human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To evaluate the potential clinical , metabolic , and economic advantages of enteral nutrition over total parenteral nutrition . Design Prospect i ve , r and omized clinical trial . Setting Department of surgery in a university hospital . Patients Two hundred and fifty-seven patients with cancer of the stomach ( n = 121 ) , pancreas ( n = 110 ) , or esophagus ( n = 26 ) were r and omized to receive postoperative total parenteral nutrition ( TPN group , n = 131 ) or early enteral nutrition ( EEN group , n = 126 ) . The nutritional goal was 25 kcal/kg/day . The two nutritional formulas were isocaloric and isonitrogenous , and they were continued until oral intake was at least 800 kcal/day . Measurements Morbidity , mortality , length of hospital stay , and treatment costs were evaluated in all patients . In 40 consecutive patients , selected nutritional , immunologic and inflammatory variables were studied . Moreover , intestinal oxygen tension was evaluated by micropolarographic implantable probes . Main Results The nutritional goal was reached in 100/126 ( 79.3 % ) patients in the EEN group and in 128/131 ( 97.7 % ) patients in the TPN group ( p < .001 ) . In the EEN group , hyperglycemia ( serum glucose , > 200 mg/dL ) was observed in 4.7 % of the patients vs. 9.1 % in the TPN group ( p = NS ) . Alteration of serum electrolyte levels was 3.9 % in the EEN group vs. 13.7 % in the TPN group ( p < .01 ) . No significant difference was found in nutritional , immunologic , and inflammatory variables between the two groups . The overall complication rate was similar ( 40.4 % for TPN vs. 35.7 % , for EEN;p = .52 ) . No difference was detected for either infectious or noninfectious complications , length of hospital stay , and mortality . From postoperative day 5 , intestinal oxygen tension recovered faster in the EEN group than in the TPN group ( 43 ± 5 mm Hg vs. 31 ± 4 mm Hg at day 7;p < .001 ) . EEN was four-fold less expensive than TPN ( $ 25 vs. $ 90.60/day , respectively ) . Conclusion EEN represents a rational alternative to TPN in patients who undergo upper gastrointestinal tract surgery for cancer and who clinical ly require postoperative artificial nutrition In a double blind controlled study including 60 patients it was found that Metoclopramide has a negative effect upon the resolution of postoperative adynamic ileus .  Metoclopramide causes a delay in the time from operation to the first passage of flatus AIM To evaluate the feasibility , safety , and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma . METHODS Three hundred and sixteen patients su bmi tted to operations associated with colorectostomy from January 2004 to September 2005 were r and omized to two groups : In experimental group ( n=161 ) , the nasogastric tube was removed after the operation from 12 to 24 h and was promised immediately oral feeding ; In control group ( n=155 ) , the nasogastric tube was maintained until the passage of flatus per rectum . Variables assessed included the time to first passage of flatus , the time to first passage of stool , the time elapsed postoperative stay , and postoperative complications such as anastomotic leakage , acute dilation of stomach , wound infection and dehiscense , fever , pulmonary infection and pharyngolaryngitis . RESULTS The median and average days to the first passage of flatus ( 3.0+/-0.9 vs 3.6+/-1.2 , P<0.001 ) , the first passage of stool ( 4.1+/-1.1 vs 4.8+/-1.4 , P<0.001 ) and the length of postoperative stay ( 8.4+/-3.4 vs 9.6+/-5.0 , P<0.05 ) were shorter in the experimental group than in the control group . The postoperative complications such as anastomotic leakage ( 1.24 % vs 2.58 % ) , acute dilation of stomach ( 1.86 % vs 0.06 % ) and wound complications ( 2.48 % vs 1.94 % ) were similar in the groups , but fever ( 3.73 % vs 9.68 % , P<0.05 ) , pulmonary infection ( 0.62 % vs 4.52 % , P<0.05 ) and pharyngolaryngitis ( 3.11 % vs 23.23 % , P<0.001 ) were much more in the control group than in the experimental group . CONCLUSION The present study shows that application of gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications . On the contrary , it may increase the incidence rate of fever , pharyngolaryngitis and pulmonary infection . These strategies of early removing gastrointestinal decompression and early oral feeding in the patients undergoing colorectostomy are feasible and safe and associated with reduced postoperative discomfort and can accelerate the return of bowel function and improve rehabilitation We attempted to determine whether the administration of erythromycin shortens the period of postoperative ileus by a prospect i ve , double-blind , placebo-controlled study . Seventy-seven patients were r and omized and included in the statistical calculations . The patients were stratified according to the operation performed ( cholecystectomy , celiotomy , or other major abdominal operations ) . Forty-one patients ( group 1 ) received 250 mg erythromycin intravenously every 8 h for nine doses upon admission to the recovery room . Thirty-six patients ( group 2 ) received placebo . The time ( in hours ) to first passage of flatus , first liquid meal , first bowel movement , and total length of hospital stay was recorded . There was no significant difference between group 1 and group 2 in time to first flatus ( 54.9 + /- 29 vs. 53.9 + /- 27 h , respectively ) , first meal ( 70.4 + /- 44 vs. 71.7 + /- 65 ) , first bowel movement ( 81.8 + /- 32 vs. 80.1 + /- 28 ) , or length of hospital stay ( 185.2 + /- 183 vs. 182.1 + /- 163 ) . Erythromycin , in the dosage tested in this study , does not seem to alter clinical parameters of gastrointestinal motility after an abdominal operation . New prokinetic agents may deserve further studies Between August 1988 and September 1989 , 100 consecutive patients who underwent elective abdominal colorectal surgical procedures were prospect ively r and omized to receive or not to receive metoclopramide . Metoclopramide was intravenously administered every 8 hours from the completion of surgery until a solid food diet was able to be tolerated . Seven patients were not included in the final tabulations because of one death , one small bowel obstruction requiring laparotomy , one anastomotic leak requiring laparotomy , and four protocol violations . Ninety-three patients , 37 men and 56 women ( mean age , 59.5 ; range , 14–89 years ) underwent 40 segmental colectomies , 13 total abdominal colectomies , 8 abdominoperineal resections , 8 ileoanal pouch procedures , 7 small bowel resections , and 17 other colorectal procedures . The 40 patients who received postoperative metoclopramide were in Group 1 , and the 53 who did not were in Group 2 . The mean length of time between laparotomy and commencement of oral fluid and oral solid intake in Groups 1 and 2 were 3.5 and 4.8 days , and 3.5 and 5.0 days , respectively . These differences were not statistically significant ( P>0.05 ) . Prolonged ileus was seen in seven patients in Group 1 and in eight patients in Group 2 . These differences were also not statistically significant ( P>0.05 ) . Prolonged ileus was defined as the need for nasogastric tube reinsertion or discontinuation of oral intake . We conclude that metoclopramide does not significantly alter the course of postoperative ileus Purpose Our objective was to determine the effect of erythromycin ( EM ) in improving gastrointestinal motility in subtotal gastrectomized patients . We used radio-opaque Kolomarks as an objective method . We conducted a prospect i ve , controlled clinical trial study of 24 patients . Methods All patients underwent subtotal gastrectomy with 3 capsules containing Kolomarks ( 20 markers per 1 capsule ) in the remnant stomach before anastomosis . From the day of the operation to the 2nd postoperative day , patients in the EM group began receiving 200 mg of EM intravenously for 30 minutes continuously . We counted the number of Kolomarks in the stomach , passed by stomach , in rectum , and in stool with serial simple abdominal X-ray films on the first postoperative day up to the 7th postoperative day . Results The study population included 14 patients in the control group and 10 patients in the EM group . The two study groups were compared in terms of their characteristics including age , gender , past medical history , cancer stage , and operation type . No significant differences were found for the demographics between the two groups . We only found a significant difference for the number of Kolomarks passed by the stomach on the 3rd postoperative day ( P = 0.026 ) . Conclusion Our results demonstrated that 200 mg of EM intravenous infusion during the postoperative period induced rapid gastric emptying , although it did not improve gastrointestinal motility for the entire gastrointestinal tract in subtotal gastrectomized patients OBJECTIVE : This prospect i ve r and omized clinical study was conducted to evaluate the safety and tolerability of early oral feeding after colorectal operations . METHODS : A total of 199 patients underwent colorectal surgery and were r and omly assigned to  early feeding ( n = 99 ) or a regular diet ( n = 100 ) . Patients ' characteristics , diagnoses , surgical procedures , comorbidity , bowel movements , defecation , nasogastric tube reinsertion , time of tolerance of solid diet , complications , and length of hospitalization were assessed . RESULTS : The two groups were similar in terms of gender , age , diagnosis , surgical procedures , and comorbidity . In the early feeding group , 85.9 % of patients tolerated the early feeding schedule . Bowel movements ( 1.7±0.89 vs. 3.27±1.3 ) , defecation ( 3.4±0.77 vs. 4.38±1.18 ) and time of tolerance of solid diet ( 