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 Hepato-Biliary-Pancreatic and Laparoscopic Surgical Unit, Southampton University Hospital. Southampton, United Kingdom
  • Anil K Hemandas Hepato-Biliary-Pancreatic and Laparoscopic Surgical Unit, Southampton University Hospital. Southampton, United Kingdom
  • Mark McPhail Hepato-Biliary-Pancreatic and Laparoscopic Surgical Unit, Southampton University Hospital. Southampton, United Kingdom
  • Gaurav Jain Hepato-Biliary-Pancreatic and Laparoscopic Surgical Unit, Southampton University Hospital. Southampton, United Kingdom
  • Ioanna Panagiotopoulou Hepato-Biliary-Pancreatic and Laparoscopic Surgical Unit, Southampton University Hospital. Southampton, United Kingdom
  • Tina Scibelli Hepato-Biliary-Pancreatic and Laparoscopic Surgical Unit, Southampton University Hospital. Southampton, United Kingdom
  • Colin D Johnson Hepato-Biliary-Pancreatic and Laparoscopic Surgical Unit, Southampton University Hospital. Southampton, United Kingdom
  • Neil W Pearce Hepato-Biliary-Pancreatic and Laparoscopic Surgical Unit, Southampton University Hospital. Southampton, United Kingdom
Keywords: /complications, Enteral Nutrition, Pancreatectomy

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.

Image: Southampton University Hospital. Southampton, United Kingdom.

Downloads

Download data is not yet available.

References

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. [PMID 1386982] (FULL TEXT: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1242589/pdf/annsurg00078-0082.pdf)

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. [PMID 17939012] (FULL TEXT: http://www.springerlink.com/content/72x12834644772j4/fulltext.html)

Jeejeebhoy KN. Enteral nutrition versus parenteral nutrition--the risks and benefits. Nat Clin Pract Gastroenterol Hepatol 2007; 4:260-5. [PMID 17476208] (FULL TEXT: http://www.nature.com/nrgastro/journal/v4/n5/full/ncpgasthep0797.html)

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. [PMID 11705560] (FULL TEXT: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(01)06578-3/fulltext)

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. [PMID 16440423] (FULL TEXT: http://www.wjgnet.com/1007-9327/12/89.asp)

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. [PMID 18040620] (FULL TEXT: http://www.springerlink.com/content/hx10q4164471u537/fulltext.pdf)

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. [PMID 1907684] (FULL TEXT: http://pen.sagepub.com/cgi/reprint/15/3/328)

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. [PMID 7491998] (FULL TEXT: http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6VHS-40SFMCP-5-1&_cdi=6074&_user=839424&_orig=search&_coverDate=12%2F31%2F1995&_sk=998299993&view=c&wchp=dGLbVlz-zSkWb&md5=2d797983fddf4654a1eeea5e6fe0292f&ie=/sdarticle.pdf)

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. [PMID 10608526] (FULL TEXT: http://journals.lww.com/jtrauma/pages/articleviewer.aspx?year=1999&issue=12000&article=00004&type=abstract)

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. [PMID 17117432] (FULL TEXT: http://www3.interscience.wiley.com/cgi-bin/fulltext/113462401/HTMLSTART)

Delany H M, Carnevale N J, Garvey J W. Jejunostomy by a needle catheter technique. Surgery 1973; 73:786-90. [PMID 4697097]

Witzel O. Zur Technik der Magenfistulaeinlegung. Zbl Chir 1891; 18:601-4.)

Tapia J, Murguia R, Garcia G, de los Monteros PE, Oñate E. Jejunostomy: techniques, indications, and complications. World J Surg 1999; 23:596-602. [PMID 10227930] (FULL TEXT: http://www.springerlink.com/content/g87ygkc8km9b6hx2/fulltext.pdf)

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. [PMID 15474870] (FULL TEXT: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TB0-4DGSXRS-1&_user=839424&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000045367&_version=1&_urlVersion=0&_userid=839424&md5=b46987bb3b00160e3742b7b89cd4e325)

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. [PMID 10595610] (FULL TEXT: http://www3.interscience.wiley.com/cgi-bin/fulltext/106565596/PDFSTART)

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. [PMID 9385860]

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. [PMID 16697499] (FULL TEXT: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WCM-4JXY3HM-2&_user=839424&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000045367&_version=1&_urlVersion=0&_userid=839424&md5=acd2bb90f7f0a9cd2f7246206590aaa2)

Sarr MG. Appropriate use, complications and advantages demonstrated in 500 consecutive needle catheter jejunostomies. Br J Surg 1999; 86:557-61. [PMID 10215836] (FULL TEXT: http://www3.interscience.wiley.com/cgi-bin/fulltext/102521997/PDFSTART)

Southampton University Hospital. Southampton, United Kingdom
Published
2016-07-13
How to Cite
Abu-HilalM., HemandasA., McPhailM., JainG., PanagiotopoulouI., ScibelliT., JohnsonC., & PearceN. (2016). A Comparative Analysis of Safety and Efficacy of Different Methods of Tube Placement for Enteral Feeding Following Major Pancreatic Resection. A Non-Randomized Study. JOP. Journal of the Pancreas, 11(1), 8-13. https://doi.org/10.6092/1590-8577/3863
Section
ORIGINAL ARTICLES