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Oesophageal I
PTU-200 Home jejunostomy feeding post-oesophagectomy: a change in practice
  1. M Fanning1,
  2. A Mc Hugh1,
  3. C Browne1,
  4. N Ravi2,
  5. J V Reynolds2,
  6. L A Healy1
  1. 1Clinical Nutrition, St. James's Hospital, Dublin, Ireland
  2. 2Department of Surgery, St. James's Hospital, Dublin, Ireland

Abstract

Introduction Early enteral nutrition support via a needle catheter jejunostomy (NCJ) is a safe and effective method of providing nutrition support post-oesophagectomy. In our specialist unit all patients have a NCJ placed at the time of surgery for post-operative nutrition support. Maintaining nutritional status in the months following oesophageal resection is very challenging and up to 82% of patients lose weight by their first outpatient (OPD) visit.1 To address this, patients are now routinely discharged on supplementary feeding until their first OPD visit (after 4 weeks) and receive a dietetic telephone review 1 week post discharge. The aim of this retrospective review was to assess the impact of home jejunostomy feeding on nutritional status, length of hospital stay and timing of the first OPD visit.

Methods All patients who had an oesophageal resection in the 12-month period before and after the change in practice were considered for this study. Patients who underwent emergency or palliative resections, were participating in a clinical trial or had incomplete data were excluded. Dietetic records and the cancer database were reviewed and analysed using SPSS®. The medians were compared using Mann–Whitney U test.

Results Weight loss was observed in 69% of all patients from discharge to first OPD visit. Patients who were discharged on home feeding experienced less weight loss (See Abstract PTU-200 table 1). Length of stay was not significantly increased in the home feeding group, but the length of time to first OPD visit increased significantly by 8 days (See Abstract PTU-200 table 1). The majority (82%) of patients were discharged on 500 ml volume of a 1.2–1.5 kcal/ml enteral feed, providing an average 40% of calculated energy and 46% of protein requirements. Of the home feeding group 52% continued to require jejunostomy feeding after the first OPD visit.

Abstract PTU-200 Table 1

Comparison of outcomes from discharge to first OPD visit

Conclusion Home jejunostomy feeding can be successful in reducing weight loss following oesphagectomy and is frequently required for longer than 1-month post discharge. The increase in telephone contact may have contributed to a delay in the timing of first OPD visit. Organisation of home feeding in hospital did not delay discharge.

Competing interests None declared.

Reference 1. Ryan, et al. Clinical Nutrition 2006;25:386–93.

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