2.48±0.85 vs. 4.77±1.81 ) were significantly earlier in the early feeding group . There was no change between the groups in terms of nasogastric tube reinsertion , overall complication or anastomotic leakage . Hospitalization ( 5.55±2.35 vs. 9.0±6.5 ) was shorter in the early feeding group . CONCLUSIONS : The present study indicated that early oral feeding after elective colorectal surgery was not only well tolerated by patients but also affected the postoperative outcomes positively . Early postoperative feeding is safe and leads to the early recovery of gastrointestinal functions Background : The current trend in postoperative nutrition is to promote a normal oral diet as early as possible . However , postoperative ileus is a frequent and common problem after major abdominal surgery . This study was design ed to investigate whether early enteral nutrition ( EEN ) , as a bridge to a normal diet , can reduce postoperative ileus . Methods : Patients undergoing major rectal surgery for locally advanced primary or recurrent rectal carcinoma ( after neoadjuvant (chemo)-radiation , with or without intraoperative radiotherapy ) were r and omly assigned to EEN ( n = 61 ) or early parenteral nutrition ( EPN , n = 62 ) in addition to an oral diet . Early nutrition was started 8 hours after surgery . Early parenteral nutrition was given as control nutrition to obtain caloric equivalence and minimize confounding . The primary endpoint was time to first defecation ; secondary outcomes were morbidity , other ileus symptoms , and length of hospital stay . Results : Baseline characteristics were similar for both groups . In intention-to-treat analysis , the time to first defecation was significantly shorter in the enteral nutrition arm than in the control arm ( P = 0.04 ) . Moreover , anastomotic leakage occurred significantly less frequently in the enteral group ( 1 patient ) compared with parenteral supplementation ( 9 patients , P = 0.009 ) . Mean length of stay in the enteral group was 13.4 ± 2.2 days versus 16.7 ± 2.3 days in the parenteral group ( P = 0.007 ) . Conclusions : Early enteral nutrition is safe and associated with significantly less ileus . Early enteral nutrition is associated with less anastomotic leakage in patients undergoing extensive rectal surgery BACKGROUND This study assesses the safety outcome of early oral feeding and reports on the factors affecting early post 
    Output:
    
agent
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 .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To evaluate the potential clinical , metabolic , and economic advantages of enteral nutrition over total parenteral nutrition . Design Prospect i ve , r and omized clinical trial . Setting Department of surgery in a university hospital . Patients Two hundred and fifty-seven patients with cancer of the stomach ( n = 121 ) , pancreas ( n = 110 ) , or esophagus ( n = 26 ) were r and omized to receive postoperative total parenteral nutrition ( TPN group , n = 131 ) or early enteral nutrition ( EEN group , n = 126 ) . The nutritional goal was 25 kcal/kg/day . The two nutritional formulas were isocaloric and isonitrogenous , and they were continued until oral intake was at least 800 kcal/day . Measurements Morbidity , mortality , length of hospital stay , and treatment costs were evaluated in all patients . In 40 consecutive patients , selected nutritional , immunologic and inflammatory variables were studied . Moreover , intestinal oxygen tension was evaluated by micropolarographic implantable probes . Main Results The nutritional goal was reached in 100/126 ( 79.3 % ) patients in the EEN group and in 128/131 ( 97.7 % ) patients in the TPN group ( p < .001 ) . In the EEN group , hyperglycemia ( serum glucose , > 200 mg/dL ) was observed in 4.7 % of the patients vs. 9.1 % in the TPN group ( p = NS ) . Alteration of serum electrolyte levels was 3.9 % in the EEN group vs. 13.7 % in the TPN group ( p < .01 ) . No significant difference was found in nutritional , immunologic , and inflammatory variables between the two groups . The overall complication rate was similar ( 40.4 % for TPN vs. 35.7 % , for EEN;p = .52 ) . No difference was detected for either infectious or noninfectious complications , length of hospital stay , and mortality . From postoperative day 5 , intestinal oxygen tension recovered faster in the EEN group than in the TPN group ( 43 ± 5 mm Hg vs. 31 ± 4 mm Hg at day 7;p < .001 ) . EEN was four-fold less expensive than TPN ( $ 25 vs. $ 90.60/day , respectively ) . Conclusion EEN represents a rational alternative to TPN in patients who undergo upper gastrointestinal tract surgery for cancer and who clinical ly require postoperative artificial nutrition In a double blind controlled study including 60 patients it was found that Metoclopramide has a negative effect upon the resolution of postoperative adynamic ileus .  