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. 2017 Jul;9(Suppl 8):S851-S860.
doi: 10.21037/jtd.2017.06.73.

Routine jejunostomy tube feeding following esophagectomy

Teus J Weijs  1 , Hanneke W J van Eden  1 , Jelle P Ruurda  1 , Misha D P Luyer  2 , Elles Steenhagen  3 , Grard A P Nieuwenhuijzen  2 , Richard van Hillegersberg  1
Affiliations

Routine jejunostomy tube feeding following esophagectomy

Teus J Weijs et al. J Thorac Dis. 2017 Jul.

Abstract

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 quartile 23.0-28.6) kg/m2 to 24.4 (22.0-27.1) kg/m2 at 30 days later [median weight loss: 3.0 (1.0-5.3) kg; 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 home-tube 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.

Keywords: Esophageal cancer; esophagectomy; jejunostomy; nutrition.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
This figure shows the median BMI with corresponding interquartile range on time points before and after surgery. BMI, body mass index; TF, tube feeding.
Figure 2
Figure 2
This figure shows the percentage of patients that was discharged with tube feeding at home each year, set out against the number of patients that had to bed readmitted within 30 days of discharge and patients that had to restart tube feeding whilst being at home.
See this image and copyright information in PMC

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