The effects of immunonutrition in upper gastrointestinal surgery: A systematic review and meta-analysis

Chee Siong Wong, E Aly

Research output: Contribution to journalArticlepeer-review


Aim: The beneficial of immunonutrition on overall morbidity and mortality remains uncertain. We undertook a systematic review to evaluate the effects of immune-enhancing enteral nutrition (IEN) in upper gastrointestinal (GI) surgery.

Methods: Main electronic databases [MEDLINE via Pubmed, EMBASE, Scopus, Web of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library, and clinical trial registry (] were searched for studies reported clinical outcomes comparing standard enteral nutrition (SEN) and immunonutrition (IEN). The systematic review was conducted in accordance with the PRISMA guidelines and meta-analysis was analysed using fixed and random-effects models.

Results: Nineteen RCTs with a total of 2016 patients (1017 IEN and 999 SEN) were included in the final pooled analysis. IEN significantly reduced post-operative wound infection (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.50 to 0.94). Although, the combined results showed that IEN had a shorter hospital stay (RR -2.51 days, 95% CI -3.47 to −1.55), there was significant heterogeneity observed across these studies. There was no statistically significant benefit on other post-operative morbidities of interest (e.g. anastomotic leak) and mortality.

Conclusion: IEN decreases wound infection rates and reduces length of stay. It can be recommended as routine nutritional support in upper GI surgery.
Original languageEnglish
Pages (from-to)S117
JournalInternational Journal of Surgery
Issue numberSuppl. 1
Publication statusPublished - Nov 2015


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