Metoclopramide causes a delay in the time from operation to the first passage of flatus AIM To evaluate the feasibility , safety , and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma . METHODS Three hundred and sixteen patients su bmi tted to operations associated with colorectostomy from January 2004 to September 2005 were r and omized to two groups : In experimental group ( n=161 ) , the nasogastric tube was removed after the operation from 12 to 24 h and was promised immediately oral feeding ; In control group ( n=155 ) , the nasogastric tube was maintained until the passage of flatus per rectum . Variables assessed included the time to first passage of flatus , the time to first passage of stool , the time elapsed postoperative stay , and postoperative complications such as anastomotic leakage , acute dilation of stomach , wound infection and dehiscense , fever , pulmonary infection and pharyngolaryngitis . RESULTS The median and average days to the first passage of flatus ( 3.0+/-0.9 vs 3.6+/-1.2 , P<0.001 ) , the first passage of stool ( 4.1+/-1.1 vs 4.8+/-1.4 , P<0.001 ) and the length of postoperative stay ( 8.4+/-3.4 vs 9.6+/-5.0 , P<0.05 ) were shorter in the experimental group than in the control group . The postoperative complications such as anastomotic leakage ( 1.24 % vs 2.58 % ) , acute dilation of stomach ( 1.86 % vs 0.06 % ) and wound complications ( 2.48 % vs 1.94 % ) were similar in the groups , but fever ( 3.73 % vs 9.68 % , P<0.05 ) , pulmonary infection ( 0.62 % vs 4.52 % , P<0.05 ) and pharyngolaryngitis ( 3.11 % vs 23.23 % , P<0.001 ) were much more in the control group than in the experimental group . CONCLUSION The present study shows that application of gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications . On the contrary , it may increase the incidence rate of fever , pharyngolaryngitis and pulmonary infection . These strategies of early removing gastrointestinal decompression and early oral feeding in the patients undergoing colorectostomy are feasible and safe and associated with reduced postoperative discomfort and can accelerate the return of bowel function and improve rehabilitation We attempted to determine whether the administration of erythromycin shortens the period of postoperative ileus by a prospect i ve , double-blind , placebo-controlled study . Seventy-seven patients were r and omized and included in the statistical calculations . The patients were stratified according to the operation performed ( cholecystectomy , celiotomy , or other major abdominal operations ) . Forty-one patients ( group 1 ) received 250 mg erythromycin intravenously every 8 h for nine doses upon admission to the recovery room . Thirty-six patients ( group 2 ) received placebo . The time ( in hours ) to first passage of flatus , first liquid meal , first bowel movement , and total length of hospital stay was recorded . There was no significant difference between group 1 and group 2 in time to first flatus ( 54.9 + /- 29 vs. 53.9 + /- 27 h , respectively ) , first meal ( 70.4 + /- 44 vs. 71.7 + /- 65 ) , first bowel movement ( 81.8 + /- 32 vs. 80.1 + /- 28 ) , or length of hospital stay ( 185.2 + /- 183 vs. 182.1 + /- 163 ) . Erythromycin , in the dosage tested in this study , does not seem to alter clinical parameters of gastrointestinal motility after an abdominal operation . New prokinetic agents may deserve further studies Between August 1988 and September 1989 , 100 consecutive patients who underwent elective abdominal colorectal surgical procedures were prospect ively r and omized to receive or not to receive metoclopramide . Metoclopramide was intravenously administered every 8 hours from the completion of surgery until a solid food diet was able to be tolerated . Seven patients were not included in the final tabulations because of one death , one small bowel obstruction requiring laparotomy , one anastomotic leak requiring laparotomy , and four protocol violations . Ninety-three patients , 37 men and 56 women ( mean age , 59.5 ; range , 14–89 years ) underwent 40 segmental colectomies , 13 total abdominal colectomies , 8 abdominoperineal resections , 8 ileoanal pouch procedures , 7 small bowel resections , and 17 other colorectal procedures . The 40 patients who received postoperative metoclopramide were in Group 1 , and the 53 who did not were in Group 2 . The mean length of time between laparotomy and commencement of oral fluid and oral solid intake in Groups 1 and 2 were 3.5 and 4.8 days , and 3.5 and 5.0 days , respectively . These differences were not statistically significant ( P>0.05 ) . Prolonged ileus was seen in seven patients in Group 1 and in eight patients in Group 2 . These differences were also not statistically significant ( P>0.05 ) . Prolonged ileus was defined as the need for nasogastric tube reinsertion or discontinuation of oral intake . We conclude that metoclopramide does not