Objective: To compare the efficacy and cost of enteral and parenteral feeding after total gastrectomy.
Design: Prospective randomised open study.
Setting: University hospital, Finland.
Subjects: 29 patients undergoing curative total gastrectomy for gastric cancer.
Interventions: 13 patients were given early enteral feeding by nasojejunal tube and 16 patients parenteral nutrition by central venous catheter.
Main outcome measures: Postoperative complications, duration of hospital stay, serum CRP and albumin concentrations, cost, and postoperative abdominal symptoms.
Results: One patient in the enteral feeding group discontinued the study on day 1. Oesophagojejunal leaks developed in one patient in each group. Infective complications occurred in 3 (23%) in the enteral group and 5 (31%) in the parenteral group. Serum CRP concentration on day six was lower in the enteral feeding group than in the parenteral feeding group (32 (16) g/L compared with 61 (41) g/L; p = 0.02). Enteral feeding was well tolerated. Diarrhoea developed earlier in the enteral than in the parenteral group (days 3-5 compared with 5-7, respectively) but there was a tendency to an increased risk of diarrhoea in the parenteral group. Parenteral feeding was more than four times as expensive as enteral feeding.
Conclusion: Enteral nasojejunal feeding is safe and well tolerated after total gastrectomy. It is also cheaper than parenteral nutrition.