Feeding Jejunostomy Tubes Placed During Esophagectomy: Are They Necessary?

Fenton, James R.; Bergeron, Edward J.; Coello, Michael; Welsh, Robert J.; Chmielewski, Gary W.

doi:10.1016/j.athoracsur.2011.03.101

Cited by 45 publications

(28 citation statements)

References 24 publications

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“…Occlusion, dislocation and insertion site infection of the jejunal feeding tube occurred frequently and were comparable to rates reported in literature (0-7% occlusion, 0-11% dislocation, 1-25% infection) (9,11,12,(16)(17)(18)(19)(20)(21)(22). Previous reports also showed that severe jejunostomy-related complications requiring reoperation occur in 0-3% of all patients, which was confirmed by the present study (9,11,12,16,18,20,23). Furthermore in a randomized trial it was shown that immediate jejunostomy tube feeding may impair respiratory mechanics and may decrease mobility following esophagectomy (24).…”

Section: Discussionsupporting

confidence: 69%

Routine jejunostomy tube feeding following esophagectomy

Weijs¹,

Eden²,

Ruurda³

et al. 2017

J. Thorac. Dis.

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Background: Malnutrition is an important problem following esophagectomy. A surgically placed jejunostomy secures an enteral feeding route, facilitating discharge with home-tube feeding and long-term nutritional support. However, specific complications occur, and data are lacking that support its use over other enteral feeding routes. Therefore routine jejunostomy tube feeding and discharge with home-tube feeding was evaluated, with emphasis on weight loss, length of stay and re-admissions.Methods: Consecutive patients undergoing esophagectomy for cancer, with gastric tube reconstruction and jejunostomy creation, were analyzed. Two different regimens were compared. Before January 07, 2011 patients were discharged when oral intake was sufficient, without tube feeding. After that discharge with home-tube feeding was routinely performed. Logistic regression analysis corrected for confounders.Results: Some 236 patients were included. The median duration of tube feeding was 35 days. Reoperation for a jejunostomy-related complication was needed in 2%. The median body mass index (BMI) remained stable during tube feeding. The BMI decreased significantly after stopping tube feeding: from 25.6 (1st-3rd 3.9% (1.5-6.3%)]. Weight loss was not affected by the duration of tube feeding duration. Routine home-tube feeding did not affect weight loss, admission time or the readmission rate.Conclusions: Weight loss following esophagectomy occurs once that tube feeding is stopped, independently from the time interval after esophagectomy. Moreover routine discharge with hometube feeding does not reduce length of stay or readmissions. These findings question the value of routine jejunostomy placement and emphasize the need for further research.

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Section: Discussionsupporting

confidence: 69%

Routine jejunostomy tube feeding following esophagectomy

Weijs¹,

Eden²,

Ruurda³

et al. 2017

J. Thorac. Dis.

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“…In those studies that have used extended enteral feeding, it has been used selectively, with a reported prevalence ranging from 14% to 48% of patients [7,20,24,27,[37][38][39][40]. The wide variation in the practice of home jejunostomy likely reflects the preferences of individual centres.…”

Section: Discussionmentioning

confidence: 99%

“…The wide variation in the practice of home jejunostomy likely reflects the preferences of individual centres. It has largely been utilised in patients who are malnourished pre-operatively [37], and those with post-operative complications [38]. A population based study from Sweden which did not disclose the number of patients discharged home with a feeding jejunostomy, identified tube placement to be associated with a reduced amount of weight loss in the first …”

