Optimisation before Crohn’s surgery using Exclusive Enteral Nutrition (OCEaN) Trial: a randomised controlled trial to determine whether preoperative exclusive enteral nutrition is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn’s disease

Pooja Badwal; Joshua Baxter; Fran Brown; Rachel M Cooney; Caris Grimes; Jack Hall; Karl Hazel; Manjinder Kaur; Miranda Lomer; Thomas Pinkney; Natalie Rowland; Konstantinos Gerasimidis; Asif Jilani Iqbal; Laura Magill; Jonathan Mathers; Raymond Oppong

Optimisation before Crohn’s surgery using Exclusive Enteral Nutrition (OCEaN) Trial: a randomised controlled trial to determine whether preoperative exclusive enteral nutrition is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn’s disease

Pooja Badwal
, Joshua Baxter
, Fran Brown
, Rachel M Cooney^*
, Caris Grimes
, Jack Hall
, Karl Hazel
, Manjinder Kaur
, Miranda Lomer
, Thomas Pinkney
, Natalie Rowland
, Konstantinos Gerasimidis
, Asif Jilani Iqbal
, Laura Magill
, Jonathan Mathers
, Raymond Oppong

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Exclusive enteral nutrition (EEN) is commonly used in paediatric Crohn’s disease patients as a first-line therapy for inducing remission. However, there are currently no randomised controlled trials evaluating the effectiveness of EEN in adults compared to unrestricted diets. Despite advances in immunosuppressive and biologic treatments, 23-47% of patients with Crohn’s disease will require surgery, with approximately 22% needing repeat surgeries. Potential suggested benefits of EEN in the perioperative setting include reduced steroid usage, reduced operative complications, and reduced need for stoma formation.

Methods: A multi-centre, two-arm, parallel group, open-label, pragmatic randomised controlled trial to assess the clinical and cost-effectiveness of EEN. The trial will be conducted in at least 40 UK-wide tertiary and district general NHS hospitals. Participants will be randomised to either six weeks of preoperative EEN or standard care as per local standard care. Primary outcomes will be quality of life and post-surgical complications at six weeks and 30 days post-surgery respectively.

Discussion: The OCEaN Trial aims to determine whether preoperative EEN is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn’s disease.

Original language	English
Journal	Colorectal Disease
Publication status	Accepted/In press - 14 Oct 2025

Bibliographical note

Not yet published as of 20/01/2026.

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BadwalP2025Optimisation_AAM
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Embargo ends: 17/02/26

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Badwal, P., Baxter, J., Brown, F., Cooney, R. M., Grimes, C., Hall, J., Hazel, K., Kaur, M., Lomer, M., Pinkney, T., Rowland, N., Gerasimidis, K., Iqbal, A. J., Magill, L., Mathers, J., & Oppong, R. (Accepted/In press). Optimisation before Crohn’s surgery using Exclusive Enteral Nutrition (OCEaN) Trial: a randomised controlled trial to determine whether preoperative exclusive enteral nutrition is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn’s disease. Colorectal Disease.

Badwal, Pooja ; Baxter, Joshua ; Brown, Fran et al. / Optimisation before Crohn’s surgery using Exclusive Enteral Nutrition (OCEaN) Trial : a randomised controlled trial to determine whether preoperative exclusive enteral nutrition is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn’s disease. In: Colorectal Disease. 2025.

@article{d3f810d36f654607a61f52c40d283b49,

title = "Optimisation before Crohn{\textquoteright}s surgery using Exclusive Enteral Nutrition (OCEaN) Trial: a randomised controlled trial to determine whether preoperative exclusive enteral nutrition is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn{\textquoteright}s disease",

abstract = "Background: Exclusive enteral nutrition (EEN) is commonly used in paediatric Crohn{\textquoteright}s disease patients as a first-line therapy for inducing remission. However, there are currently no randomised controlled trials evaluating the effectiveness of EEN in adults compared to unrestricted diets. Despite advances in immunosuppressive and biologic treatments, 23-47\% of patients with Crohn{\textquoteright}s disease will require surgery, with approximately 22\% needing repeat surgeries. Potential suggested benefits of EEN in the perioperative setting include reduced steroid usage, reduced operative complications, and reduced need for stoma formation. Methods: A multi-centre, two-arm, parallel group, open-label, pragmatic randomised controlled trial to assess the clinical and cost-effectiveness of EEN. The trial will be conducted in at least 40 UK-wide tertiary and district general NHS hospitals. Participants will be randomised to either six weeks of preoperative EEN or standard care as per local standard care. Primary outcomes will be quality of life and post-surgical complications at six weeks and 30 days post-surgery respectively. Discussion: The OCEaN Trial aims to determine whether preoperative EEN is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn{\textquoteright}s disease. ",

