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A comparative analysis of safety and efficacy of different methods of tube placement for enteral feeding following major pancreatic resection. A non-randomized study

A comparative analysis of safety and efficacy of different methods of tube placement for enteral feeding following major pancreatic resection. A non-randomized study
A comparative analysis of safety and efficacy of different methods of tube placement for enteral feeding following major pancreatic resection. A non-randomized study
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
1590-8577
8-13
Abu-Hilal, Mohammad
384e1c60-8519-4eed-8e92-91775aad4c47
Hemandas, Anil K.
d7bc1d18-0735-44ef-a8ce-961cf0fe7b28
McPhail, Mark
eeabbc1a-0099-4483-a118-981de0ed11ae
Jain, Gaurav
480918b2-3227-446a-b1f4-53a17e948c3f
Panagiotopoulou, Ionna
4eec55aa-f486-496c-b2db-417583823a3f
Scibelli, Tina
8ad442fb-437a-425a-9136-4f2a8806bf1f
Johnson, Colin D.
e50aa9cd-8c61-4fe3-a0b3-f51cc3a6c74a
Pearce, Neil W.
6e450393-03db-472b-9231-1aa2e39b0565
Abu-Hilal, Mohammad
384e1c60-8519-4eed-8e92-91775aad4c47
Hemandas, Anil K.
d7bc1d18-0735-44ef-a8ce-961cf0fe7b28
McPhail, Mark
eeabbc1a-0099-4483-a118-981de0ed11ae
Jain, Gaurav
480918b2-3227-446a-b1f4-53a17e948c3f
Panagiotopoulou, Ionna
4eec55aa-f486-496c-b2db-417583823a3f
Scibelli, Tina
8ad442fb-437a-425a-9136-4f2a8806bf1f
Johnson, Colin D.
e50aa9cd-8c61-4fe3-a0b3-f51cc3a6c74a
Pearce, Neil W.
6e450393-03db-472b-9231-1aa2e39b0565

Abu-Hilal, Mohammad, Hemandas, Anil K., McPhail, Mark, Jain, Gaurav, Panagiotopoulou, Ionna, Scibelli, Tina, Johnson, Colin D. and Pearce, Neil W. (2010) 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.

Record type: Article

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

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Published date: 8 January 2010

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Local EPrints ID: 72815
URI: http://eprints.soton.ac.uk/id/eprint/72815
ISSN: 1590-8577
PURE UUID: b08d8ba9-00a6-4f5e-b2aa-ceb8ac531c30

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Date deposited: 23 Feb 2010
Last modified: 07 Jan 2022 23:42

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Contributors

Author: Mohammad Abu-Hilal
Author: Anil K. Hemandas
Author: Mark McPhail
Author: Gaurav Jain
Author: Ionna Panagiotopoulou
Author: Tina Scibelli
Author: Neil W. Pearce

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