into two groups, One group were given an isocaloric and isonitrogenous standard diet after pancreaticoduodenectomy (group C:n = 5), another group were fed with the supplemented diet with arginine after pancreaticoduodenectomy (group A:n = 7). Feeding were started within 48 hours after operation and continued until day 8. Results: Nitrogen balance in group A became only slightly positive on postoperative day 7(group A:0.044 ± 3.57, group C: −0.93 ± 1.8 p = 0.3). In addition, lean body mass change late of subjects in group A slightly increased (group A:4.96 ± 5.7, group C:1.27 ± 4.9 p = 0.66). Post-operative Interlukin-6 levels increased on first pod (group A:68.6 ± 0.2, group C:83.4 ± 22.1) compared with pre-operative levels (group A:4 ± 1.9, group C:12.3 ± 5.7), as they are inflammation markers, but there was no difference between two groups (group A:46.7 ± 1.8, group C: 35.9 ± 22.6 p = 0.7). No significant differences in the day of oral nutrition initiation, incidence of complications, or other nutritional indices were observed. Conclusion: The early enteral nutrition with arginine supplementation might improve nitrogen balance. References ESPEN: European for Clinical Nutrition and Metabolism guidelines 2006. Fan J, Meng Q et al. Effects of early enteral nutrition supplemented with arginine on intestinal mucosal immmunity in severely bumed mice. Clin Nutr. 2010;29:124–330. Disclosure of Interest: None declared
MON-LB283 EFFECTS BY OVERNIGHT STANDARD TPN ON AMINO ACID TRANSPORTERS IN THE HUMAN RECTUS ABDOMINIS MUSCLE B.-M. Iresjö1, C. Engström1, K. Lundholm1. 1Department of surgery, University of Gothenburg, Göteborg, Sweden Rationale: Recent studies indicate that amino acid transporters may act as components to activate cell-signaling across the mTOR pathway to stimulate protein translation in addition to be conventional cell transporters. However, in vivo studies on human muscle tissue is limited, particularly in response to provision of total parenteral nutrition (TPN). In the present study we examined to what extent short term provision of “standard” total parenteral nutrition (TPN) affects the content of muscle amino acid transporters at mRNA and protein levels. Methods: 22 patients scheduled for upper GI-surgery, with potential need for postoperative parenteral nutrition, received either a continuous standard TPN infusion (0.16 gN · kg−1 · day−1, 30 kcal · kg−1 day−1) or saline infusion for 12 hours overnight feeding before operation. Biopsies from the rectus
MON-LB281 THE ROLE OF NUTRITION THERAPY TEAM IN THE MANAGEMENT OF MALNOURISHED GASTRIC CANCER PATIENTS UNDERGOING GASTRECTOMY L. V. Joon1, M. S. Jahit1. 1Department of surgery, Sungai Buloh Hospital, selangor, Malaysia Rationale: Majority of gastric cancers patients presented in a state of malnutrition. Gastrectomy and node dissection will certainly results in intra-operative stress. Prolong malnutrition post-operatively will results in delayed overall recovery. Dedicated nutrition therapy team enhances the provision perioperative nutrition optimization. Methods: This is a retrospective analysis of peri-operative nutritional optimization in patient undergoing gastrectomy for gastric cancer. Enteral feeding was given pre-operatively. Nasoenteric tube via endoscopy was performed after surgery and feeding resumed less than 24 hours post-operatively. Caloric goal and nitrogen balance were assessed to determine the perioperative nutrition optimization. Results: Total of 97 patients underwent D2 total gastrectomy. Preoperative optimization successfully reduced the caloric gap from 864 kcal/day to 1153 kcal/day and nitrogen balanced improved from-3.57 to + 1.19. Initiation of enteral feeding less than 24 hours post-operatively managed to achieve 30% of caloric requirement. Nitrogen balance dropped post-operatively to −7.82. However with a strategy to step up the caloric and protein goal judiciously the nitrogen balance improved to −1.15 at the end of the first week. Total calorie achieved at the end of the first week was 1446 kcal/day or equivalent to 80% of the daily requirement. Conclusion: Dedicated effort by nutrition therapy team is required to assess and monitor peri-operative nutritional optimization for patient undergoing major cancer surgery. Gastrectomy and node dissection has a major impact on protein degradation. Early provision of adequate calorie and protein should be the goal in major cancer surgery. Post gastrectomy early enteral feeding is safe and feasible. References Konstantinides FN Nitrogen balance studies in clinical nutrition. Nutr Clin Pract. 