Feeding routes after pancreatoduodenectomy

Delayed gastric emptying is a frequent complication after pancreatoduodenectomy and often necessitates nutritional support. Current European guidelines recommend routine enteral feeding after pancreatoduodenectomy, whereas American guidelines do not. This chapter discusses the available evidence on the optimal feeding strategy in patients after pancreatoduodenectomy. A systematic literature search yielded 22 studies with 3,920 patients. Data on five feeding routes were extracted: oral feeding (n = 2,351); enteral nutrition via either nasojejunal tube (n = 302), gastrojejunostomy tube (n = 52), or jejunostomy tube (n = 701); and total parenteral nutrition (n = 514). The length of hospital stay was the shortest in patients receiving oral feeding.Also resumption of solid diet was established most quickly in the oral feeding group. The incidence of delayed gastric emptying varied from 5.8 % to 25.5 %, but definitions varied widely. There were no major differences in overall morbidity and mortality between the five different feeding routes. In conclusion, there is no evidence to support routine enteral or parenteral feeding after pancreatoduodenectomy. An early oral diet may be considered as the preferred routine feeding strategy after pancreatoduodenectomy.