Optimizing Perioperative Nutrition in Elective Gastrointestinal Surgery: An ERAS-Focused Narrative Review.

Area of Science:

• Surgical Nutrition
• Gastrointestinal Surgery
• Enhanced Recovery After Surgery (ERAS)

Background:

• Perioperative malnutrition, sarcopenia, and reduced functional reserve are common in elective GI surgery patients.
• These conditions are linked to increased postoperative morbidity and slower recovery.
• Existing ERAS pathways include nutrition but show variable effects across different procedures and patient groups.

Purpose of the Study:

• To critically review current evidence on perioperative nutritional strategies in ERAS-focused elective GI surgery.
• To evaluate interventions like risk identification, prehabilitation, carbohydrate loading, early feeding, and microbiome adjuncts.
• To synthesize findings considering variations in surgical populations, interventions, and outcome reporting.

Main Methods:

• Narrative literature review using PubMed/MEDLINE and Scopus (2010-early 2026).
• Supplemented with clinical practice guidelines and consensus statements (e.g., ESPEN).
• Interpreted evidence by hierarchy (guidelines, meta-analyses, RCTs, observational studies) and discussed heterogeneity.

Main Results:

• Nutritional risk screening is vital for identifying and managing malnutrition/sarcopenia.
• Perioperative oral nutritional supplementation improves intake and reduces infectious morbidity in at-risk patients.
• Early oral/enteral feeding is feasible and may accelerate GI recovery; probiotics show promise in colorectal surgery.

Conclusions:

• Perioperative nutritional optimization is integral to ERAS pathways for elective GI surgery.
• Benefits are most significant in higher-risk patients and within high-compliance multidisciplinary programs.
• Future research needs procedure-specific, risk-stratified trials with standardized interventions and meaningful endpoints.