Tu1463 Failure of Oral Intake to Meet Nutritional Requirements in the Early Months After Esophagectomy

Abstract

BackgroundNutritional intake is often compromised in themonths following esophagogastric resection. Enteral nutrition has been used as an adjunct to oral intake but studies evaluating the role of extended jejunostomy feeding (JEJ) following hospital discharge are lacking. Methods As part of a randomized controlled trial investigating the effect of six weeks of home jejunostomy feeding, nutritional intake was assessed at 4 time points: hospital discharge, 6 weeks after discharge, 3 and 6 months post surgery. Dietary intake was assessed using 3 day dietary records, analysed using Dietplan6®. Information on JEJ intake was collected for the same period. Ideal nutritional requirements for energy were calculated using the Henry equation adjusted for activity level. Oral intake was considered adequate if reported intake provided >75% of estimated energy needs. Results 54 participants were enrolled in the study. There were 13 early withdrawals leaving 41 participants for analysis. Surgery comprised esophagectomy in 32 participants and total gastrectomy in 9. Twenty participants were randomised to a planned program of home JEJ feeding providing 50% of energy and protein requirements, inaddition to usual dietary intake. Twenty-one participants in the control group received care as usual with jejunostomy feeding being stopped on discharge from hospital. 17/20 participants (85%) in the intervention group received treatment as allocated. Seven participants (35%) in the control group had to recommence home feeding due to clinical and/or nutritional need. At the time of hospital discharge, dietary intake was poor in both groups with JEJ feeding still meeting the energy requirements of most participants. By 6 weeks post hospital discharge, oral nutritional intake remained inadequate in 47% and 50% of the intervention and control group respectively. Total calorie intake was adequate in the intervention group because of the contribution from jejunostomy feeding (Table). Conclusions This study has shown that energy requirements are frequently inadequate in patients after esophagectomy and total gastrectomy in the months after surgery. It has also demonstrated that supplementary jejunostomy feeding may make an important contribution to nutritional requirements in these early months.