Neither metoclopramide nor erythromycin were effective in expediting the resolution of ileus .
Analyses of 32 r and omized controlled trials showed that EEN facilitates return of normal bowel function , achieving enteral nutrition goals , and reducing hospital length of stay .
CONCLUSION In patients who have undergone abdominal surgery , we strongly recommend EEN to expedite resolution of Ileus , but we can not recommend for or against the use of either metoclopramide or erythromycin to hasten the resolution of ileus in these patients .
BACKGROUND Ileus is a common challenge in adult surgical patients with estimated incidence to be 17 % to 80 % .
The main mechanisms of the postoperative ileus pathophysiology are fluid overload , exogenous opioids , neurohormonal dysfunction , gastrointestinal stretch , and inflammation .
Management includes addressing the underlying cause and supportive care .
Multiple medical interventions have been proposed , but effectiveness is uncertain .
A working group of the Eastern Association for the Surgery of Trauma aim ed to evaluate the effectiveness of metoclopramide , erythromycin , and early enteral nutrition ( EEN ) on ileus in adult surgical patients and to develop recommendations applicable in a daily clinical practice .
Preventing prolonged post-operative ileus in gastric cancer patients undergoing gastrectomy and intra-peritoneal chemotherapy.
AIM To assess the efficacy of metoclopramide ( Met ) for prevention of prolonged post-operative ileus in advanced gastric cancer patients undergoing D2 gastrectomy and intra-peritoneal chemotherapy ( IPC ) . METHODS Thirty-two advanced gastric cancer patients undergoing D2 gastrectomy and IPC  were allocated to two groups . Sixteen patients received Met immediately after operation ( group A ) , and 16 did not ( group B ) . Another 16 patients who underwent D2 gastrectomy without IPC  were enrolled as the control group ( group C ) . All patients had received epidural pain control . The primary endpoints were time to first post-operative flatus and time until oral feeding with a soft diet without discomfort . Secondary endpoints were early complications during hospitalization . RESULTS Gender , the type of resection , operating time , blood loss , tumor status and amount of narcotics were comparable in the three groups . However , the group C patients were older than those in groups A and B ( 67.5+/-17.7 vs 56.8+/-13.2 , 57.5+/-11.7 years , P = 0.048 ) . First bowel flatus occurred after 4.35+/-0.93 d in group A , 4.94+/-1.37 d in group B , and 4.71+/-1.22 d in group C ( P>0.05 ) . Oral feeding of a soft diet was tolerated 7.21+/-1.92 d after operation in group A , 10.15+/-2.17 d in group B , and 7.53+/-1.35 d in group C ( groups A and C vs group B , P<0.05 ) . There was no significant difference in respect to the first flatus among the three groups . However , the time of tolerating oral intake with soft food in groups A and C patients was significantly shorter than that in group B patients . Levels of C-reactive protein ( CRP ) were significantly lower in group C and there was a more prominent and prolonged response in CRP level in patients undergoing IPC . The incidence of post-operative complications was similar in the three groups except for prolonged post-operative ileus . There was no increased risk of anastomotic leakage in patients receiving Met . CONCLUSION The results suggest that a combination of intravenous Met and epidural pain control may be required to achieve a considerable decrease in time to resumption of oral soft diet in advanced gastric cancer patients who underwent gastrectomy and IPC . Furthermore , the administration of Met did not increase anastomotic leakage . Met has a role in the prevention of prolonged post-operative ileus
Neither metoclopramide nor erythromycin were effective in expediting the resolution of ileus .
Analyses of 32 r and omized controlled trials showed that EEN facilitates return of normal bowel function , achieving enteral nutrition goals , and reducing hospital length of stay .
CONCLUSION In patients who have undergone abdominal surgery , we strongly recommend EEN to expedite resolution of Ileus , but we can not recommend for or against the use of either metoclopramide or erythromycin to hasten the resolution of ileus in these patients .
BACKGROUND Ileus is a common challenge in adult surgical patients with estimated incidence to be 17 % to 80 % .
The main mechanisms of the postoperative ileus pathophysiology are fluid overload , exogenous opioids , neurohormonal dysfunction , gastrointestinal stretch , and inflammation .
Management includes addressing the underlying cause and supportive care .
Multiple medical interventions have been proposed , but effectiveness is uncertain .
A working group of the Eastern Association for the Surgery of Trauma aim ed to evaluate the effectiveness of metoclopramide , erythromycin , and early enteral nutrition ( EEN ) on ileus in adult surgical patients and to develop recommendations applicable in a daily clinical practice .