significantly alter the course of postoperative ileus Purpose Our objective was to determine the effect of erythromycin ( EM ) in improving gastrointestinal motility in subtotal gastrectomized patients . We used radio-opaque Kolomarks as an objective method . We conducted a prospect i ve , controlled clinical trial study of 24 patients . Methods All patients underwent subtotal gastrectomy with 3 capsules containing Kolomarks ( 20 markers per 1 capsule ) in the remnant stomach before anastomosis . From the day of the operation to the 2nd postoperative day , patients in the EM group began receiving 200 mg of EM intravenously for 30 minutes continuously . We counted the number of Kolomarks in the stomach , passed by stomach , in rectum , and in stool with serial simple abdominal X-ray films on the first postoperative day up to the 7th postoperative day . Results The study population included 14 patients in the control group and 10 patients in the EM group . The two study groups were compared in terms of their characteristics including age , gender , past medical history , cancer stage , and operation type . No significant differences were found for the demographics between the two groups . We only found a significant difference for the number of Kolomarks passed by the stomach on the 3rd postoperative day ( P = 0.026 ) . Conclusion Our results demonstrated that 200 mg of EM intravenous infusion during the postoperative period induced rapid gastric emptying , although it did not improve gastrointestinal motility for the entire gastrointestinal tract in subtotal gastrectomized patients OBJECTIVE : This prospect i ve r and omized clinical study was conducted to evaluate the safety and tolerability of early oral feeding after colorectal operations . METHODS : A total of 199 patients underwent colorectal surgery and were r and omly assigned to  early feeding ( n = 99 ) or a regular diet ( n = 100 ) . Patients ' characteristics , diagnoses , surgical procedures , comorbidity , bowel movements , defecation , nasogastric tube reinsertion , time of tolerance of solid diet , complications , and length of hospitalization were assessed . RESULTS : The two groups were similar in terms of gender , age , diagnosis , surgical procedures , and comorbidity . In the early feeding group , 85.9 % of patients tolerated the early feeding schedule . Bowel movements ( 1.7±0.89 vs. 3.27±1.3 ) , defecation ( 3.4±0.77 vs. 4.38±1.18 ) and time of tolerance of solid diet ( 2.48±0.85 vs. 4.77±1.81 ) were significantly earlier in the early feeding group . There was no change between the groups in terms of nasogastric tube reinsertion , overall complication or anastomotic leakage . Hospitalization ( 5.55±2.35 vs. 9.0±6.5 ) was shorter in the early feeding group . CONCLUSIONS : The present study indicated that early oral feeding after elective colorectal surgery was not only well tolerated by patients but also affected the postoperative outcomes positively . Early postoperative feeding is safe and leads to the early recovery of gastrointestinal functions Background : The current trend in postoperative nutrition is to promote a normal oral diet as early as possible . However , postoperative ileus is a frequent and common problem after major abdominal surgery . This study was design ed to investigate whether early enteral nutrition ( EEN ) , as a bridge to a normal diet , can reduce postoperative ileus . Methods : Patients undergoing major rectal surgery for locally advanced primary or recurrent rectal carcinoma ( after neoadjuvant (chemo)-radiation , with or without intraoperative radiotherapy ) were r and omly assigned to EEN ( n = 61 ) or early parenteral nutrition ( EPN , n = 62 ) in addition to an oral diet . Early nutrition was started 8 hours after surgery . Early parenteral nutrition was given as control nutrition to obtain caloric equivalence and minimize confounding . The primary endpoint was time to first defecation ; secondary outcomes were morbidity , other ileus symptoms , and length of hospital stay . Results : Baseline characteristics were similar for both groups . In intention-to-treat analysis , the time to first defecation was significantly shorter in the enteral nutrition arm than in the control arm ( P = 0.04 ) . Moreover , anastomotic leakage occurred significantly less frequently in the enteral group ( 1 patient ) compared with parenteral supplementation ( 9 patients , P = 0.009 ) . Mean length of stay in the enteral group was 13.4 ± 2.2 days versus 16.7 ± 2.3 days in the parenteral group ( P = 0.007 ) . Conclusions : Early enteral nutrition is safe and associated with significantly less ileus . Early enteral nutrition is associated with less anastomotic leakage in patients undergoing extensive rectal surgery BACKGROUND This study assesses the safety outcome of early oral feeding and reports on the factors affecting early post 
    Output:
    