Early Oral Intake After Pancreaticoduodenectomy in the Age of ERAS

NCT ID: NCT02941484

Last Updated: 2016-10-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-12-31

Study Completion Date

2019-12-31

Brief Summary

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Early oral intake after Pancreaticoduodenectomy is recommended strongly according to the ERAS guideline, which was based on studies in patients with gastrointestinal cancer, mainly colorectal and gastric. Specific clinical study on early oral intake after PD is very limited. inadequate nutritional intake was significantly associated with a high incidence of postoperative complications. Therefore, the present study is aim to evaluate the tolerance, safety, and efficacy in the patients undergoing PD in the age of ERAS.

Detailed Description

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Enhanced Recovery After Surgery (ERAS) is an interdisciplinary, multimodal concept and has become an important focus of Pancreaticoduodenectomy procedures following universal accepted and practice in gastrointestinal and colorectal surgeries. Early oral diet without restrictions after operation is recommended strongly according to ERAS guideline. However, several studies demonstrated that only half validated the true practice of the postoperative oral diet. Furthermore, Oral intake tolerance after PD is controversial. Only 23% of patients were able to take solid food at day 3. It appears that adequate nutritional intake only via oral diet is a severe challenge. Besides, Studies showed that insufficient amount of dietary intake was significantly associated with extended duration of postoperative hospitalization and parenteral nutrition. Importantly, Specific clinical study on early oral intake after PD is very limited. Therefore, the present study is aim to evaluate the tolerance, safety, and efficacy in the patients undergoing PD in the age of ERAS.

Conditions

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Periampullary Carcinoma Resectable Pancreaticoduodenectomy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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1 early oral intake

early oral intake since postoperative day 1.

Group Type EXPERIMENTAL

early oral intake

Intervention Type PROCEDURE

early oral intake is started within 24 hours after pancreaticoduodenectomies following to the ERAS guideline

2 jejunostomy tube feeding (JTF)

jejunostomy tube feeding (JTF) was carried out after PD

Group Type EXPERIMENTAL

jejunostomy tube feeding (JTF)

Intervention Type PROCEDURE

The jejunostomy tube was placed using the Flocare CH-10 tube with the longitudinal Witzel jejunostomy technique.nutrition is supplemented via JTF rather than early oral intake.Velocity is progressively increased by 20ml/hr until full nutritional goal (25Kcal/Kg)

Interventions

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early oral intake

early oral intake is started within 24 hours after pancreaticoduodenectomies following to the ERAS guideline

Intervention Type PROCEDURE

jejunostomy tube feeding (JTF)

The jejunostomy tube was placed using the Flocare CH-10 tube with the longitudinal Witzel jejunostomy technique.nutrition is supplemented via JTF rather than early oral intake.Velocity is progressively increased by 20ml/hr until full nutritional goal (25Kcal/Kg)

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Periampullar carcinoma
* Pancreaticoduodenectomy
* ERAS protocol implemented

Exclusion Criteria

* Preoperative Radiotherapy/chemotherapy
* Unresectable primary cancer
* Palliative surgery
* New York Heart Association class\>3
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School

OTHER

Sponsor Role collaborator

Xuzhou Medical University

OTHER

Sponsor Role lead

Responsible Party

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Zheng Chen

the director of general surgery;

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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zheng chen, MD;PHD

Role: PRINCIPAL_INVESTIGATOR

Xuzhou Medical University Affiliated Suqian Hospital

Locations

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Suqian Hospital

Suqian, Jiangsu, China

Site Status

Countries

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China

Central Contacts

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zheng chen, MD;PHD

Role: CONTACT

86-13809092636

wanli liu, MD

Role: CONTACT

86-527-84386319

Facility Contacts

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zheng chen, MD;PHD

Role: primary

86-13809092636

wanli liu, MD

Role: backup

86-527-84386319

References

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Bozzetti F, Mariani L. Perioperative nutritional support of patients undergoing pancreatic surgery in the age of ERAS. Nutrition. 2014 Nov-Dec;30(11-12):1267-71. doi: 10.1016/j.nut.2014.03.002. Epub 2014 Mar 14.

Reference Type BACKGROUND
PMID: 24973198 (View on PubMed)

Buscemi S, Damiano G, Palumbo VD, Spinelli G, Ficarella S, Lo Monte G, Marrazzo A, Lo Monte AI. Enteral nutrition in pancreaticoduodenectomy: a literature review. Nutrients. 2015 Apr 30;7(5):3154-65. doi: 10.3390/nu7053154.

Reference Type BACKGROUND
PMID: 25942488 (View on PubMed)

Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003 Jun;22(3):321-36. doi: 10.1016/s0261-5614(02)00214-5.

Reference Type BACKGROUND
PMID: 12765673 (View on PubMed)

Afaneh C, Gerszberg D, Slattery E, Seres DS, Chabot JA, Kluger MD. Pancreatic cancer surgery and nutrition management: a review of the current literature. Hepatobiliary Surg Nutr. 2015 Feb;4(1):59-71. doi: 10.3978/j.issn.2304-3881.2014.08.07.

