Perioperative medicine & outcomes
Early Enteral vs Oral Postoperative Nutrition After Pancreatoduodenectomy: The NUTRIWHI Randomized Clinical Trial
Authors' conclusion
In this randomized clinical trial, in patients with a nutritional risk screening score of 3 or more, EEN after pancreatoduodenectomy permitted to decrease the burden and incidence of postoperative complications compared with ON.
Study context
- Population
- Patients at increased nutritional risk (nutritional risk screening score ≥3) undergoing pancreatoduodenectomy, 3 tertiary centres in Switzerland and France118 analysed
- Participants
- 142 patients
- Comparison
- Early enteral nutrition (EEN) via nasojejunal tube vs oral nutrition (ON)
- EENn = 59
- ONn = 59reference
- Primary endpoint
- Complications defined by the mean comprehensive complication index
- Follow-up
- 90 days postoperatively
Methodological detailsparallel, open-label, superiority, multicentre (3 tertiary centres), Enrolled December 15, 2021, through October 8, 2024, Parenteral nutrition need standardised in both groups, 144 included, 142 randomised 1:1; 24 dropped out after randomisation (17%)
- Parallel
- Open-label
- Superiority
- Multicentre (3 tertiary centres)
- Enrolled December 15, 2021, through October 8, 2024
- Parenteral nutrition need standardised in both groups
- 144 included, 142 randomised 1:1; 24 dropped out after randomisation (17%)
Primary result
Mean comprehensive complication index · 90 days
Mean difference
10.3
95% CI 1.8–18.8
P = 0.02
By group
EEN
25.5
mean · SD 21.1
ON
35.8
mean · SD 25.2
EEN vs ON
mean difference 10.3 (95% CI 1.8–18.8); P = 0.02
As reported in the abstract
Secondary outcomes
| Outcome | EEN | ON | RR (95% CI) | P value | |
|---|---|---|---|---|---|
| Overall morbidity · 90 days | 45 of 59 | 51 of 59 | 1.13 (0.9–1.9) | P = 0.18 | |
| 0.512Relative risk (log scale) |
Specific complications (delayed gastric emptying, pancreatic fistula, postoperative hemorrhage, surgical site infection)
- No difference between groups
Safety
| Outcome | EEN |
|---|---|
| Nasojejunal tube replacement due to involuntary removal (adverse event) | 14 events |
Original publication
Early Enteral vs Oral Postoperative Nutrition After Pancreatoduodenectomy: The NUTRIWHI Randomized Clinical Trial. JAMA Surg. Published 1 June 2026. doi:10.
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