Elimination of Routine Feeding Jejeunostomy after Esophagectomy.

Abstract Background Feeding jejeunostomy is frequently utilised to ensure nutritional intake after esophagectomy. Early return to diet is demonstrated to enhance recovery in major abdominal surgery. Early oral feeding is safe and effective in recent randomised control trials in esophagectomy. This study assesses implications of eliminating insertion of jejeunostomy after esophagectomy. Methods A retrospective study was undertaken between 2014-2017 with follow up over the first year. 50 patients did not have a jejeunostomy compared to 46 patients who followed conventional practice. Outcomes measured included change in relative weight and body mass over one year, complications and nutritional reinterventions. Results Median weight loss at one year was 10.7kg (-8 to 55.6) while median percentage weight loss was 12% (-10.1% to 39.2%). Patients without jejeunostomy lost more weight during the first month (p=0.002). Thereafter, at 6/12months there were no differences in actual or relative weight loss. Obese patients lost more weight in the non jejeunostomy group compared to those with jejeunostomy (9.9kg vs 5kg, p=0.0040). This effect was not seen in normal or overweight patients. Complications were similar, whilst leaks were more common in the jejeunostomy group, 15.2 vs 2%, p=0.019. Nutritional reinterventions were similar during index admission and subsequent readmissions (7 vs. 5 patients, p=0.640). Conclusions Routine jejeunostomy use delays rather than prevents weight loss post-esophagectomy. Oral route nutrition allows patients to maintain sufficient nutrition and does not increase complications or requirement for nutritional interventions post-operatively. Routine use of jejeunostomy may not be required in modern practice.