Routes of early enteral nutrition following oesophagectomy

Abstract

INTRODUCTION Oesophagectomy for cancer is a challenging procedure with a five-year overall survival rate of 15-20%. Early enteral nutrition following oesophagectomy is a crucial component of the postoperative recovery and carries a significant impact on the outcome. Different methods of enteral feeding were conducted in our unit. The aim of this study was to examine the efficacy and safety of nasojejunal tube (NJT), jejunostomy tube (JT) and pharyngostomy tube (PT) feeding after oesophagectomy. METHODS A retrospective review was carried out of prospectively collected data on patients with oesophageal cancer who underwent an oesophagectomy between 2011 and 2014. The primary outcome was feeding tube related complications such as occlusion, dislocation and leak. The secondary outcomes were length of stay and 30-day morbidity. RESULTS A total of 90 oesophagectomies were included in the study. A NJT was inserted in 41 patients (45.6%), a JT was used in 14 patients (15.5%) and a PT was the route for enteral nutrition in 35 patients (38.9%). In total, five patients (5.5%) developed tube related complications. There were no tube related complications in the NJT group but one JT patient (7.1%) developed tube related cellulitis (p=0.189) and four PT patients (11.4%) developed tube related haemorrhage (p=0.544), tube dislocation (p=0.544) or cellulitis (p=0.189). The median length of stay and 30-day postoperative morbidity were similar between the groups. CONCLUSIONS NJT feeding is a less invasive, feasible route for early enteral nutrition following oesophagectomy. A randomised controlled trial is recommended to verify these findings.

Critical analysis of feeding jejunostomy following resection of upper gastrointestinal malignancies

“…Parenteral nutrition has its own risks, such as central line sepsis, but has an advantage in that the decision to administer nutritional support may be postponed until the postoperative phase of recovery, when patients’ early postoperative courses can better indicate a need for such support. An alternative method of enteral access that is receiving more attention is nasojejunal tube placement at operation[ 13 , 14 ]. This modality is less invasive than jejunostomy tubes or central lines with fewer associated complications, but is more aimed towards supplemental nutrition while the patient is in-house as opposed to long-term.…”

“…Options for nutritional support following upper gastrointestinal resection include needle catheter jejunostomy, Stamm or Witzel jejunostomy, or nasojejunal feeding tube placement[ 9 - 14 ]. In some centers, feeding jejunostomy (FJT) is routinely performed following esophagectomy or total gastrectomy, with more selective utilization with subtotal gastrectomy.…”

Nutritional Management of Esophageal Cancer Patients

“…A retrospective analysis of 90 patients who underwent esophagectomy demonstrated that early enteral nutrition can be administered using three different routes (nasojejunal tube, jejunostomy tube, and pharyngostomy tube) with similar results regarding tube-related complications, length of stay, and 30-day morbidity [92]. Another study of esophageal cancer patients with dysphagia examined the effects of jejunostomy feeding on weight loss and treatment outcomes.…”

Nutritional aspects of enhanced recovery after esophagectomy with gastric conduit reconstruction

“…While up to 38% of feeding jejunostomy tubes are associated with minor complications (eg, entry site infection, entry site leakage, gastrointestinal complaints), 20‐35% of nasojejunal tubes dislocate during the course of hospitalization . To date, no clear evidence for superiority of either feeding route exists and, hence, both techniques are used . For patients that have resumed oral intake but cannot yet meet their caloric and protein demands, enteral feeding can be provided as a supplement to the patients oral diet .…”

“…[66][67][68] To date, no clear evidence for superiority of either feeding route exists and, hence, both techniques are used. 66,69 For patients that have resumed oral intake but cannot yet meet their caloric and protein demands, enteral feeding can be provided as a supplement to the patients oral diet. 14,65,70,71 The most recent ESPEN "Clinical Nutrition in Surgery" guidelines recommend early initiation of enteral tube feeding in case patients cannot eat for at least 5 days or when oral intake is expected to be inadequate (ie, <50%) for more than 7 days.…”