Enteral ecoimmunonutrition confers benefits on patients undergoing hepatectomy

In patients undergoing hepatectomy, an intervention with enteral ecoimmunonutrition (EEIN) support appears to protect liver function, reduce serum endotoxin levels and inflammatory factors, improve immune function, and promote the recovery of postoperative gastrointestinal function, according to a recent study. These findings prove that EEIN support is viable for clinical application.

A team of investigators assessed the efficacy and safety of EEIN in patients undergoing hepatectomy. They performed searchers in the following databases: Embase, PubMed, Medline, Cochrane Library, Chinese Scientific Journal Database, Chinese National Knowledge Infrastructure, and Wanfang Data.

Nine randomized controlled trials, including a total of 705 patients, met the eligibility criteria. The EEIN group demonstrated a significantly shorter time to first postoperative flatus (mean difference [MD], ‒14.60 h, 95 percent confidence interval [CI], ‒16.06 to ‒13.15; p<0.00001) than the enteral or parenteral nutrition (EN/PN) groups.

Moreover, the EEIN group had lower levels of alanine aminotransferase (MD, ‒22.26 µmol/L, 95 percent CI, ‒28.42 to ‒16.10; p<0.00001), aspartate transaminase (MD, ‒53.79 µmol/L, 95 percent CI, ‒57.37 to ‒50.21; p<0.00001), total bilirubin (MD, ‒16.28 µmol/L, 95 percent CI, ‒17.77 to ‒14.79; p<0.00001), direct bilirubin (MD, ‒8.77 µmol/L, 95 percent CI, ‒9.65 to ‒7.88; p<0.00001), endotoxin (MD, ‒0.78 ng/L, 95 percent CI, ‒0.88 to ‒0.68; p<0.00001), tumour necrosis factor-α (MD, ‒79.69 pg/ml, 95 percent CI, ‒99.90 to ‒59.49; p<0.00001), and interleukin-6 (MD, ‒46.29, 95 percent CI, ‒50.24 to ‒42.34; p<0.00001) as well as higher levels of immunoglobulin (Ig) A (MD, 0.24 g/L, 95 percent CI, 0.14‒0.35; p<0.00001), IgG (MD, 1.52, 95 percent CI, 1.22‒1.82; p<0.00001), and IgM (MD, 0.12 g/L, 95 percent CI, 0.05‒0.20; p=0.0007) compared with the EN/PN groups.