author = "Pooja Badwal and Joshua Baxter and Fran Brown and Cooney, \{Rachel M\} and Caris Grimes and Jack Hall and Karl Hazel and Manjinder Kaur and Miranda Lomer and Thomas Pinkney and Natalie Rowland and Konstantinos Gerasimidis and Iqbal, \{Asif Jilani\} and Laura Magill and Jonathan Mathers and Raymond Oppong",

note = "Not yet published as of 20/01/2026.",

year = "2025",

month = oct,

day = "14",

language = "English",

journal = "Colorectal Disease",

issn = "1463-1318",

publisher = "Wiley",

}

Badwal, P, Baxter, J, Brown, F, Cooney, RM, Grimes, C, Hall, J, Hazel, K, Kaur, M, Lomer, M, Pinkney, T , Rowland, N, Gerasimidis, K, Iqbal, AJ , Magill, L , Mathers, J & Oppong, R 2025, 'Optimisation before Crohn’s surgery using Exclusive Enteral Nutrition (OCEaN) Trial: a randomised controlled trial to determine whether preoperative exclusive enteral nutrition is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn’s disease', Colorectal Disease.

Optimisation before Crohn’s surgery using Exclusive Enteral Nutrition (OCEaN) Trial: a randomised controlled trial to determine whether preoperative exclusive enteral nutrition is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn’s disease. / Badwal, Pooja; Baxter, Joshua; Brown, Fran et al.
In: Colorectal Disease, 14.10.2025.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Optimisation before Crohn’s surgery using Exclusive Enteral Nutrition (OCEaN) Trial

T2 - a randomised controlled trial to determine whether preoperative exclusive enteral nutrition is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn’s disease

AU - Badwal, Pooja

AU - Baxter, Joshua

AU - Brown, Fran

AU - Cooney, Rachel M

AU - Grimes, Caris

AU - Hall, Jack

AU - Hazel, Karl

AU - Kaur, Manjinder

AU - Lomer, Miranda

AU - Pinkney, Thomas

AU - Rowland, Natalie

AU - Gerasimidis, Konstantinos

AU - Iqbal, Asif Jilani

AU - Magill, Laura

AU - Mathers, Jonathan

AU - Oppong, Raymond

N1 - Not yet published as of 20/01/2026.

PY - 2025/10/14

Y1 - 2025/10/14

N2 - Background: Exclusive enteral nutrition (EEN) is commonly used in paediatric Crohn’s disease patients as a first-line therapy for inducing remission. However, there are currently no randomised controlled trials evaluating the effectiveness of EEN in adults compared to unrestricted diets. Despite advances in immunosuppressive and biologic treatments, 23-47% of patients with Crohn’s disease will require surgery, with approximately 22% needing repeat surgeries. Potential suggested benefits of EEN in the perioperative setting include reduced steroid usage, reduced operative complications, and reduced need for stoma formation. Methods: A multi-centre, two-arm, parallel group, open-label, pragmatic randomised controlled trial to assess the clinical and cost-effectiveness of EEN. The trial will be conducted in at least 40 UK-wide tertiary and district general NHS hospitals. Participants will be randomised to either six weeks of preoperative EEN or standard care as per local standard care. Primary outcomes will be quality of life and post-surgical complications at six weeks and 30 days post-surgery respectively. Discussion: The OCEaN Trial aims to determine whether preoperative EEN is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn’s disease.

AB - Background: Exclusive enteral nutrition (EEN) is commonly used in paediatric Crohn’s disease patients as a first-line therapy for inducing remission. However, there are currently no randomised controlled trials evaluating the effectiveness of EEN in adults compared to unrestricted diets. Despite advances in immunosuppressive and biologic treatments, 23-47% of patients with Crohn’s disease will require surgery, with approximately 22% needing repeat surgeries. Potential suggested benefits of EEN in the perioperative setting include reduced steroid usage, reduced operative complications, and reduced need for stoma formation. Methods: A multi-centre, two-arm, parallel group, open-label, pragmatic randomised controlled trial to assess the clinical and cost-effectiveness of EEN. The trial will be conducted in at least 40 UK-wide tertiary and district general NHS hospitals. Participants will be randomised to either six weeks of preoperative EEN or standard care as per local standard care. Primary outcomes will be quality of life and post-surgical complications at six weeks and 30 days post-surgery respectively. Discussion: The OCEaN Trial aims to determine whether preoperative EEN is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn’s disease.

UR - https://onlinelibrary.wiley.com/journal/14631318

M3 - Article

SN - 1463-1318

JO - Colorectal Disease

JF - Colorectal Disease

ER -

Badwal P, Baxter J, Brown F, Cooney RM, Grimes C, Hall J et al. Optimisation before Crohn’s surgery using Exclusive Enteral Nutrition (OCEaN) Trial: a randomised controlled trial to determine whether preoperative exclusive enteral nutrition is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn’s disease. Colorectal Disease. 2025 Oct 14.