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PTH-148 Artificial nutrition support (ANS) after oesophagectomy for cancer – a review of practice
  1. O Hynes1,
  2. A Champion1,
  3. A Gardiner1,
  4. A Davies2,
  5. J Gossage2
  1. 1Dietetics, Guys and St. Thomas’ NHS Foundation Trust (GSTFT), London, UK
  2. 2Upper GI Surgery, Guys and St. Thomas’ NHS Foundation Trust (GSTFT), London, UK

Abstract

Introduction ANS is required after Oesophagectomy until resumption of oral intake. Jejunostomy tube (JT) feeding is associated with less post operative complications and shorter hospital length of stay LOS over Parenteral nutrition (PN). However, JT feeding comes with a risk of major complications including volvulus, bowel obstruction, bowel necrosis and mortality. It was routine at GSTFT to place a JT at Oesophagectomy. However, following the death of a patient due to small bowel volvulus/ischaemia this practice was suspended. Patients now receive PN.

Method A retrospective observational study was carried out looking at post Oesophagectomy ANS practices at GSTFT in 2014. Data on feeding method used, postoperative LOS, readmissions, mortality, and use of JT after discharge was collated.

Results Sixty three patients underwent an Oesophagectomy between January–December 2014; 31 received post operative feeding via a JT and 32 patients received PN. Table 1presents the demographics and descriptive statistics (using Microsoft Xcel) of results for both groups.

Median LOS was shorter in the PN group, which is at odds with the literature. The introduction of enhanced recovery and increased dietetic personnel may have contributed this difference. Nine out of the 11 readmissions were for nutrition related problems and patients went home on JT or Nasojejunal tube feeding. One third of patients who had a JT insitu after discharge, did not use their tube again before removal.

Conclusion The results of this study demonstrate the high requirements for ANS in patients following Oesophagectomy. ANS was key in the management of most readmissions. The advantage of JTs over PN is the potential for longterm use. However, given that a third of patients did not need to use their JT after discharge, is the risk of major complications too great that it outweighs the benefits? Prospective randomised studies are required to elucidate this. Better patient selection for JT insertion would prevent some patients undergoing an unnecessary additional risk at surgery.

Disclosure of interest None Declared.

Abstract PTH-148 Table 1

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