Section: Discussionmentioning

confidence: 99%

A systematic review of the nutritional consequences of esophagectomy

et al. 2016

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SummaryBackground & aims-As improved outcomes after esophagectomy have been observed over the last two decades, the focus on care has shifted to survivorship and quality of life. The aim of this review was to determine changes in nutrition after esophagectomy and to assess the evidence for extended nutrition support.Methods-A search strategy was developed to identify primary research reporting change in nutritional status a minimum of one month after esophagectomy.Results-Changes in nutritional parameters reported by 18 studies indicated a weight loss of 5-12% at six months postoperatively. More than half of patients lost >10% of body weight at 12 months. One study reported a persistent weight loss of 14% from baseline three years after surgery. Three studies reporting on longer term follow up noted that 27%-95% of patients failed to regain their baseline weight. Changes in dietary intake (three studies) indicated inadequate energy and protein intake up to three years after surgery. Global quality of life scores reported in one study correlated with better weight preservation. There were a high frequency of gastrointestinal symptoms reported in six studies, most notably in the first year after surgery, but persisting up to 19 years. Extended enteral nutrition on a selective basis has been reported in several studies.Conclusions-Nutritional status is compromised in the months/years following oesophagectomy and may never return to baseline levels. The causes/consequences of weight loss/ impaired nutritional intake require further investigation. The role of extended nutritional support in this population remains unclear.

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“…Gastrointestinal side effects were observed frequently, notably diarrhea and distension that were reported in 6%-24% (median 9%) and 3%-18% (median 4%) of patients, respectively. 8,[30][31][32][33][34][35][36][37][38][39][40][41] The frequencies of gastrointestinal side effects shown in Table 6 are those necessitating a change in the feeding regimen (reduced infusion rate, change in type of feed, cessation of feed).…”

Section: Route Of Feeding Access Enteral Vs Parenteral Nutritionmentioning

confidence: 99%

“…Table 6 summarizes the clinical outcomes for patients with feeding jejunostomies in studies reporting on 50 patients or greater. 8,[30][31][32][33][34][35][36][37][38][39][40][41] Both technical and feed-related problems are quite common. The former can usually be managed by repositioning or replacing the tube, and the latter by adjusting the rate or type of feed.…”

Section: Route Of Feeding Access Enteral Vs Parenteral Nutritionmentioning

confidence: 99%

Nutritional support and dietary interventions following esophagectomy: challenges and solutions

Paul¹,

Baker²,

Williams³

et al. 2017

NDS

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Background and aims: Provision of adequate nutrition after esophagectomy remains a major challenge. The aims of this review were to describe the challenges facing this patient population and to determine the evidence base underpinning current nutritional and dietetic interventions after esophagectomy. Methods: Medline, Embase and CINAHL databases were searched for English language publications of the period 1990-2016 reporting on the outcome of nutritional or dietetic interventions after esophagectomy or patient-related symptoms. Results: Four studies demonstrated that early reintroduction of oral fluids was safe and was associated with a shorter hospital stay and ileus duration. One of three studies comparing in-hospital enteral nutrition against usual care showed that enteral feeding was well tolerated and was associated with a shorter hospital stay. Eight studies comparing enteral with parenteral nutrition showed similar surgical complication rates. Enteral feeding was associated with a shorter duration of ileus and lower health care costs. In hospital, all types of enteral access (nasoenteral, jejunostomy) were equivalent in their safety profiles. Cohort studies indicate that technical (tube dysfunction) and feed (diarrhea, distention) problems were common with jejunostomies but are easily managed. The mortality risk associated with jejunostomy in hospital is 0.2% (reported range 0%-1%), principally due to small bowel ischemia. There have been no reports of serious jejunostomy complications in patients receiving home feeding. One study demonstrated the advantages of home feeding in weight, muscle and fat preservation. Studies reporting 12 months or more after esophagectomy indicate a high frequency of persistent symptoms, dumping syndrome 15%-75% (median 46%), dysphagia 11%-38% (median 27%), early satiety 40%-90% (median 65%) and reflux 19%-61% (median 29%). Conclusion: Patients should resume oral intake as soon as possible after surgery. In hospital, all forms of enteral access appear to be safe. Out of hospital, the ability to provide home feeding by feeding jejunostomy is likely where meaningful nutritional improvements can be made. Improving nutrition and related quality of life in the early months might improve the long-term outcome.

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Feeding Jejunostomy Tubes Placed During Esophagectomy: Are They Necessary?

Cited by 45 publications

References 24 publications

Routine jejunostomy tube feeding following esophagectomy

Routine jejunostomy tube feeding following esophagectomy

A systematic review of the nutritional consequences of esophagectomy

Nutritional support and dietary interventions following esophagectomy: challenges and solutions

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