Prospective randomised trial of bolus vs. continuous regime of jejunostomy feed

2021 ◽  
pp. 004947552110589
Author(s):  
Vipin Sharma ◽  
Uday Somashekar ◽  
Dileep Singh Thakur ◽  
Reena Kothari ◽  
Dhananjaya Sharma
Keyword(s):  
Functional Outcomes ◽  
Randomised Trial ◽  
Physical Activities ◽  
Feeding Jejunostomy ◽  
Upper Gi ◽  
Prospective Randomised Trial ◽  
Continuous Regime ◽  
Continuous Feeding ◽  
Daily Physical Activities ◽  
Jejunostomy Feeding

Enteral alimentation can be administered continuously, cyclically, intermittently, or by a bolus technique. Current literature does not suggest superiority of any one regime. Most studies have used nasogastric feeds, little is known about the outcome of jejunal feeding. This study compares the efficiency and safety of bolus and continuous jejunostomy feeding. 46 adults undergoing a feeding jejunostomy for nutritional support or as an adjunct to a major upper GI surgery, were randomised to bolus feeding (BF group, n = 24) and continuous feeding (CF group, n = 22). Demographic, anthropometric, and laboratory parameters were measured preoperatively and on post-operative days (POD) 3, 7, 15, and 30. These parameters; as well as nutritional and functional outcomes, and complications at POD 30; were comparable in both groups. Both groups tolerated jejunal feeds well. Bolus feeding is simple, inexpensive, and permits daily physical activities. Hence it may be preferred over continuous jejunostomy feeding for enteral alimentation.

THE EFFECT OF EARLY BLOOD TRANSFUSION ON THE OUTCOME OF GASTROINTESTINAL HAEMORRHAGE

1987 ◽  
Author(s):  
S D Blair ◽  
S B Javanvrin ◽  
C N McCollum ◽  
R M Greenhalgh
Keyword(s):  
Blood Transfusion ◽  
Blood Coagulation ◽  
Whole Blood ◽  
Randomised Trial ◽  
Gastrointestinal Haemorrhage ◽  
Clotting Time ◽  
Prospective Randomised Trial ◽  
Coagulation Tests ◽  
To Receive ◽  
Upper Gastrointestinal

It has been suggested that mortality due to upper gastrointestinal haemorrhage may be reduced by restricting blood transfusion [1], We have assessed whether this is due to an anticoagulant effect in a prospective randomised trial.One hundred patients with severe, acute gastrointestinal haemorrhage were randomised to receive either at least 2 units of blood during the first 24 hours of admission, or no blood unless their haemaglobin was lessthan 8g/dl or they were shocked. Minor bleeds and varices were excluded As hypercoagulation cannot be measured using conventional coagulation tests, fresh whole blood coagulation was measured by the Biobridge Impedance Clotting Time (ICT). Coagulation was assessed at 24 hour intervals and compared to age matched controls with the results expressed as mean ± sem.The ICT on admission for the transfusion group (n=50) was 3.2±0.2 mins compared to 10±0.2 mins in controls. This hyper-coagulable state was partially reversed to 6.4±0.3 mins at 24 hours (p<0.001). The 50 allocated to receive no blood had a similar ICT on admission of 4.4±0.4 mins but the hypercoagulable state was maintained with ICT at 24 hours of 4.320.4 mins. Only 2 patients not transfused rebled compared to 15 in the early transfusion group (p<0.001). Five patients died, and they were all in the early transfusion group.These findings show there is a hypercoagulable response to haemorrhage which is partially reversed by blood transfusion leading to rebleeding

scholarly journals Enteral resorbable diet versus standard diet in primary sphincter reconstruction: a prospective randomised trial

2021 ◽  
Author(s):  
Andreas Joos ◽  
Dieter Bussen ◽  
Christian Galata ◽  
Christoph Reißfelder ◽  
Alexander Herold ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Healing Rate ◽  
Negative Impact ◽  
Randomised Trial ◽  
Sample Size Calculation ◽  
Standard Diet ◽  
Complication Rates ◽  
Significance Level ◽  
Sphincter Reconstruction ◽  
Prospective Randomised Trial

Abstract Aim Bowel movements after reconstructive anorectal surgery may negatively affect surgical outcome. This study was aimed to assess any differences between a standard diet (SD) and the enteral resorbable diet (ED) in terms of operative outcomes and patient tolerance after fistulectomy with primary sphincter reconstruction. Method Adult patients undergoing elective fistulectomy with primary sphincter reconstruction for anorectal and rectovaginal fistulas were eligible for inclusion. Patients were intraoperatively randomised to receive either the ED and peristalsis-inhibiting medication (ED) or a SD. The primary endpoint was the healing rate. Secondary endpoints included continence scores, complications and quality of life. Sample size calculation resulted in the analysis of 60 patients to detect a difference in fistula recurrence of 30% with 70% power and a 5% significance level. Results Sixty-six patients (24 women) were prospectively and randomly assigned to the ED (n = 34: 51%) or a SD (n = 32; 48%); mean age was 47 (18-74) years. The primary healing rate was 64 out of 66 patients (96%). No statistical difference in healing rate was seen between the groups. However, patient satisfaction was significantly higher in the SD group (P < 0.0001). Conclusions Fistulectomy with primary sphincter reconstruction is a safe method with low complication rates. Postoperative stool behaviour has no significant influence on the healing rate but has a significant negative impact on patient satisfaction. Therefore, maintaining a standard diet seems to be preferable following reconstructive anal surgery. Trial registration The trial was registered with the German Clinical Trials Register (DRKS00020524).

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