This document discusses the role of enteral nutrition in patients undergoing pancreaticoduodenectomy (PD). It notes that malnutrition is a risk factor for postoperative complications and mortality. Three studies conducted in the author's department examined the effects of early enteral nutrition in PD patients. The first study found early enteral feeding improved outcomes. The second study found that early, low-cost indigenous enteral feeding improved nutritional parameters, liver and immune function, and reduced complications and length of stay. A third ongoing study is examining if immune nutrients added to enteral feeds can further reduce complications after PD. Based on the promising results, the author questions if early enteral nutrition with or without immune nutrients will become the gold standard for PD patients.

1. Role of enteral nutrition in
pancreaticoduodenectomy
patients
DR MD ABDUL QUIYUM
Phase B
Hepatobiliary, pancreatic & Liver Transplant Surgery

2. Introduction
 Malnutrition has long been recognized as a risk factor for post-operative
morbidity and mortality.
 a multi-modal approach focused on modulating the metabolic status of the
patient before (e.g. carbohydrate and fluid loading), during (e.g. epidural
anesthesia) and after (e.g. early oral feeding) surgery in the promotion of
early recovery from major surgical trauma.
 Preoperative assessment, timely intervention and stress reduction strategies
significantly improve postoperative outcome.

5. Tools of
assessment
History &
Examination
Anthropometric
measurement
Screening tools
Lab.test

11. Post operative nutrition :why so important
nutrition
Proper healing of
wound &
anastomosis
Reduce
wound
infection
Early recovery
and less LOS
Prevent wasting
and regaining
strength

12. Parenteral nutrition available in market

13. Formulated enteral nutrition available in market

14. TPN Vs EN after PD
Matter of debate ???

15. 3 study conducted in our department
• Effect of early and delay starting of enteral feeding in
• post-pancreaticoduodenectomy patients..Dr Mozzamel
2017
• “Effect of early starting low cost indigenous enteral
feeding for pancreatoduodenectomy patients in early
post- operative period in BSMMU”..Dr Quiyum
2020
• Effect of immune nutrient in postoperative outcome
after pancreaticoduodenectomy..Dr Tanjim
2021-

16. 1st study showed…

17. 2nd study :Effect of early starting low cost indigenous enteral feeding for
pancreatoduodenectomy patients in early post- operative period in BSMMU”..

19. EEN with blenderized formulated diet 1kcal/ml)

20. Study results…

21. Nutritional parameter

22. Cholestatic function

23. Inflammatory parameter

24. Immunological parameter

26. Surgical outcome

27. 3rd study :
 # immune nutrient reduce postoperative infective and non
infective complication.
 # multiple metanalysis showed the efficacy of Immune
nutrient postoperatively but no study in Bangladesh.
 # immune nutrition like glutamine, arginine, omega 3
fatty acid will be added to regular enteral feeding to see
the post operative outcome

28. With the optimistic result of all these study,
 Question to the audience
Will it be the future gold standard of nutrition
provision in PD patient ?

29. Dr Omar