{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:52:42Z","timestamp":1792601562106,"version":"4.5.0"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"\n Importance<\/jats:title>\n The optimal type of nutritional support after pancreatoduodenectomy remains controversial.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare postoperative early enteral nutrition (EEN) with oral nutrition (ON) in patients nutritionally at risk in terms of postoperative morbidity.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This study was a parallel, open-label, superiority randomized clinical trial that took place at 3 tertiary centers in Switzerland and France. Patients at increased nutritional risk (nutritional risk screening score \u22653) were randomized 1:1 into the EEN or ON groups. Patients in the EEN group received enteral nutrition immediately after surgery via a nasojejunal tube placed intraoperatively and were allowed to have oral food based on the same protocol as the other group. Patients in the ON group were not allowed to have enteral nutrition during hospitalization. In both groups, parenteral nutrition need was standardized. These data were analyzed from February 2025 to April 2025.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n EEN via nasojejunal tube vs ON.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcome was complications at 90 days postoperatively, defined by the mean comprehensive complication index. Secondary end points were morbidity rates (overall, minor, and major complications), mortality, delayed gastric emptying, pancreatic fistula, postoperative hemorrhage, surgical site infections, infectious complications, pulmonary complications, length of stay, and 90-day readmission.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Patients were enrolled from December 15, 2021, through October 8, 2024. A total of 144 patients were included and 142 patients were randomized. After randomization, 24 patients dropped out (17%), leaving 118 patients for analysis (59 in the EEN group and 59 in the ON group). Patients in the EEN group had a lower mean 90-day comprehensive complication index compared with ON patients (mean [SD], 25.5 [21.1] vs 35.8 [25.2]; mean difference 10.3; 95% CI 1.8-18.8;\n P<\/jats:italic>\n \u2009=\u2009.02). At 90 days, overall morbidity rates were 45 of 59 and 51 of 59 in the EEN and ON groups (risk ratio [RR], 1.13; 95% CI, 0.9-1.9;\n P<\/jats:italic>\n \u2009=\u2009.18). No difference was found between both groups regarding specific complications (delayed gastric emptying, pancreatic fistula, postoperative hemorrhage, and surgical site infection). In the EEN group, nasojejunal tube was replaced in 14 patients due to involuntary removal (adverse event).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05042882<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2026.1048","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T15:30:48Z","timestamp":1776871848000},"page":"575","source":"Crossref","is-referenced-by-count":6,"title":["Early Enteral vs Oral Postoperative Nutrition After Pancreatoduodenectomy"],"prefix":"10.1001","volume":"161","author":[{"given":"Ga\u00ebtan-Romain","family":"Joliat","sequence":"first","affiliation":[{"name":"Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland"},{"name":"Graduate School of Health Sciences, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismail","family":"Labgaa","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Uldry","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Melloul","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nermin","family":"Halkic","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Cristaudi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Regional Hospital of Lugano, Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Majno-Hurst","sequence":"additional","affiliation":[{"name":"Department of Surgery, Regional Hospital of Lugano, Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gioia","family":"Pozza","sequence":"additional","affiliation":[{"name":"Department of Surgery, Regional Hospital of Lugano, Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Fuks","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland"},{"name":"Department of Digestive, Pancreatic, Hepatobiliary and Endocrine Surgery, Cochin Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo","family":"Marchese","sequence":"additional","affiliation":[{"name":"Department of Digestive, Pancreatic, Hepatobiliary and Endocrine Surgery, Cochin Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Demartines","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Sch\u00e4fer","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"soi260018r1","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1097\/SLA.0000000000003451","article-title":"Textbook outcome: nationwide analysis of a novel quality measure in pancreatic surgery.","volume":"271","author":"van Roessel","year":"2020","journal-title":"Ann Surg"},{"issue":"1","key":"soi260018r2","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znad330","article-title":"Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries.","volume":"111","author":"PancreasGroup.org Collaborative","year":"2024","journal-title":"Br J Surg"},{"issue":"6","key":"soi260018r3","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.1016\/j.suc.2016.07.013","article-title":"Postpancreatectomy complications and management.","volume":"96","author":"Malleo","year":"2016","journal-title":"Surg Clin North Am"},{"issue":"7","key":"soi260018r4","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1002\/jso.23304","article-title":"Malnutrition and pancreatic surgery: prevalence and outcomes.","volume":"107","author":"La Torre","year":"2013","journal-title":"J Surg Oncol"},{"issue":"12","key":"soi260018r5","doi-asserted-by":"publisher","first-page":"1839","DOI":"10.3390\/nu16121839","article-title":"Impact of preoperative malnutrition on patients with pancreatic neoplasms post-duodenopancreatectomy: a retrospective cohort study.","volume":"16","author":"Pellegrinelli","year":"2024","journal-title":"Nutrients"},{"issue":"3","key":"soi260018r6","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1080\/07315724.2004.10719365","article-title":"The influence of nutritional status on complications after major intraabdominal