Elimination of Routine Feeding Jejunostomy After Esophagectomy

Abstract

Feeding jejunostomy is frequently used to ensure nutritional intake after esophagectomy. Early return to diet is demonstrated to enhance recovery in major abdominal surgery. Early oral feeding is safe and effective in recent randomized controlled trials in esophagectomy. This study assesses the implications of eliminating the insertion of jejunostomy after esophagectomy. A retrospective study was undertaken between 2014 and 2017 with follow-up over the first year. Fifty patients did not have a jejunostomy, compared with 46 patients who had conventional treatment. Outcomes measured included change in relative weight and body mass over 1 year, complications, and nutritional reinterventions. Median weight loss at 1 year was 10.7 kg (range, -8 to 55.6) whereas median percent weight loss was 12% (range, -10.1% to 39.2%). Patients without jejunostomy lost more weight during the first month (P= .002). Thereafter, at 6 of 12 months, there were no differences in actual or relative weight loss. Obese patients lost more weight in the group without jejunostomy compared with those who had it (9.9 versus 5 kg; P= .004). This effect was not seen in normal or overweight patients. Complications were similar, whereas leaks were more common in the jejunostomy group (15.2% versus 2%; P= .019). Nutritional reinterventions were similar during index admission and subsequent readmissions (7 versus 5 patients; P= .640). Routine jejunostomy use delays rather than prevents weight loss after esophagectomy. Oral route nutrition allows patients to maintain sufficient nutrition and does not increase complications or requirement for nutritional interventions after surgery. Routine use of jejunostomy may not be required in modern practice.