1992;7(5):231–238. Vaithiswaran V et al. Effect of early enteral feeding after upper gastrointestinal surgery. Trop Gastroenterol. 2008;29(2):91–94. Blumenstein I et al. Gastroenteric tube feeding:Techniques, problems and solutions. J. World J Gastroenterol. 2014;20(26):8505–8524. Disclosure of Interest: None declared
S257 MON-LB282 EFFECT OF EARLY ENTERAL NUTRITION SUPPLEMENTED WITH ARGININE ON POSTOPERATIVE COURSE FOR PATIENTS WITH PANCREATICODUODUODENECY Y. Okamoto1, Y. Ikematsu2, M. Ogiku2, T. Ogasawara3. 1Clinical Nutritional Management, 2Surgery, 3Respiratory, Hamamatsu Medical Center, Hamamatsu, Japan Rationale: To evaluate if the administration of an enteral diet supplemented with arginine modulates postoperative responses for patients with pancreaticoduodenectomy. Methods: A prospective randomized, clinical trial was performed. Twelve patients with pancreatic cancer were randomized into two groups, One group were given an isocaloric and isonitrogenous standard diet after pancreaticoduodenectomy (group C:n = 5), another group were fed with the supplemented diet with arginine after pancreaticoduodenectomy (group A:n = 7). Feeding were started within 48 hours after operation and continued until day 8. Results: Nitrogen balance in group A became only slightly positive on postoperative day 7(group A:0.044 ± 3.57, group C: −0.93 ± 1.8 p = 0.3). In addition, lean body mass change late of subjects in group A slightly increased (group A:4.96 ± 5.7, group C:1.27 ± 4.9 p = 0.66). Post-operative Interlukin-6 levels increased on first pod (group A:68.6 ± 0.2, group C:83.4 ± 22.1) compared with pre-operative levels (group A:4 ± 1.9, group C:12.3 ± 5.7), as they are inflammation markers, but there was no difference between two groups (group A:46.7 ± 1.8, group C: 35.9 ± 22.6 p = 0.7). No significant differences in the day of oral nutrition initiation, incidence of complications, or other nutritional indices were observed. Conclusion: The early enteral nutrition with arginine supplementation might improve nitrogen balance. References ESPEN: European for Clinical Nutrition and Metabolism guidelines 2006. Fan J, Meng Q et al. Effects of early enteral nutrition supplemented with arginine on intestinal mucosal immmunity in severely bumed mice. Clin Nutr. 2010;29:124–330. Disclosure of Interest: None declared
MON-LB283 EFFECTS BY OVERNIGHT STANDARD TPN ON AMINO ACID TRANSPORTERS IN THE HUMAN RECTUS ABDOMINIS MUSCLE B.-M. Iresjö1, C. Engström1, K. Lundholm1. 1Department of surgery, University of Gothenburg, Göteborg, Sweden Rationale: Recent studies indicate that amino acid transporters may act as components to activate cell-signaling across the mTOR pathway to stimulate protein translation in addition to be conventional cell transporters. However, in vivo studies on human muscle tissue is limited, particularly in response to provision of total parenteral nutrition (TPN). In the present study we examined to what extent short term provision of “standard” total parenteral nutrition (TPN) affects the content of muscle amino acid transporters at mRNA and protein levels. Methods: 22 patients scheduled for upper GI-surgery, with potential need for postoperative parenteral nutrition, received either a continuous standard TPN infusion (0.16 gN · kg−1 · day−1, 30 kcal · kg−1 day−1) or saline infusion for 12 hours overnight feeding before operation. Biopsies from the rectus