OGC P24 The impact of early enteral feed composition on the rate of chyle leak post-oesophagectomy

Abstract

Abstract Background Patients undergoing oesophagectomy are at significant risk of malnutrition and benefit from peri-operative enteral feeding. Chyle leak presents in up to 20% of patients undergoing an oesophageal resection and is associated with immunosuppression, malnutrition and increased complications. Early enteral feeding can increase the rate of chyle leak in these patients. Enteral feed with a high percentage of fat as medium chain triglycerides (MCT) is more easily absorbed and can reduce chyle production. We evaluated the impact of early enteral MCT-rich feed on the prevalence and severity of chyle leak post-oesophagectomy. Secondary outcomes include length stay, and post-operative weight change. Methods Retrospective review of records from consecutive patients undergoing oesophagectomy at a single tertiary centre between January 2015 and December 2022. Following specialist dietician input, patients received enteral feed on post-operative day 1 – 5 with Nutrison Protein Plus Energy (standard; 5.8% total fat, 0.9% (MCT)) (2015-June 2021) or Nutrison Peptisorb Plus HEHP (HEHP; 5% total fat and 3% MCT) enteral feed (June 2021 to Dec 2022). All patients transitioned to standard feed on post-operative day 6 onwards and were discharged on IDDSI level 4 diet and supplemental jejunal feeding. Patients who did not commence early enteral feeding were excluded from analysis. Results A total of 329 patients were included. Patients who received early enteral HEHP feed had fewer chyle leaks (5/52; 9.6%) compared to patients who received early enteral standard feed (68/277; 24.5% p=0.017). The proportion of ECCG grade I and II leaks was similar between groups. No patients required surgical intervention for a chyle leak during the study period. The HEHP group had a shorter critical care (p<0.001) and total length of hospital stay (p=0.011). Weight change from pre-operative baseline was equivalent in both groups at 6 weeks (standard; -4.5%, HEHP; -2.3%, P=0.066) and 3 months (standard; -5.6%, HEHP -4.0%, P=0.400). Conclusions In the context of routine jejunostomy use and early enteral feeding post-oesophagectomy, HEHP feed on post-operative day 1- day 5 was associated with a significantly lower chyle leak rate with corresponding shorter length of stay compared to standard feed. No difference was noted in post-operative weight change between groups which was relatively well preserved up to 3 months post-operatively.