Is the routine placement of a feeding jejunostomy during esophagectomy worthwhile?—a systematic review and meta-analysis

Abstract

Background: Malnutrition dramatically increases the risk of postoperative complications and delays patient recovery. Therefore, a feeding jejunostomy tube (FJT) is routinely placed during esophagectomy to maintain the postoperative nutrition supply. However, recently published studies have questioned the need of a FJT in every esophageal cancer patient. Because most patients can resume oral intake shortly after surgery, the nutrition-providing function of a FJT becomes much less critical. In contrast, FJT-related complications could be severe.Methods: Relevant publications were found out by systemic searching of four medical databases (Pubmed, EMBASE, Medline, and Cochrane Center Register of Controlled Trials). By reading the titles and the abstracts, potentially relevant studies were screened from the search results. The incidence of postoperative complications and FJT-related complications were calculated and compared to evaluate the efficacy of a FJT.Results: Eighteen studies were included in the meta-analysis. The no-FJT group had a similar or even lower incidence of postoperative complications [anastomotic leakage (AL), pulmonary complications, and wound infections] compared with the FJT group. Ileus and FJT site infections were the most common FJTrelated complications. The incidence of ileus was approximately 6% (95% CI: 3-12%), and over 63% of the patients with an ileus required re-operation to relieve the obstruction. The pooled mean rate of FJT site infections was 7% (95% CI: 6-9%). Approximately 7% of patients had dysfunction (obstruction or dislocation) of the jejunostomy tube (95% CI: 3-14%). Conclusions:The non-selective placement of a FJT during esophagectomy provides few benefits to the patients and may even increase the risk of postoperative complications. Therefore, an intraoperative FJT should be selectively prescribed, but not routinely in the surgical treatment of esophageal cancer.

Long-Term Insufficiency of Oral Intake after Esophagectomy: Who Needs Intense Nutritional Support after Esophagectomy?

“…On the other hand, the nasoenteral tube could be displaced, externalized, and even obstructed, which would prevent its use as an enteral nutritional route [39]. In the feeding enterostomy, SBO or infectious complications related to the enterostomy sometimes occur [11][12][13][14]. Therefore, the route of nutrition should be selected on consideration of the risks of postoperative dysphagia, postoperative complications, and the possible duration of nutritional support following surgery into account.…”

“…Although the significance of postoperative enteral nutrition for the patients who underwent esophagectomy has shown conflicting results and the optimal route of enteral nutrition remains unclear [3][4][5][6][7][8][9][10][11], enteral tube feeding is commonly used for postoperative enteral nutrition. Feeding enterostomy allows home nutritional support easily for these patients, whereas middle-to longterm complications such as small-bowel obstruction (SBO) or infectious complications related to the enterostomy can develop [11][12][13][14]. On the other hand, noninvasive feeding access such as a nasoenteral tube might be sufficient for short-term perioperative nutritional support.…”

Oral Nutritional Supplements and Enteral Nutrition in Patients with Gastrointestinal Surgery

“…There was no increased risk for jejunostomy-related complications [56]. These arguments are for the selective use in high-risk patients undergoing esophagectomy [57], while the preoperative identification may be a matter of debate.…”

Postoperative Nutrition Management: Who Needs What?

“…Another recent meta-analysis of 18 studies in patients undergoing esophagectomy emphasized the risk of ileus, catheter dysfunction due to occlusion and dislodgement, and site infection [37]. These results showed that carefully selected patients at risk of anastomotic leakage, increased overall morbidity, or postoperative weight loss may benefit from the insertion of feeding jejunostomy [38]. The higher risk of early dislodgement and patient discomfort of nasojejunal tubes are also concerns regarding the use of FNCJ.…”