AHP P03 Challenges in the nutritional management of patients undergoing Endoluminal Vacuum therapy (EVT) for upper gastrointestinal (UGI) leaks and perforations

Abstract

Abstract Background The management of upper gastrointestinal (UGI) leaks and perforations is complex and challenging. Patients often have multiple comorbidities, have undergone major surgical interventions with protracted pathways, and are associated with compromised nutritional states. Endoluminal Vacuum therapy (EVT) is a novel approach to managing UGI leaks that aims to avoid unnecessary major surgical intervention. Optimising nutrition for this cohort is of paramount importance, however, this may be challenging to achieve due to repeated interventions and interruptions in nutritional support. This study aimed to objectively measure and describe some of these challenges and explore areas of development to optimise outcomes for patients. Methods A retrospective analysis of all leaks and perforations managed with EVT between September 2018 and June 2023 was undertaken. This included patients who had undergone cancer resections (oesophagectomy and gastrectomy), bariatric surgery and those presenting with benign disease (e.g. oesophageal perforation and iatrogenic injury). The setting was a regional tertiary oesophago-gastric and bariatric centre in the North-West of England serving a population of 3.5 million people. A comprehensive dataset relating to the nutritional status of patients preoperatively and the change in nutritional parameters was collected and analysed. Results 59 patients (43 males; median age 61) were included; 88% were discharged from hospital. Median weight on admission and last EVT was 88.5kg (IQR 51-131kg) and 76.9kg. 31% had >10% pre-admission weight loss (IQR 2.4-30%). Median weight loss to last EVT was 7.1% (IQR +16.5 to -18.1%) vs. 9.4% (IQR +2 to -23%) for overall stay. Initial feeding routes were 46% (27/59) jejunostomy, 41% (24/59) parenteral nutrition (PN), 12% (7/59) PN/jejunostomy, and 2% (1/59) naso-gastric. Median weight loss during admission was less (9%) in the jejunostomy cohort versus the other feeding groups (PN 12.4%, PN/jejunostomy 13.9%, nasogastric 9.2%). Conclusions Meeting the nutritional needs in this complex, co-morbid and often nutritionally deplete group is a challenging task. Management algorithms were heterogenous and lacked consistency. An accurate understanding of nutritional requirements was difficult due to a combination of a lack of clinically validated guidelines and little consensus regarding which data points should be used to measure nutritional provision. These issues must be addressed to accurately ascertain the role of nutritional optimisation in this cohort, and to be able to identify modifiable factors and areas of development that may improve patient outcomes.