Annals of Clinical Nutrition and Metabolism

Guideline

A practical guide for enteral nutrition from the Korean Society for Parenteral and Enteral Nutrition: Part II. selection and initiation of enteral feeding routes: Ja Kyung Min, Ye Rim Chang, Bo-Eun Kim, In Seok Lee, Jung Mi Song, Hyunjung Kim, Jae Hak Kim, Kyung Won Seo, Sung Shin Kim, Chi-Min Park, Jeongyun Park, Eunjung Kim, Eunmi Sul, Sung-Sik Han, Jeong Wook Kim, Seungwan Ryu, Minji Seok, Jinhee Yoon, Eunhee Kong, Youn Soo Cho, Jeong Meen Seo, for KSPEN Enteral Nutrition Committee; Ann Clin Nutr Metab 2025;17(3):165-171. Published online December 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0037

Abstract PDF: Purpose
We developed evidence-based recommendations for selecting and initiating the enteral nutrition (EN) delivery route in adult and pediatric patients to improve safety and standardize practice in Korea.
Methods
Key questions covered feeding tube selection, methods to verify tube placement, confirmation in pediatric patients, and timing of EN following percutaneous endoscopic gastrostomy (PEG). Recommendations were drafted and refined through multidisciplinary expert consensus under the Korean Society for Parenteral and Enteral Nutrition (KSPEN).
Results
Feeding tube selection should be based on gastrointestinal anatomy, function, and expected EN duration. Short-term feeding is recommended with nasogastric or orogastric tubes, whereas long-term feeding should use percutaneous or surgical routes such as PEG. Tube position must always be verified before use, preferably with radiography or pH testing; auscultation alone is unreliable and should not be used. In pediatric patients, radiographic confirmation remains the gold standard, although pH testing and insertion-length assessment may be considered when imaging is not feasible. After PEG, EN can be initiated safely within 4 hours in both adults and children without increasing complications if trained staff monitor for leakage or infection.
Conclusion
This guideline offers a structured framework for safe and timely EN tailored to patient characteristics. Early verification and multidisciplinary collaboration help reduce complication, improving outcomes of EN therapy.

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Original Article

Development of a pre- and re-habilitation protocol for gastrointestinal cancer surgery: Eun Young Kim, Jung Hoon Bae, Jiseon Kim, Eun Joo Yang, Sang-Jae Park, In Kyu Lee, on behalf of the Task Force Team for Development and Trial Application of Pre/Rehabilitation Protocol in GI Cancer Surgery; Ann Clin Nutr Metab 2025;17(1):25-40. Published online April 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0001

Abstract PDF Supplementary Material: Purpose
Surgical resection is the primary curative treatment for gastrointestinal (GI) cancer; however, it is associated with high postoperative complication rates and impaired recovery. Frailty, malnutrition, and sarcopenia increase morbidity and mortality, underscoring the need for perioperative rehabilitation programs. Standardized rehabilitation protocols during the perioperative period are currently lacking in Korea. We aimed to develop an evidence-based rehabilitation protocol for GI cancer patients to enhance postoperative outcomes and facilitate clinical implementation.
Methods
A multidisciplinary task force team comprising experts in surgery, clinical nutrition, and rehabilitation medicine conducted a systematic literature search and comprehensive review from 2012 to 2022 to develop a standardized pre- and re-habilitation protocol for GI cancer surgery. The protocol underwent external validation and subsequent refinements before being finalized through expert consensus.
Results
The protocol development process was organized into four consecutive phases: keyword selection, literature review and case report form development, initial protocol drafting, and external validation leading to the final version of the protocol. The final version of the rehabilitation protocol is presented in the main text and included as Supplements.
Conclusion
This protocol provides a standardized clinical guideline based on the latest evidence-based pre- and re-habilitation strategies and is designed for seamless integration into routine clinical practice. By facilitating proactive rehabilitation interventions, it aims to improve outcomes in GI cancer patients who are at high risk of postoperative complications, functional decline, and malnutrition.

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