P174 Pre-operative use of exclusive enteral nutrition in adult patients with Crohn’s disease: a single centre experience

Introduction

The role of exclusive enteral nutrition (EEN) in the management of adult patients with Crohn’s disease (CD) is evolving, with non-randomised evidence suggesting a reduction in post-operative complications. However, the use of pre-operative EEN is not standardised across centres and is often under-utilised. We performed a service evaluation to assess the use of EEN and post-operative outcomes in patients undergoing surgery for CD.

Methods

We performed a retrospective study at a single NHS Trust comprising a tertiary Inflammatory Bowel Disease unit. Consecutive adult patients with CD undergoing surgery for stricturing, penetrating and medication-refractory disease from January 2018 to December 2021 were included. Patients prescribed at least 6 weeks of EEN prior to surgery (‘EEN’) were compared to those who were not (‘non-EEN’). Outcome assessments included intestinal failure (IF) requiring parenteral nutrition, post-operative complications using the Clavien Dindo classification, length of stay (LOS), unplanned readmission at 3 months and disease recurrence at 6 months. Analysis used t-test for continuous data and chi-squared for categorical data. Statistical significance was set at p<0.05.

Results

142 patients were included, comprising 22 EEN and 120 non-EEN patients. The EEN group were younger (29±11.9 vs. 37.6yrs±15.4 years) and had a lower BMI (21.7±4.7 vs. 23.2±5.6 kg/m2). No significant differences were observed between groups for disease phenotype, smoking status or type of surgery. Primary anastomosis was formed in 72.7% (16/22) of the EEN group, and 85.8% (103/120) of the non-EEN group. Nutritional screening scores using the malnutrition universal screening tool (MUST) were recorded from January 2020 onwards due to a transition to electronic records; 95.5% of patients in the EEN group had scores recorded compared to only 37.5% in the non-EEN group (p<0.0001). There were no cases of postoperative IF in the EEN cohort, whilst 18.3% of non-EEN patients (22/120; p=0.04) developed type one IF. The mean LOS (days) was significantly less in the EEN group (8.3±3.6 vs. 15.9±17.3, p=0.04), as were the complication rates when using a Clavien Dindo score of ≥2 (13.6% vs. 36.7%, p=0.04). Outcomes for unplanned admission at 3 months (OR 0.44, p= 0.3) and disease recurrence at 6 months (OR 0.45, p= 0.3) favoured the EEN cohort but were not significant.

Conclusion

Our data is in line with other studies, demonstrating a potential benefit in post-operative outcomes in adult patients treated with at least 6 weeks of EEN. This study supports an upcoming randomized controlled trial in this area. Additionally, nutritional screening may be underused in adult patients undergoing surgery for CD.