JPEN. Journal of parenteral and enteral nutrition · 2026
Surrogate measure of gut blood flow via superior mesenteric circulation on ultrasound in adults who underwent esophagectomy: A descriptive cohort study.
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Narita Tomonori, Fukatsu Kazuhiko, Inoue Reo, Murakoshi Satoshi, Noguchi Midori, Matsumoto Nana, Yajima Shoh, Yagi Koichi, Baba Yoshifumi
Аннотация
BACKGROUND: Early enteral nutrition is recommended for critically ill patients. However, feeding an ischemic gastrointestinal tract with enteral nutrition may lead to gut necrosis. Although gut tolerance of enteral nutrition is assessed by various symptoms, none of them provide conclusive evidence of gut ischemia. We investigated the blood flow in the superior mesenteric artery and vein using ultrasonography after esophagectomy along with conventional physical findings.
METHODS: We enrolled 30 patients who underwent esophagectomy at The University of Tokyo Hospital from October 2022 to July 2023. Superior mesenteric artery, vein, and common carotid arteries blood flow were measured during the preoperative fasting period and on postoperative days 1, 2, 3, 5, 7, and 9. The relationships between blood flow and physical findings were analyzed.
RESULTS: Superior mesenteric artery and vein blood flows were lower on postoperative day 1 than during the preoperative fasting period (superior mesenteric artery: 81% P = 0.03, superior mesenteric vein: 85% P = 0.01) but recovered to preoperative levels after postoperative day 2. Common carotid artery blood flow remained constant perioperatively. None of the physical findings observed correlated with the superior mesenteric artery and vein blood flows at any time point. Superior mesenteric artery and vein blood flows increased when enteral nutrition was initiated. No cases of gut necrosis were observed.
CONCLUSION: Despite the relatively severe insult, gut blood flow recovered promptly. As traditional indicators did not correlate with gut blood flow, routine measurement of superior mesenteric artery and vein blood flows may allow assessment of potential gut hypoperfusion after major surgery.
METHODS: We enrolled 30 patients who underwent esophagectomy at The University of Tokyo Hospital from October 2022 to July 2023. Superior mesenteric artery, vein, and common carotid arteries blood flow were measured during the preoperative fasting period and on postoperative days 1, 2, 3, 5, 7, and 9. The relationships between blood flow and physical findings were analyzed.
RESULTS: Superior mesenteric artery and vein blood flows were lower on postoperative day 1 than during the preoperative fasting period (superior mesenteric artery: 81% P = 0.03, superior mesenteric vein: 85% P = 0.01) but recovered to preoperative levels after postoperative day 2. Common carotid artery blood flow remained constant perioperatively. None of the physical findings observed correlated with the superior mesenteric artery and vein blood flows at any time point. Superior mesenteric artery and vein blood flows increased when enteral nutrition was initiated. No cases of gut necrosis were observed.
CONCLUSION: Despite the relatively severe insult, gut blood flow recovered promptly. As traditional indicators did not correlate with gut blood flow, routine measurement of superior mesenteric artery and vein blood flows may allow assessment of potential gut hypoperfusion after major surgery.