Skip to main content

Advertisement

Log in

Benefits Versus Risks: A Prospective Audit

Feeding Jejunostomy During Esophagectomy

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The purpose of this prospectively collected database is to evaluate the safety, efficacy, and utility of postoperative jejunostomy feeding in terms of achieving nutritional goals and evaluating gastrointestinal and mechanical complications in patients undergoing esophagectomy.

Methods

The study included 204 consecutive patients who underwent esophagectomy for various benign and malignant conditions. All patients underwent Witzel feeding jejunostomy at the time of laparotomy. Patients were followed prospectively to record nutritional intake, type of feed administered, rate progression, tolerance, and complications either mechanical or gastrointestinal.

Results

Feeding jejunostomy could be performed in 99.5% patients; 6.0% of the patients had a blocked catheter during the course of feeding. The target calorie requirement could be achieved in 78% of patients by third day. In all, 95% of patients could be successfully fed exclusively by jejunostomy catheter during the postoperative period. Minor gastrointestinal complications developed in 15% of the patients and were managed by slowing the rate of infusion or administering medication. Patients spent a mean of 16.67 ± 22.00 days (range 0–46 days) on jejunostomy feeding after surgery; however, 13% required prolonged jejunostomy feeding beyond 30 days. Altogether, 64% of the patients with an anastomotic leak and 50% of the patients with postoperative complications required catheter jejunostomy feeding beyond 30 days. The mean duration for which jejunostomy tube feeding was used was significantly higher for patients who developed anastomotic disruptions (33.05 ± 16.24 vs. 14.69 ± 19.04 days; p = 0.000) and postoperative complications (26.67 ± 25.56 vs. 14.52 ± 18.64 days; p = 0.000) when compared to those without disruption or complications. There were no serious complications related to the feeding catheter that required reintervention. There was no difference in the mean body weight or weight deficit at the end of 10 days and at 1 month in patients who developed complications or anastomotic disruption when compared to their counterparts. No patient died as a result of a complication related to the feeding jejunostomy.

Conclusions

Tube jejunostomy feeding is an effective method for providing nutritional support in patients undergoing esophagectomy, and it allows home support for the subset who fail to thrive. Prolonged tube feeding was continued in patients developing anastomotic disruptions and postoperative complications. Feeding jejunostomy has a definitive role to play in the management of the patients undergoing esophagectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Davies AR, Forshaw MJ, Khan AA, Noorani AS, Patel VM, Strauss DC, Mason RC (2008) Transhiatal esophagectomy in a high volume institution. World J Surg Oncol 6:88

    Article  PubMed  Google Scholar 

  2. Hulscher JB, Tijssen JGP, Obertop H, van Lanschot JJB (2001) Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thoracic Surg 72:306–313

    Article  CAS  Google Scholar 

  3. Orringer MB, Marshall B, Chang AC, Lee J, Pickens A, Lau CL (2007) Two thousand transhiatal esophagectomies. Ann Surg 246:363–374

    Article  PubMed  Google Scholar 

  4. Kight CE (2008) Nutrition consideration in esophagectomy patients. Nutr Clin Pract 23:521–528

    Article  PubMed  Google Scholar 

  5. Baigrie RJ, Devitt PG, Watkin DS (1996) Enteral versus parenteral nutrition after oesophagogastric surgery: a prospective randomized comparison. Aust N Z J Surg 66:668–670

    Article  PubMed  CAS  Google Scholar 

  6. Jenkinson AD, Lim J, Agrawal N, Menzies D (2007) Laparoscopic feeding jejunostomy in esophagogastric cancer. Surg Endosc 21:299–302

    Article  PubMed  CAS  Google Scholar 

  7. Han-Geurts IJ, Hop WC, Verhoef C, Tran KT, Tilanus HW (2007) Randomized clinical trial comparing feeding jejunostomy with nasoduodenal tube placement in patients undergoing oesophagectomy. Br J Surg 94:31–35

    Article  PubMed  CAS  Google Scholar 

  8. Ryan AM, Rowley SP, Healy LA, Flood PM, Ravi N, Reyonalds JV (2006) Post-oesophagectomy early enteral nutrition via a needle catheter jejunostomy: 8-year experience at a specialist unit. Clin Nutr 25:386–393

    Article  PubMed  Google Scholar 

  9. Yagi M, Hashimoto T, Nezuka H, Ito H, Tani T, Shimizu K, Miwa K (1999) Complications associated with enteral nutrition using catheter jejunostomy after esophagectomy. Surg Today 29:214–218

