ORIGINAL ARTICLE

JOP. J Pancreas (Online) 2010 Jan 8; 11(1):8-13.

A Comparative Analysis of Safety and Efficacy of Different Methods of Tube Placement for Enteral Feeding Following Major Pancreatic Resection. A Non-Randomized Study

Mohammad Abu-Hilal, Anil K Hemandas, Mark McPhail, Gaurav Jain, Ioanna Panagiotopoulou, Tina Scibelli, Colin D Johnson, Neil W Pearce

Hepato-Biliary-Pancreatic and Laparoscopic Surgical Unit, Southampton University Hospital. Southampton, United Kingdom

ABSTRACT

Context Postoperative enteral nutrition is thought to reduce complications and speed recovery after pancreatic resection. There is little evidence on the best route for delivery of enteral nutrition. Currently we use percutaneous transperitoneal jejunostomy or percutaneous transperitoneal gastrojejunostomy, or the nasojejunal route to deliver enteral nutrition, according to surgeon preference.

Objective To compare morbidity, efficiency, and safety of these three routes for enteral nutrition following pancreaticoduodenectomy.

Patients Data were obtained from a prospectively maintained database, for all patients undergoing pancreatic resection between January 2007 and June 2008. One-hundred pancreatic resected patients underwent enteral nutrition: 93 had Whipple’s operations and 7 had total pancreatectomies.

Intervention Enteral nutrition was delivered by agreed protocol, starting within 24 h of operation and increasing over 2-3 days to meet full nutritional requirement.

Results Delivery route of enteral nutrition was: percutaneous transperitoneal jejunostomy in 25 (25%), percutaneous transperitoneal gastrojejunostomy in 32 (32%) and nasojejunal in 43 (43%). The incidence of catheter-related complications was higher in percutaneous techniques: 24% in percutaneous transperitoneal jejunostomy and 34% in percutaneous transperitoneal gastrojejunostomy as compared to nasojejunal technique (12%). Median time to complete establishment of oral intake was 14, 14 and 10 days in percutaneous transperitoneal jejunostomy, percutaneous transperitoneal gastrojejunostomy, and nasojejunal groups, respectively. Nasojejunal tubes were removed at median 11 days (mean 11.5 days) compared to 5-6 weeks for percutaneous transperitoneal jejunostomy and percutaneous transperitoneal gastrojejunostomy. Commonest catheter-related complication in the percutaneous transperitoneal jejunostomy and percutaneous transperitoneal gastrojejunostomy was blockage (n=6; 10.5%), followed by pain after removal of feeding tube at 5-6 weeks (n=5; 8.8%), whereas in the nasojejunal group it was blockage (n=3; 7.0%), followed by displacement (n=2; 4.7%). Two patients died postoperatively in this cohort, however, there were no catheter-related mortalities.

Conclusion Enteral nutrition following pancreatic resection can be delivered in different ways. Nasojejunal feeding was associated with fewest and less serious complications. On current evidence surgeon preference is a reasonable way to decide enteral nutrition but a randomized controlled trial is needed to address this issue.

Full text: HTML format  PDF format

References

  1. Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, Morgenstein-Wagner TB, et al. Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 1992; 216:172-83. [More details]

  2. Mazaki T, Ebisawa K. Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature. J Gastrointest Surg 2008; 12:739-55. [More details]

  3. Jeejeebhoy KN. Enteral nutrition versus parenteral nutrition--the risks and benefits. Nat Clin Pract Gastroenterol Hepatol 2007; 4:260-5. [More details]

  4. Bozzetti F, Braga M, Gianotti L, Gavazzi C, Mariani L. Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial. Lancet 2001; 358:1487-92. [More details]

  5. Okabayashi T, Kobayashi M, Nishimori I, Sugimoto T, Akimori T, Namikawa T, et al. Benefits of early postoperative jejunal feeding in patients undergoing duodenohemipancreatectomy. World J Gastroenterol 2006; 12:89-93. [More details]

  6. Okabayashi T, Kobayashi M, Nishimori I, Sugimoto T, Onishi S, Hanazaki K. Risk factors, predictors and prevention of pancreatic fistula formation after pancreatoduodenectomy. J Hepatobiliary Pancreat Surg 2007; 14:557-63. [More details]

  7. Smith CD, Sarr MG. Clinically significant pneumatosis intestinalis with postoperative enteral feedings by needle catheter jejunostomy: an unusual complication. JPEN J Parenter Enteral Nutr 1991; 15:328-31. [More details]

  8. Myers JG, Page CP, Stewart RM, Schwesinger WH, Sirinek KR, Aust JB. Complications of needle catheter jejunostomy in 2,022 consecutive applications. Am J Surg 1995; 170:547-50. [More details]

  9. Holmes JH 4th, Brundage SI, Yuen P, Hall RA, Maier RV, Jurkovich GJ. Complications of surgical feeding jejunostomy in trauma patients. J Trauma 1999; 47:1009-12. [More details]

  10. Han-Geurts IJ, Hop WC, Verhoef C, Tran KT, Tilanus HW. Randomized clinical trial comparing feeding jejunostomy with nasoduodenal tube placement in patients undergoing oesophagectomy. Br J Surg 2007; 94:31-5. [More details]

  11. Delany H M, Carnevale N J, Garvey J W. Jejunostomy by a needle catheter technique. Surgery 1973; 73:786-90. [More details]

  12. Witzel O. Zur Technik der Magenfistulaeinlegung. Zbl Chir 1891; 18:601-4. [More details]

  13. Tapia J, Murguia R, Garcia G, de los Monteros PE, Oñate E. Jejunostomy: techniques, indications, and complications. World J Surg 1999; 23:596-602. [More details]

  14. Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition 2004; 20:843-8. [More details]

  15. De Gottardi A, Krähenbühl L, Farhadi J, Gernhardt S, Schäfer M, Büchler MW. Clinical experience of feeding through a needle catheter jejunostomy after major abdominal operations. Eur J Surg 1999; 165:1055-60. [More details]

  16. Sonawane RN, Thombare MM, Kumar A, Sikora SS, Saxena R, Kapoor VK, Kaushik SP. Technical complications of feeding jejunostomy: a critical analysis. Trop Gastroenterol 1997; 18:127-8. [More details]

  17. Ryan AM, Rowley SP, Healy LA, Flood PM, Ravi N, Reynolds JV. Post-oesophagectomy early enteral nutrition via a needle catheter jejunostomy: 8-year experience at a specialist unit. Clin Nutr 2006; 25:386-93. [More details]

  18. Sarr MG. Appropriate use, complications and advantages demonstrated in 500 consecutive needle catheter jejunostomies. Br J Surg 1999; 86:557-61. [More details]

Keywords /complications; Enteral Nutrition; Pancreatectomy

Correspondence Mohammad Abu-Hilal: mohammed.abuhilal@suht.swest.nhs.uk; abu_hlal@yahoo.com

JOP Home page