Feeding jejunostomy in upper gastrointestinal resections: a UK-wide survey

Abstract

Introduction The usage of a feeding jejunostomy has been a well-established practice in maintaining nutrition in patients undergoing resections for upper gastrointestinal cancer. As surgical technique has evolved, together with the adoption of enhanced recovery after surgery pathways, the routine insertion of feeding jejunostomy tubes appears to be changing. Materials and methods A survey was constructed using Google Forms. The link was distributed to consultant upper gastrointestinal surgeons via the Association of Upper Gastrointestinal Surgeons’ membership database. Results were collated and analysed using Microsoft Excel. Results A total of 55 responses were received from 28 units across the UK; 27 respondents (49.1%) no longer routinely use feeding jejunostomy in upper gastrointestinal resections, oesophagectomy or gastrectomy. The most common primary feeding modality used by these respondents was oral diet 17 (65.4%), with total parenteral nutrition (19.2%) and nasojejunal (11.5%) routes also being used. Respondents who used feeding jejunostomies inserted them primarily for oesophagectomy (n = 27; 96.4%), with fewer surgeons using them in extended total gastrectomy (n = 12; 42.9%) and total gastrectomy (n = 11; 39.3%). Of the total, 20 surgeons (71.4%) would insert the jejunostomy using an open approach, with 19 (67.9%) employing a Witzel tunnel. Eleven respondents (39.3%) would continue feeding via the jejunostomy after discharge. Some 24 responders thought that feeding jejunostomies did not facilitate the enhanced recovery after surgery pathway (strongly and slightly disagree), whereas 17 considered that they did (strongly and slightly agree); 13 responders did not have strong views either way. Conclusions There is a split in current practice regarding the usage of feeding jejunostomies. There is also a division of opinion on the role of feeding jejunostomy in enhanced recovery after surgery.

Feeding Jejunostomy Tube in Patients Undergoing Esophagectomy: Utilization and Outcomes in a Nationwide Cohort

“…However, this finding is not surprising, given the advent of enhanced recovery protocols and MIE [23]. Recent survey results from the UK highlight the lack of agreement on the usage of JTs [24]. Further, enteral feedings are associated with a significant burden on an already distressed patient population facing a life-limiting diagnosis, leading to psychosocial problems including gustatory distress, physical distress, and tube-related discomfort [25].…”

Preoperative nutritional counselling in patients undergoing oesophagectomy

“…This could limit the generalizability of our study. Individual institutions vary in preference for or against routine jejunostomy placement at the time of oesophagectomy (Álvarez-Sarrado et al 2019, Ireland & Jaunoo 2020, Purkayastha et al 2019). The optimal route of nutrition immediately postoperatively after oesophagectomy remains to be determined (Carroll et al 2020, Holmén et al 2020, Zheng et al 2021).…”

The impact of jejunostomy feeding on nutritional outcomes after oesophagectomy

“…Across the UK, and worldwide, there is wide variation in the practice of postoperative feeding after oesophagectomy. 10,14,15 In a recent survey, 56% of centres in the UK reported routinely place a feeding jejunostomy, but 11% were considering stopping its use and 15% of centres had divided practice among its consultants. 10 One of the reasons for this variation in clinical practice is due to the heterogeneity of current evidence.…”