Early enteral feeding compared with parenteral nutrition after oesophageal or oesophagogastric resection and reconstruction

Abstract

After resective and reconstructive surgery in the gastrointestinal tract, oral feeding is traditionally avoided in order to minimize strain to the anastomoses and to reduce the inherent risks of the postoperatively impaired gastrointestinal motility. However, studies have given evidence that the small bowel recovers its ability to absorb nutrients almost immediately following surgery, even in the absence of peristalsis, and that early enteral feeding would preserve both the integrity of gut mucosa and its immunological function. The aim of this study was to investigate the impact of early enteral feeding on the postoperative course following oesophagectomy or oesophagogastrectomy, and reconstruction. Between May 1999 and November 2002, forty-four consecutive patients (thirty-eight males and six females; mean age 62, range 30–82) with oesophageal carcinoma (stages I–III), who had undergone radical resection and reconstruction, entered this study (early enteral feeding group; EEF). A historical group of forty-four patients (thirty-seven males and seven females; mean age 64, range 41–79; stages I–III) resected between January 1997 and March 1999 served as control (parenteral feeding group; PF). The duration of both postoperative stay in the Intensive Care Unit (ICU) and the total hospital stay, perioperative complications and the overall mortality were compared. Early enteral feeding was administered over the jejunal line of a Dobhoff tube. It started 6 h postoperatively at a rate of 10 ml/h for 6 h with stepwise increase until total enteral nutrition was achieved on day 6. In the controls oral enteral feeding was begun on day 7. If compared to the PF group, EEF patients recovered faster considering the duration of both stay in the ICU and in the hospital. There was a significant difference in the interval until the first bowel movements. No difference in overall 30 d mortality was identified. A poor nutritional status was a significant prognostic factor for an increased mortality. Early enteral feeding significantly reduces the duration of ICU treatment and total hospital stay in patients who undergo oesophagectomy or oesophagogastrectomy for oesophageal carcinoma. The mortality rate is not affected.

Nutritional access routes following oesophagectomy—a systematic review

“…Shiraishi et al (2005) report no statistically significant difference in any outcomes between enteral and parenteral feeding groups, however, there were only 15 patients in this study. Gabor et al (2005) reported that patients in their combined group had a shorter stay on the intensive care unit and in the hospital overall, however, what is striking in this study is the extremely high anastomotic leak rate (48% for combined routes and 52% parenteral nutrition alone). The accepted anastomotic leak rate in oesophagectomy is less than 20,% (Briel et al 2004;Ercan et al, 2005;Law et al, 2005) raising concerns regarding the external validity of this study.…”

“…Several studies have suggested that following gastrointestinal surgery, enteral nutrition is superior to parenteral nutrition (PN), resulting in a reduced length of hospitalisation and serious postoperative complication rates (McCarter et al, 1996;Velez et al, 1997;Aiko et al, 2001;Gabor et al, 2005;Mazaki and Ebisawa, 2008). However, these benefits are not necessarily reproduced following oesophagectomy.…”

“…No jejunostomy related complications were reported. Gabor et al (2005) similarly compared a combined regime (jejunostomy with central line feeding) with central line feeding alone in a case-control study. Intensive care and overall hospital stay was shorter in the combined group.…”

Study of Feeding Jejunostomy as an Add on Procedure in Upper Gastrointestinal Surgeries

“…Enteral nutrition is considered to be better than total parenteral nutrition for providing feeding in various clinical settings because it is less expensive, safer and maintains the nutritional, metabolic, immunological and barrier function of the intestines with fewer septic complications [6][7][8][9][10]. Jejunostomy is a surgical procedure by which a tube is situated in the lumen of proximal jejunum, primarily to administer enteral nutrition or sometimes medications and on rare occasion to aspirate intestinal contents.…”

Routine jejunostomy tube feeding following esophagectomy

“…In the remaining 14 (39%) patients a nasojejunal tube had to be placed because the jejunostomy had already been removed. Tube feeding was restarted via the jejunostomy at 34 days from surgery, and via the Duration within 6 months (days) 24 Continued tube feeding >6 months postoperative 9 [25] This table shows the data on restarting tube feeding within 6 months after discharge. Continuous variables data are presented as median [1st-3rd quartile], all other data are numbers [percentages].…”