Fine bore jejunostomy feeding following major abdominal surgery: A controlled randomized clinical trial

Abstract

A randomized controlled prospective clinical trial has been undertaken to examine the efficacy of the technique of early postoperative feeding using a fine bore catheter jejunostomy. Fifty patients undergoing surgery for gastrointestinal malignancy were randomly allocated into treatment and control groups. A low residue liquidized diet (Isocal) was administered to the patients in the treatment group. Control patients received routine intravenous therapy. Nutritional parameters (serum albumin, serum transferrin, serum prealbumin, weight, body fat and fat free mass) were measured pre-operatively and on the tenth postoperative day. Postoperative surgical complications were similar in both groups. There were 20 catheter complications and one death directly attributable to the jejunal catheter feeding. Postoperative stay was significantly longer (P less than 0.01) in the treatment group patients. Evaluation of the nutritional parameters showed no advantage for either the treatment group or a selected complication-free, 'successful treatment', subgroup. It is concluded that no significant clinical or nutritional advantage for jejunal catheter feeding has been demonstrated and because of the related complications, its routine use cannot be recommended.

Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: A systematic review

“…These included 9 RCTs (82,84,90,104,111,120,123,125,126) and 1 non-RCT (116) comparing nutritional support with routine care, 3 RCTs comparing EPA provided as either enriched ETF (102,124) or capsules (46) with routine care, and 15 RCTs comparing ETF with PN (76,80,83,85,86,90,93,98,103,112,115,117,118,122,127). One study provided data both for analysis of nutritional support vs. routine care, and ETF vs. PN (90).…”

“…The majority (n=23) utilised ETF, with only 4 studies using ONS (84,104) or a combination of oral and tube routes (46,82). The type of cancer varied; most (n=24) were gastrointestinal (46,76,80,(82)(83)(84)(85)(86)90,93,98,(102)(103)(104)111,112,115,117,118,120,(123)(124)(125)127), with 3 studies on patients with head/neck (116,126) and liver cancer (122).…”

“…Individual RCTs reported no significant effects from pre-and postoperative ETF on body weight and body composition measurements in a variety of cancer patients undergoing surgery (90,111,123,126).…”

Nutritional support

“…55 No differences were found in the other ®ve trials reporting this outcome. 56±60 Similarly, when the trials were considered in toto, no differences were apparent regarding the morbidity or mortality rates in the treated and control groups.…”

Feeding Tube Enterostomies in Upper Aerodigestive Tract Cancers

“…61,62 A randomized trial of jejunostomy feeding versus intravenous fluids among patients undergoing upper GI surgery found no differences in the nutritional parameters (serum albumin, serum transferrin, serum prealbumin, weight, body fat and fat free mass) on the tenth postoperative day compared to preoperative levels between treatment groups. 63 However, institutions performing high volume esophagectomies with feeding jejunostomy as a routine adjunct find it invaluable in patients with a complicated postoperative course in whom resumption of oral feeds is delayed. 64,65 Feeding was used in all patients in the immediate postoperative period, for more than 3 weeks in 11%, and for more than 2 months in 6.9% among 523 patients studied by Orringer's group, with a 2.1% complication rate and zero jejunostomy-related mortality.…”