Nutrison

The feeding goal was at least 30 kcal/kg⁻¹/d⁻¹ and 1.5 to 2 g of protein/kg⁻¹/d⁻¹, while 2 g of nitrogen for per liter of fistula output was administered. High-output EF required 1.5–2 times the usual calories because of the ongoing loss [15 (link)]. All patients received total parenteral nutrition (TPN) (all in one fluid, Jinling Hospital, Nanjing, China) for varying intervals before fistuloclysis/TEN to induce stability. Subsequently, in the fistuloclysis group, TEN and the collected succus entericus were infused into the distal fistula through the Foley catheter or through the nasojejunal tube (for patients with biliary fistula) for at least 28 days. If patients did not tolerate nonelemental feed (Ensure powder (Abbot, Shanghai, China), Nutrison (Nutricia, Shanghai, China)), then they changed to receive semielemental feed (Perative, Abbot, Shanghai, China) or elemental feed (Peptisorb, Abbot, Shanghai, China). In the control group, only TEN was applied for at least 28 days through similar ways as the fistuloclysis group. The fistula output was drained out through double-lumen tubes [13 (link)] and discarded, while the volume deficit was corrected by fluid replacement.

The surgery procedures were previously described by Grüeneberger et al. [7 (link)]. Isoflurane 2% with oxygen flow at 2 l/min under spontaneous breathing was used to induce and maintain anaesthesia. After an abdominal midline incision, length 4–5 cm was performed and the Bauhin's valve was determined. 50% of the distal ileum was localized and transected. The ileal continuity was restored by an end-to-end extramucosal anastomosis using PDS 6/0 (Ethicon, Blue Ash, OH), excluding the transposed segment. Then, the ligament of Treitz was determined, and the jejunum was divided 5 cm aborally. The transposed segment of ileum was inserted in an isoperistaltic fashion, and two end-to-end anastomoses were performed. For control and sham surgery, transections were performed at all three analogous points. Anastomoses were completed correspondingly, nevertheless without IT (Figure 1). Fascia and skin closures were performed as a continuous suture using Monocryl 4/0 and Vicryl 4/0. After the surgery, all rats were kept on a liquid diet for 24 h (Nutrison, Nutricia, Poland).

The patients in the experimental group were administered a whole-course enteral nutrition management. The basic process is as follows: (1) nutritional risk screening with NRS-2002, nutritional assessment with PG-SGA; (2) enteral nutrition with oral nutritional supplement (ONS, Nutrison produced by Nutricia) or tube feeding based on the results of nutrition assessment, dietary investigation, degree of dysphagia; (3) timely evaluation of the treatment effect and adjustment of the nutritional program according to the dynamic changes of the nutritional status and adverse effect of patients; (4) quality control of the whole-course nutrition. The enteral nutrition was conducted by a nutrition support team (NST), which included clinicians, nutritionists, pharmacologists and nutrition nurses. The intake goals for energy and protein were set as 30–35 kcal/kg/d and 1.5–2.0g/kg/d, respectively. Doctors and nurses recorded and checked the patients’ energy and protein intake every day and ensured nutrition quality control, such that each patient received sufficient nutrients.
Whereas, the control group was treated with unsystematic nutrition based on the general eating conditions, hematologic test and treatment toxicities but not the nutritional assessment and dietary investigation, without considering the intake goals and nutrition quality control.