Background: Suggested guidelines for nutritional support after pancreaticoduodenectomy are still
controversial. Recent evidence suggests that combining enteral nutrition (EN) with parenteral nutrition
(PN) improves outcome. For ten years, patients have been treated with Early Combined Parenteral and
Enteral Nutrition (ECPEN) after PD. The aim of this study was to report on rationale, safety, effectiveness
and outcome associated with this method.
Methods: Consecutive PD performed between 2003 and 2012 were analyzed retrospectively. Early EN
and PN was standardized and started immediately after surgery. EN was increased to 40 ml/h (1 kcal/ml)
over 24 h, while PN was supplemented based on a daily energy target of 25 kcal/kg. Standard enteral and
parenteral products were used.