Assessment of enteral nutrition through feeding stomas or gastric tubes in digestive surgery

Abstract

Ostomy feeding remains a reference approach for enteral nutritional assistance. In Madagascar, the techniques are still conventional surgical procedures due to the lack of adequate endoscopic equipment. This study aims to evaluate the benefits and risks of enteral nutrition with a two-week follow-up. Included patients who had benefited from enteral nutrition by tube feeding using nasogastric, gastrostomy, and jejunostomy tubes over six months in Joseph Ravoahangy Andrianavalona Hospital. Prevalence, age and gender, current body mass index (BMI), weight, nutritional grade, initial pathology, psychological status, comorbidities, type of feeding stoma, and the surgical technique (gastrostomy or jejunostomy) were studied. After 15 days, the effectiveness of enteral nutrition was assessed using BMI, serum albumin, C-Reactive Protein (CRP) level, as well as postoperative complications and quality of life. The patient's outcome on the 15th day has been determined. The Chi-square test analyzed the associations and Mann Whitney test compared the effects of enteral nutrition by ostomy and gastric tube use. Forty-two patients were included, aged 47(17-78). The sex ratio was 0.5. Initially, the body mass index was 17(12-23) kg/m², the serum albumin value 3.4 (2.5-4.7) gr/dl with a median CRP level of 16 (2-74.2) mg/l. Nutritional assistance resulted in a weight variation between baseline and 15th day. Comparing enteral nutrition by ostomy and gastric tube, only variation of C Reactive Protein on the 15th day has a significative difference. Mortality was 33% (gastrostomy), 31% (jejunostomy), 24% (nasogastric tube). Nutritional support and the choice of ostomy or gastric tube for enteral nutrition were not associated with mortality. The effectiveness of nutritional assistance is still questionable in this study if the results are more promising in the literature. The death rate linked to the initial pathology and the general state of the patients is still considerable, hence the interest in decision-making in multidisciplinary consultation meetings.