surgery.","volume":"23","author":"Sungurtekin","year":"2004","journal-title":"J Am Coll Nutr"},{"issue":"5","key":"soi260018r7","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.1016\/j.surg.2018.05.040","article-title":"Nutritional support and therapy in pancreatic surgery: a position paper of the International Study Group on Pancreatic Surgery (ISGPS).","volume":"164","author":"Gianotti","year":"2018","journal-title":"Surgery"},{"issue":"7","key":"soi260018r8","doi-asserted-by":"publisher","first-page":"2056","DOI":"10.1007\/s00268-020-05462-w","article-title":"Guidelines for perioperative care for pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019.","volume":"44","author":"Melloul","year":"2020","journal-title":"World J Surg"},{"issue":"5","key":"soi260018r9","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1097\/SLA.0000000000001896","article-title":"Early enteral versus total parenteral nutrition in patients undergoing pancreaticoduodenectomy: a randomized multicenter controlled trial (Nutri-DPC).","volume":"264","author":"Perinel","year":"2016","journal-title":"Ann Surg"},{"issue":"5","key":"soi260018r10","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1002\/bjs.9049","article-title":"Systematic review of five feeding routes after pancreatoduodenectomy.","volume":"100","author":"Gerritsen","year":"2013","journal-title":"Br J Surg"},{"issue":"4","key":"soi260018r11","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1007\/s11605-007-0362-1","article-title":"Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature.","volume":"12","author":"Mazaki","year":"2008","journal-title":"J Gastrointest Surg"},{"issue":"4","key":"soi260018r12","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1016\/S0261-5614(03)00098-0","article-title":"ESPEN guidelines for nutrition screening 2002.","volume":"22","author":"Kondrup","year":"2003","journal-title":"Clin Nutr"},{"issue":"11","key":"soi260018r13","doi-asserted-by":"publisher","first-page":"726","DOI":"10.7326\/0003-4819-152-11-201006010-00232","article-title":"CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials.","volume":"152","author":"Schulz","year":"2010","journal-title":"Ann Intern Med"},{"key":"soi260018r14","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.855784","article-title":"Early enteral vs. oral nutrition after Whipple procedure: study protocol for a multicentric randomized controlled trial (NUTRIWHI trial).","volume":"12","author":"Joliat","year":"2022","journal-title":"Front Oncol"},{"issue":"1","key":"soi260018r15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/SLA.0b013e318296c732","article-title":"The comprehensive complication index: a novel continuous scale to measure surgical morbidity.","volume":"258","author":"Slankamenac","year":"2013","journal-title":"Ann Surg"},{"issue":"6","key":"soi260018r16","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1097\/SLA.0000000000002132","article-title":"The comprehensive complication index (CCI): added value and clinical perspectives 3 years \u201cdown the line\u201d.","volume":"265","author":"Clavien","year":"2017","journal-title":"Ann Surg"},{"issue":"5","key":"soi260018r17","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1097\/SLA.0000000000000948","article-title":"The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials.","volume":"260","author":"Slankamenac","year":"2014","journal-title":"Ann Surg"},{"issue":"2","key":"soi260018r18","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann Surg"},{"issue":"5","key":"soi260018r19","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1016\/j.surg.2007.05.005","article-title":"Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS).","volume":"142","author":"Wente","year":"2007","journal-title":"Surgery"},{"issue":"1","key":"soi260018r20","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.surg.2005.05.001","article-title":"Postoperative pancreatic fistula: an international study group (ISGPF) definition.","volume":"138","author":"Bassi","year":"2005","journal-title":"Surgery"},{"issue":"1","key":"soi260018r21","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.surg.2007.02.001","article-title":"Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition.","volume":"142","author":"Wente","year":"2007","journal-title":"Surgery"},{"issue":"10","key":"soi260018r22","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1086\/646436","article-title":"CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections.","volume":"13","author":"Horan","year":"1992","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"1","key":"soi260018r23","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1097\/JS9.0000000000000786","article-title":"Early oral feeding versus nasojejunal early enteral nutrition in patients following pancreaticoduodenectomy: a propensity score-weighted analysis of 428 consecutive patients.","volume":"110","author":"Jing","year":"2024","journal-title":"Int J Surg"},{"issue":"7","key":"soi260018r24","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1016\/j.hpb.2019.01.005","article-title":"Enteral versus parenteral nutrition following pancreaticoduodenectomy: a systematic review and meta-analysis.","volume":"21","author":"Adiamah","year":"2019","journal-title":"HPB (Oxford)"},{"issue":"1","key":"soi260018r25","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.hpb.2019.06.002","article-title":"A meta-analysis of the effect of early enteral nutrition versus total parenteral nutrition on patients after pancreaticoduodenectomy.","volume":"22","author":"Cai","year":"2020","journal-title":"HPB (Oxford)"},{"issue":"9","key":"soi260018r26","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1002\/bjs.11217","article-title":"Meta-analysis of effect of routine enteral nutrition on postoperative outcomes after pancreatoduodenectomy.","volume":"106","author":"Tanaka","year":"2019","journal-title":"Br J Surg"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2847846\/jamasurgery_joliat_2026_oi_260018_1780929713.21655.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T15:00:20Z","timestamp":1781103620000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2847846"}},"subtitle":["The NUTRIWHI Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":26,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2026.1048","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2026,6,1]]}}}