The Safety and Efficacy of Early Enteral Nutrition After Paediatric Enterostomy Closure - The EPOC Study

Infographic · Jun 2024 · 1 min read

In brief

Retrospective study of 69 children demonstrates that early enteral nutrition within 24 hours of enterostomy closure significantly reduces hospital stay and time to full feeds without increasing complications. Findings challenge traditional nil-by-mouth protocols and support enhanced recovery pathways in pediatric intestinal surgery.

Early enteral nutrition within 24h after pediatric stoma closure reduces hospital stay by ~29h compared to delayed feeding (p=0.0045).
Starting feeds early significantly decreases time to full enteral intake and return of bowel function without increasing complication rates.
Traditional nil-by-mouth protocols (up to 5 days) may unnecessarily prolong hospitalization and risk malnutrition in pediatric patients.
Early feeding protocol is safe and efficacious for children 3 months to 16 years undergoing intestinal stoma closure.
Retrospective data supports challenging conventional post-operative fasting practices after pediatric intestinal anastomosis surgery.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, with surgical technique variations. Bar charts or percentage indicators display outcome metrics below each approach. The design uses a clean, clinical color palette with icons and arrows to highlight key differences between methods.

New infographic by Dr. Jose Campos and the Chilean Society of pediatric surgeons

"The Safety and Efficacy of Early Enteral Nutrition After Paediatric Enterostomy Closure - The EPOC Study"

Authors: James Cope, Douglas Greer, Soundappan S.V. Soundappan, Aneetha Pasupati, Susan Adams

Full article: https://gcmd.co/4cnWw2V

Introduction

Keeping children nil by mouth until return of bowel function after intestinal anastomosis surgery is said to reduce complications. Fasting may extend up to five days, risking malnourishment and usage of parenteral nutrition. This study aims to establish the efficacy and safety of early enteral nutrition in children undergoing intestinal stoma closure.

Methodology

A retrospective cohort study of children aged three months to 16 years who underwent an intestinal stoma closure between 1/1/2019 and 31/12/2021 at two tertiary paediatric hospitals was undertaken. Children fed clear fluids within 24 h (EEN) were compared to those commencing feeds later (LEN). The primary outcome was length of post-operative stay (LOS) and secondary outcomes included: time to feeds; time to stool; and complications.

Results

Of the 129 children that underwent a stoma closure, 69 met inclusion criteria: 35 (51 %) in the LEN group and 34 (49 %) in the EEN group. Children in the EEN group had a significantly shorter LOS (92.6 h vs 121.7 h, p = 0.0045). Early feeding was also associated with a significantly decreased time to free fluids (p < 0.001) and full enteral intake (p = 0.007). There was no significant intergroup difference in complications.

Conclusion

Commencing feeding within 24 h of stoma closure is efficacious and safe, with clear reductions in LOS, time to full feeds and time to stool, and no increase in complications. Further research is required to extrapolate these findings to other populations.

The text in the image