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In their recommendations, the series editors support the early commencement of enteral feeding on the basis of potential benefits to gut mucosal integrity and the some weak evidence of benefit, such as that seen in a metaanalysis of trials on early EN (within 24 hours) which demonstrated a significant reduction in mortality [OR = 0.34], but which was limited by the poor quality of included trials.
Where enteral nutrition is either contraindicated or not sufficiently tolerated to allow provision of full caloric requirements, the role of supplemental parenteral nutrition is controversial, and no significant benefit has been demonstrated in a number of trials. Indeed, as outlined in the accompanying review article, the EDEN trial (as well as a number of smaller RCTs) demonstrated no significant harm (or benefit) associated with underfeeding with “trophic feeding” protocols compared to full caloric replacement.
In the absence of strong evidence of the most appropriate time to initiate supplemental parenteral nutrition, the editors suggest that it may be appropriate to commence parenteral nutrtion if there is likely to be a significant delay to the establishement of trophic feeding either because of intolerance or surgical issues (the patient has, after all, been admitted post colectomy)
The associated review article can be found here.