A 65-year-old patient is undergoing major upper GI cancer surgery and will be unable to tolerate oral intake for at least 7 days post-operatively. Preoperative nutritional assessment shows albumin 28 g/L and BMI 18.5 kg/m². What is the most appropriate nutritional strategy per ESPEN guidelines?
- A Early enteral nutrition via nasojejunal tube or feeding jejunostomy within 24 hours post-op ✓
- B Total parenteral nutrition (TPN) initiated immediately post-operatively
- C IV dextrose infusion until oral feeding resumes
- D Preoperative TPN for 7 days followed by early post-operative oral feeding
Explanation
ESPEN guidelines and Enhanced Recovery After Surgery (ERAS) protocols strongly advocate early enteral nutrition (EN) within 24 hours of major GI surgery, as it: (1) maintains gut mucosal integrity and reduces bacterial translocation, (2) reduces infectious complications, (3) improves wound healing and immune function, and (4) reduces hospital stay compared to TPN. In malnourished patients (albumin <30 g/L, BMI <18.5) unable to eat post-operatively, a feeding jejunostomy or nasojejunal tube placed at operation ensures this. TPN is reserved for EN-intolerant patients or when the gut is non-functional. IV dextrose alone provides inadequate calories and protein.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.