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Enteral nutrition
PMO-086 How useful is feeding jejunostomy in upper gastro intestinal cancer surgery—a retrospective review
  1. V Daya Shetty
  1. Department of Upper GI Surgery, Salford Royal Hospitals NHS Foundation Trust, Bolton, UK

Abstract

Introduction A retrospective review of outcome of 100 consectutive open feeding jejunostomies performed as part upper GI cancer surgery in our Centre in the last 3 years.

Methods 100 consecutive patients undergoing open insertion of Freka feeding jejunostomy as a part of Upper GI cancer surgery in the last 3 years are included. All feeding tubes were inserted approximately 30cms distal to the duodenojejunal flexure. The average procedure time for jejunostomy placement was 20 min. The feeding jejunostomy was flushed with water on the night of surgery and a standardised feeding regime initiated used from fthe first postoperative day. The standard regime was water at 20 mls/h on day 1 followed by feed (Jevity/Osmolyte) at 30 mls/h on day 2. The rate of feed was increased on daily increment of 10 mls/h/day to achieve target rate based on patient's nutritional requirements. All patients were discharged with feeding jejunostomy in situ. It was removed at first follow-up clinic appointment 2 weeks after discharge if patient was nutritionally stable.

Results A total of 100 patients (male: female=66:34) who had feeding jejunostomy tubes inserted are included. The indications were cardio-oesophagectomy (77%); total gastrectomy (19%); inoperable tumour at laparotomy (3%) and in one patient prior to neoadjuvant chemotherapy. There were no intra operative procedure related complications. The median duration the feeding jejunostomy was in situ was 28 days (range 3–238 days). Postoperative feeding tube related complications were seen in 14% (n=14). These include tube fallout (n=5); minimal leak (n=2) and skin puncture site cellulitis (n=7). Enteral feed related complications were seen in 15% (n=15). These complications were minor and they included diarrhoea (n=9), abdominal cramps and bloating (n=4). Major complication was seen in only 6.8% (n=2) both due to feed (Jevity) forming a solid bezoar which caused small bowel obstruction. Laparotomy was necessary in one patient, with full recovery. The other the patient died following small bowel infarction. The availability of enteral route was particularly beneficial in 30 of our patients, to provide additional nutritional support for longer than anticipated, due to post operative difficulties including poor oral intake, anastamotic leak, and respiratory complications. In our series in only 5% (n=5) additional parenteral nutrition was necessary. This includes chyle leak—(n=3) and dislodged feeding tube (n=2).

Conclusion Feeding jejunostomy aids early establishment of enteral nutrition in patients undergoing upper GI cancer surgery. It is useful in providing continued nutritional support in patients who develop perioperative complications where oral route for nutrition is otherwise unavailable or inadequate, although jejunostomy tube placement and usage can also be a source of morbidity.

Competing interests None declared.

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