Safety and clinical outcome of ultra-early oral nutrition after endoscopic treatment of gastroesophageal variceal bleeding in liver cirrhosis patients / 中华临床营养杂志

ABSTRACT

Objective:To investigate the safety and clinical outcome of ultra-early oral nutrition after endoscopic treatment of gastroesophageal variceal bleeding in liver cirrhosis patients.Methods:Cirrhotic patients with gastroesophageal variceal bleeding who received endoscopic treatment at the Endoscopic Center of Beijing Haidian Hospital were retrospectively included from January 2018 to January 2022. The patients were divided into ultra-early oral nutrition group where patients would fast for 4 hours after endoscopic treatment and routine treatment group where patients would fast for at least 48 hours after operation and receive parenteral nutrition during fasting. The rebleeding, infection events (including pulmonary infection, urinary infection, spontaneous bacterial peritonitis, etc.), hospitalization duration and hospital readmission were recorded and compared between the two groups.Results:A total of 96 patients were enrolled, including 52 with ultra-early oral nutrition, 44 with routine treatment. There was no significant difference in age, gender, BMI, cause of liver cirrhosis, Child-Pugh score, LDRf classification of gastroesophageal varices and degree of esophageal varices between the two groups ( P > 0.05). All patients were followed up for 6 weeks and there was no significant difference in incidence of rebleeding (5.8% vs 4.5%, P > 0.999), peritonitis (1.9% vs 4.5%, P = 0.883), pulmonary infection (5.8% vs 11.4%, P = 0.537) and urinary infection (3.8% vs 2.3%, P > 0.999) between the two groups. The non-inferiority analysis suggested that the safety defined as free from rebleeding in ultra-early oral nutrition group was not inferior to that in routine treatment group ( P = 0.0018). The hospitalization duration in ultra-early oral nutrition group was significantly shorter than that in routine treatment group (6 days vs 9 days, P < 0.001). The hospital readmission rate within 6 weeks in the ultra-early oral nutrition group tended to be lower than that in the routine treatment group (3.8% vs 9.1%, P = 0.526). Conclusion:Ultra-early oral nutrition after endoscopic treatment of gastroesophageal variceal bleeding in liver cirrhosis patients shows similar rebleeding risk compared with current practice and can shorten hospitalization duration.