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Clin Nutr. 2019 Oct 25. pii: S0261-5614(19)33110-3. doi: 10.1016/j.clnu.2019.10.023. [Epub ahead of print]

Enhanced recovery programs in gastrointestinal surgery: Actions to promote optimal perioperative nutritional and metabolic care.

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School of Medicine and Surgery, Milano - Bicocca University, Department of Surgery, San Gerardo Hospital, Monza, Italy. Electronic address:
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.
Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.


The enhanced recovery after surgery (ERAS) pathway is an evidence-based approach to the use of care elements along the patient perioperative pathway. All care elements that may impact on clinically relevant outcomes have been considered and reviewed. The combined ERAS actions allow a quicker return to bowel function, oral feeding, nutritional and metabolic equilibrium, normal activity and ultimately to achieve better outcomes. Because of the multi factorial approach and the commitment of all the professionals caring for the patient, it is necessary to have the engagement of all disciplines, such as surgery, anesthesiology, clinical nutrition, nursing, physiatry, involved. ERAS is a dynamic process and new evidence are constantly integrated into the program. The primary endpoint of this review is to give updated information on the key ERAS actions to achieve optimal perioperative nutritional and metabolic care.


Clinical nutrition; Early oral feeding; Enhanced recovery after surgery (ERAS); Metabolism; Surgery


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