Jejunostomy Feeding Tube Placement in Gastrectomy Procedures: A Systematic Review

Abstract

Many nutritional interventions have been developed to improve nutritional outcomes following upper gastrointestinal surgery. The aim of this systematic review was to investigate whether or not the routine use of intraoperative jejunostomy feeding tubes in partial and total gastrectomy procedures is warranted when assessing complications and nutritional benefits such as improved chemotherapy tolerance. An electronic search of MEDLINE, Web of Science, Embase and CINAHL databases was performed to identify studies which reported complications and/or post-operative outcomes of patients who received an intraoperative jejunostomy feeding tube in gastrectomy procedures. Five articles met the inclusion criteria (n = 636) with four retrospective cohort studies and one RCT. Studies varied in regards to the complications and nutritional outcomes reported. Jejunostomy feeding tube insertion may carry a risk of increased infectious complications but appears to reduce patient post-operative weight-loss and may improve chemotherapy tolerance. Due to the lack of high-quality studies, it is unclear if the routine use of an intraoperative jejunostomy feeding tube is indicated for all patients undergoing gastrectomy procedures or only those at a high-risk of post-operative malnutrition. More comprehensive research is recommended, particularly on the usefulness of home enteral nutrition post-gastrectomy.

Survey of nutritional practices in total gastrectomy and oesophagectomy procedures

“…Jejunostomy tube feeding acts as a useful means of achieving nutritional targets for patients postoperatively, yet carries the risk of both minor and major tube-related complications. 7,8 This survey revealed that surgeons were more likely to insert a jejunostomy feeding tube intraoperatively in Ivor Lewis oesophagectomy procedures as compared to total gastrectomy procedures, a finding consistent with UK data, whereby 68% of oesophagectomy patients had a feeding jejunostomy inserted compared to only 33% of gastrectomy patients. 14 One potential explanation for the difference in practice between the two procedures could be that surgeons are more likely to insert a jejunostomy feeding tube in Ivor Lewis oesophagectomy procedures as a safety mechanism should the patient develop an anastomotic leak.…”

“…Jejunostomy tube feeding acts as a useful means of achieving nutritional targets for patients postoperatively, yet carries the risk of both minor and major tube‐related complications . This survey revealed that surgeons were more likely to insert a jejunostomy feeding tube intraoperatively in Ivor Lewis oesophagectomy procedures as compared to total gastrectomy procedures, a finding consistent with UK data, whereby 68% of oesophagectomy patients had a feeding jejunostomy inserted compared to only 33% of gastrectomy patients .…”

“…Further research utilising qualitative methods is recommended to elucidate surgeon reasoning for their preferred practices and decision‐making rationale. The optimal means and duration of nutritional support for total gastrectomy and Ivor Lewis oesophagectomy patients remains unclear and further research is required to develop evidence‐based guidelines which can be implemented worldwide …”

“…concluded that EEN is preferred following oesophagectomy; however, which method of enteral delivery remains unclear . A recent systematic review of partial and total gastrectomy patients was inconclusive whether enteral nutrition delivered via a jejunostomy or nasojejunal feeding tube is the preferred means of postoperative nutritional support . Early oral intake following many types of upper gastrointestinal surgery has been demonstrated to improve patient outcomes and serves as a core component of enhanced recovery after surgery protocols .…”

“…7 A recent systematic review of partial and total gastrectomy patients was inconclusive whether enteral nutrition delivered via a jejunostomy or nasojejunal feeding tube is the preferred means of postoperative nutritional support. 8 Early oral intake following many types of upper gastrointestinal surgery has been demonstrated to improve patient outcomes and serves as a core component of enhanced recovery after surgery protocols. [9][10][11][12] Given the broad range of nutritional support options, it is not surprising that there is a paucity of clear, evidence-based guidelines on the optimal perioperative nutritional management of gastrectomy and oesophagectomy patients.…”