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Randomized Clinical Trial: Nasoenteric Tube or Jejunostomy as a Route for Nutrition After Major Upper Gastrointestinal Operations

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Abstract

Background

Curative treatment of upper gastrointestinal tract neoplasms is complex and associated with high morbidity and mortality. In general, the patients are already malnourished, and early postoperative enteral nutrition is recommended. However, there is no consensus concerning the best enteral access route in these cases.

Methods

A prospective randomized trial was performed from 2008 to 2012 with 59 patients who underwent esophagectomy, total gastrectomy, or pancreaticoduodenectomy. In all, 4 patients declined to participate, and 13 did not meet the inclusion criteria and were excluded. Of the 42 included patients, 21 had nasoenteric tubes, and 21 had a jejunostomy.

Results

The two groups were similar in demographic and clinical aspects. The nasoenteric (NE) and jejunostomy groups underwent early enteral therapy in 71 and 62 % of cases (p > 0.05), respectively. The median length of enteral therapy use was less in the NE group (5.0 vs. 8.5 days), but the difference was not statistically significant. The NE group required introduction of parenteral therapy more frequently than the jejunostomy group (p < 0.05). Complications related to the enteral route occurred in 38.0 and 28.5 % of patients (p > 0.05) in the NE and jejunostomy groups, respectively. In the NE group, there were four losses and four tube obstructions. In the jejunostomy group, there were two losses, four obstructions, and two cases of leakage around the tube. In the latter group, patients who underwent therapy for a longer time had tubal complications (p < 0.05) and longer intensive care unit and hospital stays (p < 0.05).

Conclusion

The two enteral routes were associated with the same number of complications. However, the presence of a jejunostomy allowed enteral therapy for longer periods, especially in patients with complications, thus avoiding the need for parenteral nutrition.

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Acknowledgments

There was a CNPq grant to MITD Correia. We also received financial support for copy-editing from Pró-reitoria de pesquisa (PRPQ) Universidade Federal de Minas Gerais.

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Authors and Affiliations

  1. Governador Israel Pinheiro Hospital, Belo Horizonte, Minas Gerais, Brazil

    Luiz Gonzaga Torres Júnior & Fernando Augusto de Vasconcellos Santos

  2. Alfa Institute of Gastroenterology, Hospital of Clinics, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Maria Isabel Toulson Davisson Correia

Authors
  1. Luiz Gonzaga Torres Júnior
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  2. Fernando Augusto de Vasconcellos Santos
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  3. Maria Isabel Toulson Davisson Correia
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Correspondence to Luiz Gonzaga Torres Júnior.

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Torres Júnior, L.G., de Vasconcellos Santos, F.A. & Correia, M.I.T.D. Randomized Clinical Trial: Nasoenteric Tube or Jejunostomy as a Route for Nutrition After Major Upper Gastrointestinal Operations. World J Surg 38, 2241–2246 (2014). https://doi.org/10.1007/s00268-014-2589-9

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  • DOI: https://doi.org/10.1007/s00268-014-2589-9

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