Needle Catheter Jejunostomy in Patients Undergoing Surgery for Upper Gastrointestinal and Pancreato-Biliary Cancer–Impact on Nutritional and Clinical Outcome in the Early and Late Postoperative Period

Abstract

The metabolic risk for patients undergoing abdominal cancer resection increases in the perioperative period and malnutrition may be observed. In order to prevent further weight loss, the guidelines recommend for high-risk patients the placement of a needle catheter jejunostomy (NCJ) for supplementing enteral feeding in the early and late postoperative period. Our aim was to evaluate the safety of NCJ placement and its potential benefits regarding the nutritional status in the postoperative course. We retrospectively analyzed patients undergoing surgery for upper gastrointestinal cancer, such as esophageal, gastric, and pancreato-biliary cancer, and NCJ placement during the operation. The nutritional parameters body mass index (BMI), perioperative weight loss, phase angle measured by bioelectrical impedance analysis (BIA) and the clinical outcome were assessed perioperatively and during follow-up visits 1 to 3 months and 4 to 6 months after surgery. In 102 patients a NCJ was placed between January 2006 and December 2016. Follow-up visits 1 to 3 months and 4 to 6 months after surgery were performed in 90 patients and 88 patients, respectively. No severe complications were seen after the NCJ placement. The supplementing enteral nutrition via NCJ did not improve the nutritional status of the patients postoperatively. There was a significant postoperative decline of weight and phase angle, especially in the first to third month after surgery, which could be stabilized until 4–6 months after surgery. Placement of NCJ is safe. In patients with upper gastrointestinal and pancreato-biliary cancer, supplementing enteral nutrition during the postoperative course and continued after discharge may attenuate unavoidable weight loss and a reduction of body cell mass within the first six months.

The clinical relevance and mechanism of skeletal muscle wasting

“…with 500 or 1000 kcal/d overnight. Appropriate training will enable most of the patients to administer jejunostomy tube feeds themselves [204]. The data from the six RCTs do not show with certainty that routine postoperative or post-hospital administration of ONS improves outcome but there is benefit in terms of nutritional status, rate of minor complications, well-being, and quality of life in patients who cannot meet their nutritional requirements at home from normal food [144,145,205].…”

Oral Nutritional Supplements and Enteral Nutrition in Patients with Gastrointestinal Surgery

“…Therefore, the identification of risk patients is essential preoperatively. In elderly people in particular, this should include functionality and nutritional status in a “complex geriatric assessment” [ 15 , 16 ]. As screening for malnutrition, the ESPEN nutritional risk score (NRS), according to Kondrup [ 17 ], has been well validated for surgical patients.…”

“…The guidelines recommend the implantation of needle-catheter-jejunostomy (FIT) during surgery. Our own results in patients with esophageal and gastric resection, including partial pancreato-duodenectomy, show a weight loss of >10% in 40% of patients after 6 months, even with consistent postoperative continuation of nutritional therapy via feeding jejunostomy [ 16 ]. Early postoperative weight decreased up to 3 months, while stabilization occurred between 4–6 months after surgery; a further decline could be prevented by continuing enteral feeding supplementation [ 16 ].…”

“…Our own results in patients with esophageal and gastric resection, including partial pancreato-duodenectomy, show a weight loss of >10% in 40% of patients after 6 months, even with consistent postoperative continuation of nutritional therapy via feeding jejunostomy [ 16 ]. Early postoperative weight decreased up to 3 months, while stabilization occurred between 4–6 months after surgery; a further decline could be prevented by continuing enteral feeding supplementation [ 16 ]. In comparison with a control group, Chen et al demonstrated in elderly patients after esophagectomy significant benefits from home enteral nutrition for at least 8 weeks for the BMI, PG-SGA score, serum albumin, and immune parameters [ 62 ].…”

Update enterale und parenterale Ernährung

“…Die Leitlinien empfehlen die Implantation einer Ernährungssonde bei der Operation, wobei die Feinnadelkatheterjejunostomie (FKJ) eine Möglichkeit der längerfristigen, auch poststationären Supplementierung bietet [14]. Unsere eigenen Erfahrungen zeigen nach Ösophagus-und Magenresektion sowie partieller Duodenopankreatektomie auch bei poststationärer Fortsetzung einer enteralen Ernährungstherapie einen perioperativen Gewichtsverlust > 10 % bei 40 % der Patienten [44]. Eine Stabilisierung des Körpergewichts wurde bei fortgesetzter enteraler Supplementierung nach 4-6 Monaten erreicht.…”