Background: Despite data reporting that exclusive enteral nutrition (EEN) improves nutritional status and inflammation in patients with Crohn's disease, few studies have reported its systematic use in the perioperative setting. EEN involves the use of a liquid nutrition formula to meet all of an individual's dietary requirements. We sought to test the hypothesis that EEN provides a safe and effective bridge to surgery and reduces post-operative complications in adult patients with Crohn's disease requiring urgent surgery for stricturing or penetrating complications.
Methods: Fifty-one patients who were treated with EEN prior to planned surgery for stricturing or penetrating complications of Crohn's disease were identified from our specialist dietician's database. Thirty eight out of these fifty-one patients had surgery and they were each matched with two control patients for disease behaviour, type of surgery, age at diagnosis and disease duration. Data on disease phenotype, nutritional status, operative course, and post-operative complications were obtained.
Results: Clinical status improved in 25% [13/51] of the EEN patients such that they no longer required surgery. EEN had no effect on pre-operative weight, but it significantly reduced median [interquartile range (IQR)] serum CRP levels (baseline 36 [13–91] vs. pre-operation 8 [4–31] mg/L, p=0.02). The median [IQR] length of surgery was shorter in patients pre-optimised with EEN than controls (3.0 [2.5–3.5] vs. 3.5 [3.0–4.0] hours respectively, p<0.001). Multivariable logistic regression analysis confirmed that going straight-to-surgery compared with EEN pre-optimisation was associated with a nine-fold increase in the incidence of post-operative abscess and/or anastomotic leak (OR 9.1 95% CI [1.2–71.2], p=0.04).
Conclusions: EEN in adult patients presenting with stricturing or penetrating complications of Crohn's disease is associated with a reduction in systemic inflammation, operative times and the incidence of post-operative abscess or anastomotic leak. Further controlled trials are needed to elucidate how EEN may improve operative outcomes and to confirm that EEN provides a safe and effective bridge to surgery.