    Article  PubMed  CAS  Google Scholar 

  10. Watters JM, Kirkpatrick SM, Norris SB, Shamji FM, Wells GA (1997) Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility. Ann Surg 226:369–380

    Article  PubMed  CAS  Google Scholar 

  11. Brock MV, Venbrux AC, Heitmiller RF (2000) Percutaneous replacement jejunostomy after esophagogastrectomy. J Gastrointest Surg 4:407–410

    Article  PubMed  CAS  Google Scholar 

  12. Ruiz-Elizalde AR, Frischer JS, Cowles RA (2008) Button-loop feeding jejunostomy. J Gastrointest Surg, Sep 30 [Epub ahead of print]

  13. Slappy AL, Odell JA, Hinder RA, McKinney JM (2006) Jejunopexy for selectively placed fluoroscopically guided percutaneous jejunal feeding tubes. Ann Thorac Surg 82:756–758

    Article  PubMed  Google Scholar 

  14. Harbinson SP (2007) Intubation of the stomach and small intestine. In: Yeo CJ, Dempsy DT, Klein JH, Pemberton JH, Peters JH (eds) Surgery of the alimentary tract, vol 1, 6th edn. Saunders Elsevier, Philadelphia, pp 749–759

    Google Scholar 

  15. Sica GS, Sujendran V, Wheeler, Soin B, Maynard N (2005) Needle catheter jejunostomy at esophagectomy for cancer. J Surg Oncol 91:276–279

    Article  PubMed  Google Scholar 

  16. Gerndt SJ, Orringer MB (1994) Tube jejunostomy as an adjunct to esophagectomy. Surgery 115:164–169

    PubMed  CAS  Google Scholar 

  17. Bueno JT, Schattner MA, Barrera R, Gerdes H, Bains M, Shike M (2003) Endoscopic placement of direct percutaneous jejunostomy tubes in patients with complications after esophagectomy. Gastrointest Endosc 57:536–540

    Article  PubMed  Google Scholar 

  18. Venskutonis D, Bradulskis S, Adamonsi K, Urbanavicius L (2007) Witzel catheter feeding jejunostomy: is it safe? Dig Surg 24:349–353

    Article  PubMed  Google Scholar 

  19. Wakefield SE, Mansell NJ, Baigrie RJ, Dowling BL (1995) Use of a feeding jejunostomy after oesophagogastric surgery. Br J Surg 82:811–813

    Article  PubMed  CAS  Google Scholar 

  20. Reichle RL, Venbrux AC, Heitmiller RF, Osterman FA (1995) Percutaneous jejunostomy replacement in patients who have undergone esophagectomy. J Vasc Interv Radiol 6:939–942

    Article  PubMed  CAS  Google Scholar 

  21. Pramesh CS, Mistry RC, Deshpande RK, Sharma S (2002) Enteral feeding access with feeding jejunostomy is advisable after esophagectomy. Eur J Cardiothorac Surg 22:666–672

    Article  Google Scholar 

  22. McCarter MD, Gomez ME, Daly JM (1997) Early postoperative enteral feeding following major upper gastrointestinal surgery. J Gastrointest Surg 1:278–285

    Article  PubMed  CAS  Google Scholar 

  23. Kondra J, Ong SR, Clifton J, Evans K, Finley RJ, Yee J (2008) A change in clinical practice: a partially stapled cervical esophagogastric anastomosis reduces morbidity and improves functional outcome after esophagectomy for cancer. Dis Esophagus 21:422–429

    Article  PubMed  CAS  Google Scholar 

  24. Hunerbein M, Stroszczynski C, Moesta KT, Schlag PM (2004) Treatment of thoracic anastomotic leak after esophagectomy with self-expanding plastic stent. Ann Surg 240:801–807

    Article  PubMed  Google Scholar 

  25. Gupta NM, Gupta R, Manikyam SR, Gupta V (2001) Minimizing cervical esophageal anastomotic complications by a modified technique. Am J Surg 181:534–539

    Article  PubMed  CAS  Google Scholar 

  26. Finley FJ, Lamy A, Clifton J, Evans KG, Fradet G, Nelems B (1995) Gastrointestinal function following esophagectomy for malignancy. Am J Surg 169:471–475

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vikas Gupta.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gupta, V. Benefits Versus Risks: A Prospective Audit. World J Surg 33, 1432–1438 (2009). https://doi.org/10.1007/s00268-009-0019-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-009-0019-1

Keywords

Navigation