Enteral Versus Parenteral Nutrition in the Conservative Treatment of Upper Gastrointestinal Fistula After Surgery (NUTRILEAK)
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|ClinicalTrials.gov Identifier: NCT03742752|
Recruitment Status : Recruiting
First Posted : November 15, 2018
Last Update Posted : September 11, 2020
The incidence of clinically significant anastomotic leaks (AL) after upper gastrointestinal (GI) surgery is approximately 4 % - 20 %, and the associated mortality can be as high as 80 % . Nutritional support is a key component of therapy in such cases, related to high prevalence of malnutrition and nil per month required for leak treatment.
In the prophylactic setting, before the occurrence of any AL, a literature review based on seven randomised trials showed that enteral nutrition (EN) is associated with shorter hospital stay, lower incidence of severe of infectious complications, lower severity of complications and decreased cost compared to parenteral nutrition (TPN) following major upper GI surgery .
In the curative setting, after the AL occurrence, very few evidence is available. Only one randomized clinical trial suggested the superiority of EN versus TPN after pancreatic surgery with a increase of the 30-day fistula closure rate from 37% in the TPN group to 60% in the EN group .
This sole randomised study available did not include all postoperative upper GI AL (PUGIAL) that can occur after esophageal, gastric, duodenal, pancreatic surgery (including obesity surgery), whereas the concept of enteral nutritional support is highly relevant for all these situations.
However surgeons are usually reluctant to provide EN in case of AL. A randomized study suggested the feasibility of EN in 47 patients with upper GI AL but no randomized study to date has been designed to test the superiority of EN versus TPN in PUGIAL.
The study aim is to demonstrate the superiority of EN versus TPN to accelerate AL healing after upper GI surgery.
EN increases the 30-day fistula closure rate in PUGIAL, allowing better HRQOL without increasing morbi-mortality.
|Condition or disease||Intervention/treatment||Phase|
|Gastrointestinal Fistula Enteral Nutritional Support||Other: Enteral nutrition Other: Parenteral nutrition||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||321 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|Official Title:||Enteral Versus Parenteral Nutrition in the Conservative Treatment of Upper Gastrointestinal Fistula After Surgery: a Multicenter, Randomized, Parallel-group, Open Label|
|Actual Study Start Date :||June 7, 2019|
|Estimated Primary Completion Date :||July 2022|
|Estimated Study Completion Date :||July 2022|
Experimental: Enteral Nutrition (EN)
To demonstrate the superiority of EN versus TPN in the treatment of postoperative upper GI anastomotic leak (PUGIAL) after upper GI surgery (including esophageal, gastric, duodenal, pancreatic and obesity surgery).
Patients will be randomized to receive EN through jejunostomy or nasojejunal tube until oral diet covering at least 60% of their daily requirement
Other: Enteral nutrition
administration of enteral nutrition
Active Comparator: Parenteral Nutrition (TPN)
Patients will be randomized to receive TPN through central venous access, piccline or totally implantable venous access port tube until oral diet covering at least 60% of their daily requirement
Other: Parenteral nutrition
administration of parenteral nutrition
- 30-day fistula closure rate [ Time Frame: 30 days after randomization ]Fistula closure will be defined as an output of no fluid for at least 48 hours in wound or drainage AND absence of any fluid collection on imaging (Computed Tomography scan with injection of contrast product).
- 6-month fistula closure rate [ Time Frame: at 6 months after randomization ]Percentage of patients having their fistula closed according to the definition above within 6 months after randomization
- Time to first fistula closure [ Time Frame: at 6 months after randomization ]Time to first fistula closure defined as time in days from randomization to first AL closure within 6 months after randomization
- Treatment-related complications [ Time Frame: longitudinal evaluation during all the study duration (from randomization to 6 months) ]number of patients presenting at least one complication related to the nutritional support (catheter related infection or thrombosis, tube related complication)
- Postoperative mortality rate [ Time Frame: at 30 days after randomization ]rate of death after operation
- Postoperative morbidity rate [ Time Frame: at 30 days after randomization ]rate of patients with a Clavien-Dindo grade 3-4-5 complications
- Weight [ Time Frame: longitudinal evaluation during all the study duration (from randomization to 6 months) ]in kg
- Albumin and prealbumin [ Time Frame: longitudinal evaluation during all the study duration (from randomization to 6 months) ]in g/L
- C reactive protein [ Time Frame: longitudinal evaluation during all the study duration (from randomization to 6 months) ]mg/L
- Grip test [ Time Frame: longitudinal evaluation during all the study duration (from randomization to 6 months) ]muscular strength
- Length of hospital stay in healthcare structure [ Time Frame: from the randomization until the end of hospitalization, up to 6 months ]Length of hospital stay in healthcare structure (including home hospitalization) based on the number of days of hospitalization
- Short form questionnaire 36 (SF-36) [ Time Frame: at inclusion, day 30, day 60, 3 months and 6 months ]Patient's Health-related quality of life (HRQOL) score. The SF-36 includes a single-item measure of health transition or change. he SF-36® Health Survey items and scales were constructed using the Likert method of summated ratings.4 Answers to each question are scored (some items need to be recoded). These scores are then summed to produce raw scale scores for each health concept which are then transformed to a 0 - 100 scale. Thie higher the score is, the better the quality of life is.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03742752
|Contact: Guillaume Piessen, MD,PhD||3 20 44 44 07 ext +firstname.lastname@example.org|
|Contact: Caroline Gronnier, MDemail@example.com|
|Hôpital Claude Huriez, CHU||Recruiting|
|Principal Investigator: Guillaume Piessen, MD,PhD|
|Principal Investigator:||Guillaume Piessen, MD,PhD||University Hospital, Lille|