Reference Type BACKGROUND
PMID: 25713805 (View on PubMed)

Lassen K, Coolsen MM, Slim K, Carli F, de Aguilar-Nascimento JE, Schafer M, Parks RW, Fearon KC, Lobo DN, Demartines N, Braga M, Ljungqvist O, Dejong CH; Enhanced Recovery After Surgery (ERAS) Society, for Perioperative Care; European Society for Clinical Nutrition and Metabolism (ESPEN); International Association for Surgical Metabolism and Nutrition (IASMEN). Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. World J Surg. 2013 Feb;37(2):240-58. doi: 10.1007/s00268-012-1771-1. No abstract available.

Reference Type BACKGROUND
PMID: 22956014 (View on PubMed)

Nussbaum DP, Penne K, Stinnett SS, Speicher PJ, Cocieru A, Blazer DG 3rd, Zani S, Clary BM, Tyler DS, White RR. A standardized care plan is associated with shorter hospital length of stay in patients undergoing pancreaticoduodenectomy. J Surg Res. 2015 Jan;193(1):237-45. doi: 10.1016/j.jss.2014.06.036. Epub 2014 Jun 26.

Reference Type BACKGROUND
PMID: 25062813 (View on PubMed)

Wei J, Chen W, Zhu M, Cao W, Wang X, Shi H, Dong B, Sun J, Chen H, Zhou Y, Zhou S, Xu J; Chinese Medical Association's Nutrition Support Group for Geriatric Patients. Guidelines for parenteral and enteral nutrition support in geriatric patients in China. Asia Pac J Clin Nutr. 2015;24(2):336-46. doi: 10.6133/apjcn.2015.24.2.11.

Reference Type BACKGROUND
PMID: 26078252 (View on PubMed)

Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P; DGEM (German Society for Nutritional Medicine); Jauch KW, Kemen M, Hiesmayr JM, Horbach T, Kuse ER, Vestweber KH; ESPEN (European Society for Parenteral and Enteral Nutrition). ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin Nutr. 2006 Apr;25(2):224-44. doi: 10.1016/j.clnu.2006.01.015. Epub 2006 May 15.

Reference Type BACKGROUND
PMID: 16698152 (View on PubMed)

Bounoure L, Gomes F, Stanga Z, Keller U, Meier R, Ballmer P, Fehr R, Mueller B, Genton L, Bertrand PC, Norman K, Henzen C, Laviano A, Bischoff S, Schneider SM, Kondrup J, Schuetz P; Members of the Working Group. Detection and treatment of medical inpatients with or at-risk of malnutrition: Suggested procedures based on validated guidelines. Nutrition. 2016 Jul-Aug;32(7-8):790-8. doi: 10.1016/j.nut.2016.01.019. Epub 2016 Feb 18.

Reference Type BACKGROUND
PMID: 27160498 (View on PubMed)

Joliat GR, Labgaa I, Petermann D, Hubner M, Griesser AC, Demartines N, Schafer M. Cost-benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy. Br J Surg. 2015 Dec;102(13):1676-83. doi: 10.1002/bjs.9957. Epub 2015 Oct 22.

Reference Type BACKGROUND
PMID: 26492489 (View on PubMed)

Coolsen MM, Bakens M, van Dam RM, Olde Damink SW, Dejong CH. Implementing an enhanced recovery program after pancreaticoduodenectomy in elderly patients: is it feasible? World J Surg. 2015 Jan;39(1):251-8. doi: 10.1007/s00268-014-2782-x.

Reference Type BACKGROUND
PMID: 25212064 (View on PubMed)

Chaudhary A, Barreto SG, Talole SD, Singh A, Perwaiz A, Singh T. Early discharge after pancreatoduodenectomy: what helps and what prevents? Pancreas. 2015 Mar;44(2):273-8. doi: 10.1097/MPA.0000000000000254.

Reference Type BACKGROUND
PMID: 25479587 (View on PubMed)

Bischoff SC, Singer P, Koller M, Barazzoni R, Cederholm T, van Gossum A. Standard operating procedures for ESPEN guidelines and consensus papers. Clin Nutr. 2015 Dec;34(6):1043-51. doi: 10.1016/j.clnu.2015.07.008. Epub 2015 Jul 16.

Reference Type BACKGROUND
PMID: 26254807 (View on PubMed)

Braga M, Pecorelli N, Ariotti R, Capretti G, Greco M, Balzano G, Castoldi R, Beretta L. Enhanced recovery after surgery pathway in patients undergoing pancreaticoduodenectomy. World J Surg. 2014 Nov;38(11):2960-6. doi: 10.1007/s00268-014-2653-5.

Reference Type BACKGROUND
PMID: 24870390 (View on PubMed)

Coolsen MM, van Dam RM, van der Wilt AA, Slim K, Lassen K, Dejong CH. Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies. World J Surg. 2013 Aug;37(8):1909-18. doi: 10.1007/s00268-013-2044-3.

Reference Type BACKGROUND
PMID: 23568250 (View on PubMed)

Other Identifiers

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XuzhouMedSch

Identifier Type: -

Identifier Source: org_study_id

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