Utility and outcomes of routine jejunostomy placement following oesophagectomy

Feeding jejunostomy (FJ) is used widely as a nutritional adjunct in oesophagectomy. However, FJ placement is also associated with additional morbidity. While FJ may be invaluable in some patients, particularly in those who suffer postoperative complications, it may be an avoidable source of distress and morbidity in others. This study aimed to assess the utility and outcomes of FJ in patients with uncomplicated recovery after oesophagectomy.

Outcomes for 100 consecutive patients who underwent oesophagectomy with uncomplicated recovery (Clavien-Dindo ≤2) were included from a prospectively maintained database. All had routine FJ placement. Demographic, disease, operative and clinical outcomes were analysed. Necessity of FJ usage (as assessed by specialist dietician) and complications were recorded. Differences between patients requiring postdischarge FJ use, and those who did not, were assessed.

Complete data for a total of 97 patients were included. Overall, only 9/97(9.3%) patients required ongoing FJ usage on discharge. No significant differences in demographics between two groups were observed. Postoperative complications were seen in 42/97(43.3%) patients, most commonly respiratory complications. FJ-related complications were recorded in 18/97(18.5%) patients, most commonly jejunostomy tube displacement.

The low rate of postoperative FJ usage and relatively high risk of associated complications suggests that a selective FJ placement strategy may have positive implications for patients over a routine placement strategy. No significant predictive factors for requiring postoperative FJ use were identified; work to define optimal feeding adjunct strategies in the postoperative context is needed.