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World Journal of Surgery

, Volume 38, Issue 9, pp 2241–2246 | Cite as

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

  • Luiz Gonzaga Torres JúniorEmail author
  • Fernando Augusto de Vasconcellos Santos
  • Maria Isabel Toulson Davisson Correia
Article

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.

Keywords

Enteral Nutrition Enteral Feeding Parenteral Therapy Enteral Route Catheter Complication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

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.

References

  1. 1.
    Sorensen LT, Malaki A, Wille-Jorgensen P et al (2007) Risk factors for mortality and postoperative complications after gastrointestinal surgery. J Gastrointest Surg 11:903–910PubMedCrossRefGoogle Scholar
  2. 2.
    Shukla PJ, Barreto SG, Mohandas KM et al (2009) Defining the role of surgery for complications after pancreatoduodenectomy. ANZ J Surg 79:33–37PubMedCrossRefGoogle Scholar
  3. 3.
    Marin FA, Lamonica-Garcia VC, Henry MA et al (2010) Grade of esophageal cancer and nutritional status impact on postsurgery outcomes. Arq Gastroenterol 47:348–353PubMedCrossRefGoogle Scholar
  4. 4.
    Atkins BZ, Shah AS, Hutcheson KA et al (2004) Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 78:1170–1176PubMedCrossRefGoogle Scholar
  5. 5.
    Lassen K, Dejong CH, Ljungqvist O et al (2005) Nutritional support and oral intake after gastric resection in five northern European countries. Dig Surg 22:346–352PubMedCrossRefGoogle Scholar
  6. 6.
    Dong K, Yu XJ, Li B et al (2006) Advances in mechanisms of postsurgical gastroparesis syndrome and its diagnosis and treatment. Chin J Dig Dis 7:76–82PubMedCrossRefGoogle Scholar
  7. 7.
    Waitzberg DL, Caiaffa WT, Correia MI (2001) Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition 17:573–580PubMedCrossRefGoogle Scholar
  8. 8.
    Correia MI, Waitzberg DL (2003) The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 22:235–239PubMedCrossRefGoogle Scholar
  9. 9.
    Osland E, Yunus RM, Khan S et al (2011) Early versus traditional postoperative feeding in patients undergoing resectional gastrointestinal surgery: a meta-analysis. JPEN J Parenter Enteral Nutr 35:473–487PubMedCrossRefGoogle Scholar
  10. 10.
    Park JS, Chung HK, Hwang HK et al (2012) Postoperative nutritional effects of early enteral feeding compared with total parental nutrition in pancreaticoduodectomy patients: a prosepective, randomized study. J Korean Med Sci 27:261–267PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Mazaki T, Ebisawa K (2008) Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature. J Gastrointest Surg 12:739–755PubMedCrossRefGoogle Scholar
  12. 12.
    Shrikhande SV, Shetty GS, Singh K et al (2009) Is early feeding after major gastrointestinal surgery a fashion or an advance? Evidence-based review of literature. J Cancer Res Ther 5:232–239PubMedCrossRefGoogle Scholar
  13. 13.
    Gabor S, Renner H, Matzi V et al (2005) Early enteral feeding compared with parenteral nutrition after oesophageal or oesophagogastric resection and reconstruction. Br J Nutr 93:509–513PubMedCrossRefGoogle Scholar
  14. 14.
    Correia MI, da Silva RG (2004) The impact of early nutrition on metabolic response and postoperative ileus. Cur Opin Nutr Metab Care 7:577–583CrossRefGoogle Scholar
  15. 15.
    Kwon RS, Banerjee S, Desilets D et al (2010) Enteral nutrition access devices. Gastrointest Endosc 72:236–248PubMedCrossRefGoogle Scholar
  16. 16.
    Abu-Hilal M, Hemandas AK, McPhail M et al (2010) A comparative analysis of safety and efficacy of different methods of tube placement for enteral feeding following major pancreatic resection: a non-randomized study. JOP 11:8–13PubMedGoogle Scholar
  17. 17.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Soares JS, Siqueira AL (2008) Em: Introdução à Estatística Médica. COOPMED, Belo Horizonte, p 306Google Scholar
  19. 19.
    Han-Geurts IJ, Hop WC, Verhoef C et al (2007) Randomized clinical trial comparing feeding jejunostomy with nasoduodenal tube placement in patients undergoing oesophagectomy. Br J Surg 94:31–35PubMedCrossRefGoogle Scholar
  20. 20.
    Gerritsen A, Besselink MG, Cieslak KP et al (2012) Efficacy and complications of nasojejunal, jejunostomy and parenteral feeding after pancreaticoduodenectomy. J Gastrointest Surg 16:1144–1151PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Weimann A, Braga M, Harsanyi L et al (2006) ESPEN guidelines on enteral nutrition: surgery including organ transplantation. Clin Nutr 25:224–244PubMedCrossRefGoogle Scholar
  22. 22.
    Seder CW, Stockdale W, Hale L et al (2010) Nasal bridling decreases feeding tube dislodgment and may increase caloric intake in the surgical intensive care unit: a randomized, controlled trial. Crit Care Med 38:797–801PubMedGoogle Scholar
  23. 23.
    Han-Geurts IJ, Verhoef C, Tilanus HW (2004) Relaparotomy following complications of feeding jejunostomy in esophageal surgery. Dig Surg 21:192–196PubMedCrossRefGoogle Scholar
  24. 24.
    Halloran O, Grecu B, Sinha A (2011) Methods and complications of nasoenteral intubation. JPEN J Parenter Enteral Nutr 35:61–66PubMedCrossRefGoogle Scholar
  25. 25.
    Ramamurthy A, Negi SS, Chaudhary A (2008) Prophylactic tube jejunostomy: a worthwhile undertaking. Surg Today 38:420–424PubMedCrossRefGoogle Scholar
  26. 26.
    Markides GA, Alkhaffaf B, Vickers J (2011) Nutritional access routes following oesophagectomy: a systematic review. Eur J Clin Nutr 65:565–573PubMedCrossRefGoogle Scholar
  27. 27.
    Wani ML, Ahangar AG, Lone GN et al (2010) Feeding jejunostomy: does the benefit overweight the risk (a retrospective study from a single centre). Int J Surg 8:387–390PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Luiz Gonzaga Torres Júnior
    • 1
    Email author
  • Fernando Augusto de Vasconcellos Santos
    • 1
  • Maria Isabel Toulson Davisson Correia
    • 2
  1. 1.Governador Israel Pinheiro HospitalBelo HorizonteBrazil
  2. 2.Alfa Institute of Gastroenterology, Hospital of Clinics, Medical SchoolUniversidade Federal de Minas GeraisBelo HorizonteBrazil

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