Routes for early enteral nutrition after esophagectomy. A systematic review

Weijs, Teus J.; Berkelmans, Gijs H K; Nieuwenhuijzen, Grard A. P.; Ruurda, Jelle P.; Hillegersberg, Richard van; Soeters, Peter B.; Luyer, Misha

doi:10.1016/j.clnu.2014.07.011

Cited by 117 publications

(110 citation statements)

References 27 publications

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“…The majority of clinical trials studying nutrition after esophagectomy have focused on the perioperative period, with feeding adjuncts targeted to either the preoperative phase or the immediate (in hospital) postoperative phase [9][10][11][12]. These studies have identified minimal or no improvement in clinical outcomes for patients receiving enteral feeding in hospital [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…These studies have identified minimal or no improvement in clinical outcomes for patients receiving enteral feeding in hospital [9][10][11][12]. There has been little written about the potential value of extended nutritional support following discharge from hospital.…”

Section: Introductionmentioning

confidence: 99%

“…There exists a worldwide variation in practice regarding nutritional supplementation after esophagectomy, both in terms of provision and route [10]. Even, within countries there are large geographical disparities.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A systematic review of the nutritional consequences of esophagectomy

et al. 2016

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“…However, the overall complication rate of a surgically placed jejunostomy is 13-38%, and serious complications Original Article Routine jejunostomy tube feeding following esophagectomy Teus J. Weijs 1 requiring a relaparotomy occur in 0-3% of the patients (6). On the other hand a jejunostomy is considered to be comfortable and effective for long-term nutritional support (2,6).…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand a jejunostomy is considered to be comfortable and effective for long-term nutritional support (2,6). Furthermore routine discharge with home-tube feeding has been advocated recently, which is facilitated by routine creation of a jejunostomy (7).…”

Section: Introductionmentioning

confidence: 99%

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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Nutritional aspects of enhanced recovery after esophagectomy with gastric conduit reconstruction

Kingma

Steenhagen

Ruurda

et al. 2017

Journal of Surgical Oncology

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Enhanced Recovery After Surgery (ERAS) aims to accelerate recovery by a set of multimodality management strategies. For esophagectomy, several nutritional elements of ERAS can be safely introduced and are advised in routine practice, including preadmission counseling to screen and treat for potential malnutrition, shortened preoperative fasting, and carbohydrate loading. However, the timing of oral intake and the use of routine nasogastric decompression remain matter of debate after esophagectomy. Furthermore, more research is needed on future developments such as perioperative immunonutrition.

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Routes for early enteral nutrition after esophagectomy. A systematic review

Cited by 117 publications

References 27 publications

A systematic review of the nutritional consequences of esophagectomy

A systematic review of the nutritional consequences of esophagectomy

Routine jejunostomy tube feeding following esophagectomy

Nutritional aspects of enhanced recovery after esophagectomy with gastric conduit reconstruction

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