Effect of enteral ecoimmunonutrition support for patients undergoing hepatectomy: A meta-analysis of randomized controlled trials

Background Whether to conduct enteral ecoimmunonutrition (EEIN) in patients undergoing hepatectomy remains controversial. This study aimed to systematically explore the efficacy and safety of EEIN in patients undergoing hepatectomy. Subject We performed searches in the Embase, PubMed, Medline, Cochrane Library, Chinese Scientific Journal Database (VIP), Chinese National Knowledge Infrastructure (CNKI) and Wanfang databases. Results A total of 9 randomized controlled trials (705 patients) were included. The meta-analysis revealed a significantly shorter time to first postoperative flatus (h) (MD, −14.60; 95% CI, −16.06~−13.15; P < 0.00001); lower levels of alanine aminotransferase (µmol/L) (MD, −22.26; 95% CI, −28.42~−16.10; P < 0.00001), aspartate transaminase (µmol/L) (MD, −53.79; 95% CI, −57.37~−50.21; P < 0.00001), total bilirubin (µmol/L) (MD, −16.28; 95% CI, −17.77~−14.79; P < 0.00001), direct bilirubin (µmol/L) (MD, −8.77; 95% CI, −9.65~−7.88; P < 0.00001), endotoxin (ng/L) (MD, −0.78; 95% CI, −0.88~−0.68; P < 0.00001), tumor necrosis factor-α (pg/ml) (MD, −79.69; 95% CI, −99.90~−59.49; P < 0.00001), and interleukin-6 (pg/ml) (MD, −46.29; 95% CI, −50.24~−42.34; P < 0.00001); and higher levels of immunoglobulin A (g/L) (MD, 0.24; 95% CI, 0.14~0.35; P < 0.00001), immunoglobulin G (g/L) (MD, 1.52; 95% CI, 1.22~1.82; P < 0.00001), and immunoglobulin M (g/L) (MD, 0.12; 95% CI, 0.05~0.20; P = 0.0007) in the EEIN group than in the enteral or parenteral nutrition (EN/PN) groups. Conclusion Enteral ecoimmunonutrition support in patients undergoing hepatectomy may effectively protect liver function, reduce serum endotoxin levels and inflammatory factors, improve the immune function of patients, and promote the recovery of postoperative gastrointestinal function, which is worthy of clinical application.