Feeding Duodenostomy Decreases the Incidence of Mechanical Obstruction After Radical Esophageal Cancer Surgery

• Published in: World journal of surgery Vol. 39; no. 5; pp. 1105 - 1110
• Main Authors: Oya, Hisaharu, Koike, Masahiko, Iwata, Naoki, Kobayashi, Daisuke, Torii, Koji, Niwa, Yukiko, Kanda, Mitsuro, Tanaka, Chie, Yamada, Suguru, Fujii, Tsutomu, Nakayama, Goro, Sugimoto, Hiroyuki, Nomoto, Shuji, Fujiwara, Michitaka, Kodera, Yasuhiro
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-05-2015; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Anastomosis, Surgical; Carcinoma, Squamous Cell - surgery; Cardiac Surgery; Catheter-Related Infections - etiology; Catheters, Indwelling - adverse effects; Duodenostomy - adverse effects; Duodenostomy - methods; Enteral Feeding; Enteral Nutrition; Enteral Nutrition - adverse effects; Enteral Nutrition - methods; Equipment Failure; Esophageal Cancer; Esophageal Neoplasms - surgery; Esophagectomy - adverse effects; Female; Gastric Tube; General Surgery; Humans; Intestinal Obstruction - etiology; Intestinal Obstruction - surgery; Jejunostomy - adverse effects; Male; Mechanical Obstruction; Medicine; Medicine & Public Health; Middle Aged; Original Scientific Report; Peritonitis - etiology; Retrospective Studies; Surgery; Thoracic Surgery; Vascular Surgery; Gastric Tube; Esophageal Cancer; Enteral Nutrition; Mechanical Obstruction; Enteral Feeding
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-015-2952-5

Background
Nutritional support influences the outcome of gastroenterological surgery, and enteral nutrition effectively mitigates postoperative complications in highly invasive surgery such as resection of esophageal cancer. However, feeding via jejunostomy can cause complications including mechanical obstruction, which could be life threatening. From 2009, we began enteral feeding via duodenostomy to reduce the likelihood of complications. In this study, we compared duodenostomy with the conventional jejunostomy feeding, mainly looking at the catheter-related complications.
Methods
The database records of 378 patients with esophageal cancer who underwent radical esophagectomy with retrosternal or posterior mediastinal gastric tube reconstruction in our department from January 1998 to December 2012 were examined. Of the 378 patients, 111 underwent feeding via duodenostomy (FD) and 267 underwent feeding via jejunostomy (FJ), and their records were reviewed for the following catheter-related complications: site infection, dislodgement, peritonitis, and mechanical obstruction.
Results
Mechanical obstruction occurred in 12 patients in the FJ group but none in the FD group (4.5 % vs. 0 %,
P
 = 0.023). Of the 12 cases, 7 (58.3 %) required surgery of which 2 had bowel resection due to strangulated mechanical obstruction. Catheter site infection was seen in 14 cases in the FJ group, of which 2 (14.2 %) had peritonitis following catheter dislocation, while only one case of site infection was seen in the FD group (5.2 % vs. 0.9 %,
P
 = 0.078).
Conclusions
Feeding via duodenectomy could be the procedure of choice since neither mechanical obstruction nor relaparotomy was seen during enteral feeding through this technique.