Abstract
Background
The impact of early oral feeding after esophagectomy on brain-gut peptide secretion
and gut function recovery has not been well investigated. This study aimed to fill
this research gap.
Methods
This study was based on a randomized clinical trial (ClinicalTrials.gov: NCT01998230). The patients in the early oral feeding group started oral food intake on postoperative
day 1. In the late oral feeding group, nasogastric/nasoenteral feeding was applied
from postoperative day 1 to 7, after which the patients began oral food intake. Serum
brain-gut peptides were selected as the primary end points and tested before surgery
and on postoperative days 1, 3, and 5. The time to first flatus and first defecation
after surgery were evaluated.
Results
A total of 110 participants undergoing minimally invasive McKeown esophagectomy were
prospectively included, with 63 patients in the early oral feeding group and 47 patients
in the late oral feeding group. The distribution of clinicopathological characteristics
was balanced between the 2 groups. Perioperative dynamic surveillance demonstrated
higher serum concentrations of excitatory brain-gut peptides (gastrin P = .021, motilin P = .027, and substance-P P = .023) and lower serum concentrations of inhibitory brain-gut peptides (cholecystokinin
P = .004 and somatostatin P = .019) in the early oral feeding group. Perioperative serum levels of brain-gut
peptides correlated with postoperative early flatus and defecation. The multivariate
analysis showed early oral feeding (versus late oral feeding) to be an independent
predictive factor for early flatus and defecation (hazard ratio 2.40, P < .001; hazard ratio 2.73, P < .001, respectively).
Conclusion
The early oral feeding program may accelerate the recovery of gut function by regulating
brain-gut peptide secretion. Brain-gut peptides are possible treatment targets to
improve early oral feeding benefits and promote personalized early oral feeding programs.
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Article info
Publication history
Published online: July 03, 2022
Accepted:
April 29,
2022
Footnotes
Author Contributions: (I) Conception and design: XC, HS, XL, RZ, JQ, and YL; (II) Administrative support: HS, XL, and YL; (III) Provision of study materials or patients: HS, RZ, and JQ; (IV) Collection and assembly of data: PW, YY, HL, JZ, CL, and ZW; (V) Data analysis and interpretation: XC, PW, CL, RZ, XH, and YY; (VI) Manuscript drafting and editing: All authors; (VII) Final approval of manuscript: All authors.
Xiankai Chen and Peiyu Wang contributed equally to this work.
Identification
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