- βFirst trial to investigate low-carb tube feeding for glycemic control in non-diabetic surgical patients β expanding blood sugar management beyond diagnosed diabetes
- βUses continuous glucose monitoring (CGM) to capture real-time blood sugar data across the full 8-day post-operative window, providing richer insight than traditional spot checks
- βResults could directly inform US hospital feeding protocols for the 22,000+ Americans undergoing esophageal cancer surgery annually
| Country | Japan |
| Journal | PloS one |
| Year | 2025 |
| Authors | Terayama, Imamura, Kitazawa |
| PMID | 40435183 |
Japan Trial Tests Low-Carb Tube Feeding After Esophageal Cancer Surgery
A study from Japan is breaking new ground in surgical nutrition care, asking a question that has largely been ignored in operating rooms worldwide: should doctors actively manage blood sugar in non-diabetic patients recovering from major cancer surgery? Researchers at the Cancer Institute Hospital of the Japanese Foundation for Cancer Research in Tokyo believe the answer may be yes β and they have launched a formal clinical trial to find out.
What the Study Is Testing
The ENLICHE trial is a randomized Phase II study enrolling 50 non-diabetic patients undergoing esophagectomy β a complex and physically demanding surgery to remove part or all of the esophagus due to cancer. After surgery, patients cannot eat normally and receive all their nutrition through a feeding tube, a process called enteral nutrition (EN).
The trial randomly assigns patients to one of two tube-feeding formulas: a standard formula or a low-carbohydrate formula. Both groups follow the same feeding schedule, starting at roughly 14 oz (400 mL) per day on the first day after surgery and gradually increasing to about 54 oz (1,600 mL) by day four.
The primary goal is measuring Time-in-Range (TIR) β the percentage of time a patient's blood glucose stays between 70 and 180 mg/dL during the critical first 48 hours after surgery. Continuous glucose monitors (CGMs), the same wearable devices increasingly used by American diabetics, are worn by every patient throughout the eight-day monitoring period.
Why Non-Diabetic Patients? Why Now?
Surgeons have long known that high blood sugar after major operations increases the risk of serious infections in diabetic patients. But the Tokyo team is challenging the assumption that blood sugar management only matters if you already have diabetes. The physical stress of a major surgery like esophagectomy can drive blood glucose dangerously high β above 180 mg/dL β even in people with no prior history of diabetes. These spikes are tracked as Time-Above-Range (TAR) in the study.
By comparing standard versus low-carbohydrate tube feeds, researchers will also track infection rates within 30 days, the need for blood sugar interventions, and changes in key nutritional markers like serum albumin and prealbumin β important indicators of healing and recovery.
Why This Matters for US Patients
In the United States, esophageal cancer affects approximately 22,000 Americans annually, and esophagectomy remains one of the most physiologically demanding surgeries performed. Current US clinical nutrition guidelines from the American Society for Parenteral and Enteral Nutrition (ASPEN) recommend glycemic targets of 140β180 mg/dL in ICU patients β consistent with this Japanese trial's TIR range β but guidance specific to non-diabetic surgical patients remains limited.
If Japan's ENLICHE trial demonstrates that low-carbohydrate enteral formulas keep blood sugar in a safer range and reduce post-operative infections in non-diabetic patients, it could directly influence how US hospitals design feeding protocols for cancer surgery patients. Given that CGM use is already expanding rapidly in US hospitals, American care teams would be well-positioned to adopt similar monitoring strategies quickly.
This research also carries implications beyond esophageal cancer. Any patient undergoing prolonged major surgery β colorectal, pancreatic, or cardiac β may benefit from rethinking post-operative nutrition formulas, regardless of diabetes status.
The Bottom Line
This pioneering Japanese trial challenges a long-held assumption that blood sugar management after surgery is only a diabetes problem. The results, expected from this ongoing trial registered as jRCTs031240081, could help redefine standard of care for surgical nutrition on both sides of the Pacific.
Source: Terayama, Imamura, Kitazawa. "The effect of a low-carbohydrate enteral nutrition formula on postoperative hyperglycemia in non-diabetic patients with esophageal cancer: A randomized exploratory phase II trial (ENLICHE study)." PLoS ONE, 2025. PMID: 40435183. DOI: 10.1371/journal.pone.0325039