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Systematic review
Distal feeding–bowel stimulation to treat short-term or long-term pathology: a systematic review
  1. Stella Maye Dilke1,
  2. Laura Gould1,
  3. Mark Yao2,
  4. Maria Souvatzi1,
  5. Adam Stearns3,
  6. Ana Ignjatovic-Wilson4,
  7. Phil Tozer5,
  8. Carolynne J Vaizey6
  1. 1 Colorectal Surgery, St Mark’s Academic Institute, Harrow, UK
  2. 2 General Surgery, Whittington Hospital, London, London, UK
  3. 3 Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
  4. 4 Gastroenterology, St Mark’s Hospital, London, UK
  5. 5 Colorectal Surgery, St Mark's Hospital, London, UK
  6. 6 Sir Alan Parks Physiology Unit, St Mark’s Hospital, London, UK
  1. Correspondence to Dr Stella Maye Dilke, Colorectal Surgery, St Mark's Academic Institute, Harrow HA1 2UJ, UK; stella.dilke{at}


Background Distal feeding (DF) describes the insertion of a feeding tube into a fistula or stoma to administer a liquid feed into the distal bowel. It is currently used clinically in patients who are unable to absorb enough nutrition orally. This systematic review investigates DF as a therapeutic measure across a spectrum of patients with stomas and fistulae.

Methods A total of 2825 abstracts and 44 full-text articles were screened via OVID. Fifteen papers were included for analysis. Randomised controlled trials, cohort and observational studies investigating DF as a therapeutic measure were included.

Results Three feeds were used across the studies—reinfusion of effluent, infusion of prebiotic or a mixture. The studies varied the length of feeding between 24 hours and 61 days, and the mode of feeding, bolus or continuous varied.

DF was demonstrated to effectively wean patients from parenteral nutrition in two papers. Two papers demonstrated a significant reduction in stoma output. Three papers demonstrated improved postoperative complication rates with distal feeding regimens, including ileus (2.85% vs 20% in unfed population, p=0.024). One paper demonstrated a reduction in postoperative stool frequency.

Conclusions This review was limited by study heterogeneity and the lack of trial data, and in the patient groups involved, the variability in diet and length of regimen. These studies suggest that DF can significantly reduce stoma output and improve renal and liver function; however, the mechanism is not clear. Further mechanistic work on the immunological and microbiological action of DF would be important.

  • intestinal failure
  • colorectal cancer
  • nutritional supplementation
  • short bowel syndrome
  • prebiotic

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  • Contributors SMD and LG selected and analysed the papers. SMD wrote the paper with LG with editing input from MS, PT, AI-W and CJV. MY interpreted the Chinese papers. Clara Blanchard interpreted the French papers.

  • Funding St Mark’s Academic Institute paid for Covidence software, no other costs were incurred.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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