Optimisation before Crohn's surgery using Exclusive enteral Nutrition (OCEaN): 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

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

doi:10.1111/codi.70435

Optimisation before Crohn's surgery using Exclusive enteral Nutrition (OCEaN): 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

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

^*Corresponding author for this work

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

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Abstract

Background
Exclusive enteral nutrition (EEN) is commonly used in paediatric Crohn's disease patients as a first-line therapy for inducing remission. 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 preoperative 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 optimisation before Crohn's surgery using exclusive enteral nutrition trial aimed to determine whether preoperative EEN is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn's disease.

Trial Registration
ISRCTN73953171

Original language	English
Article number	e70435
Number of pages	12
Journal	Colorectal Disease
Volume	28
Issue number	5
Early online date	21 Apr 2026
DOIs	https://doi.org/10.1111/codi.70435
Publication status	Published - May 2026

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BadwalP2025Optimisation_AAMAccepted author manuscript, 1.65 MBLicence: Creative Commons: Attribution (CC BY)

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OCEaN Collaborative Group, Badwal, P., Baxter, J., Brown, F., Cooney, R., Grimes, C., Hall, J., Hazel, K., Kaur, M., Lomer, M., Pinkney, T., Rowland, N., Gerasimidis, K., Iqbal, A., Magill, L., Mathers, J., & Oppong, R. (2026). Optimisation before Crohn's surgery using Exclusive enteral Nutrition (OCEaN): 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, 28(5), Article e70435. https://doi.org/10.1111/codi.70435

OCEaN Collaborative Group ; Badwal, Pooja ; Baxter, Joshua et al. / Optimisation before Crohn's surgery using Exclusive enteral Nutrition (OCEaN) : 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. 2026 ; Vol. 28, No. 5.

@article{d3f810d36f654607a61f52c40d283b49,

title = "Optimisation before Crohn's surgery using Exclusive enteral Nutrition (OCEaN): 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",

abstract = "Background Exclusive enteral nutrition (EEN) is commonly used in paediatric Crohn's disease patients as a first-line therapy for inducing remission. 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 preoperative 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 optimisation before Crohn's surgery using exclusive enteral nutrition trial aimed to determine whether preoperative EEN is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn's disease. Trial Registration ISRCTN73953171",

author = "\{OCEaN Collaborative Group\} and Pooja Badwal and Joshua Baxter and Fran Brown and Rachel Cooney 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 Asif Iqbal and Laura Magill and Jonathan Mathers and Raymond Oppong",

year = "2026",

month = may,

doi = "10.1111/codi.70435",

language = "English",

volume = "28",

journal = "Colorectal Disease",

issn = "1463-1318",

publisher = "Wiley",

number = "5",

}

OCEaN Collaborative Group, Badwal, P, Baxter, J, Brown, F, Cooney, R, Grimes, C, Hall, J, Hazel, K, Kaur, M, Lomer, M, Pinkney, T , Rowland, N, Gerasimidis, K, Iqbal, A , Magill, L , Mathers, J & Oppong, R 2026, 'Optimisation before Crohn's surgery using Exclusive enteral Nutrition (OCEaN): 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, vol. 28, no. 5, e70435. https://doi.org/10.1111/codi.70435

Optimisation before Crohn's surgery using Exclusive enteral Nutrition (OCEaN): 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. / OCEaN Collaborative Group; Badwal, Pooja; Baxter, Joshua et al.
In: Colorectal Disease, Vol. 28, No. 5, e70435, 05.2026.

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

TY - JOUR

T1 - Optimisation before Crohn's surgery using Exclusive enteral Nutrition (OCEaN)

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 - OCEaN Collaborative Group

AU - Badwal, Pooja

AU - Baxter, Joshua

AU - Brown, Fran

AU - Cooney, Rachel

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

AU - Magill, Laura

AU - Mathers, Jonathan

AU - Oppong, Raymond

PY - 2026/5

Y1 - 2026/5

N2 - Background Exclusive enteral nutrition (EEN) is commonly used in paediatric Crohn's disease patients as a first-line therapy for inducing remission. 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 preoperative 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 optimisation before Crohn's surgery using exclusive enteral nutrition trial aimed to determine whether preoperative EEN is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn's disease. Trial Registration ISRCTN73953171

AB - Background Exclusive enteral nutrition (EEN) is commonly used in paediatric Crohn's disease patients as a first-line therapy for inducing remission. 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 preoperative 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 optimisation before Crohn's surgery using exclusive enteral nutrition trial aimed to determine whether preoperative EEN is more clinically and cost effective compared with standard care in patients undergoing surgery for Crohn's disease. Trial Registration ISRCTN73953171

U2 - 10.1111/codi.70435

DO - 10.1111/codi.70435

M3 - Article

SN - 1463-1318

VL - 28

JO - Colorectal Disease

JF - Colorectal Disease

IS - 5

M1 - e70435

ER -

OCEaN Collaborative Group, Badwal P, Baxter J, Brown F, Cooney R, Grimes C et al. Optimisation before Crohn's surgery using Exclusive enteral Nutrition (OCEaN): 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. 2026 May;28(5):e70435. Epub 2026 Apr 21. doi: 10.1111/codi.70435