Endoscopic placement of direct percutaneous jejunostomy tubes in patients with complications after esophagectomy.

BACKGROUND Complications after esophagectomy may prevent oral intake, lead to dependence on total parenteral nutrition, and lengthen hospital stay. Direct percutaneous endoscopic placement of a jejunostomy tube allows enteral feeding in the presence of postoperative complications and eliminates the need for total parenteral nutrition. METHODS A total parenteral nutrition database was used to identify patients who received total parenteral nutrition because of complications after esophagectomy. Records of all patients subsequently referred for percutaneous endoscopic jejunostomy placement were reviewed. RESULTS Twenty-five patients with postesophagectomy complications were referred for percutaneous endoscopic jejunostomy placement. A percutaneous endoscopic jejunostomy was successfully placed in 21 patients (84%), all of whom were weaned off total parenteral nutrition. Six patients (29%) in whom percutaneous endoscopic jejunostomy placement was successful died during hospitalization at a mean of 20 days (range 5-40 days) after the procedure for reasons unrelated to percutaneous endoscopic jejunostomy tube insertion. The remaining 15 patients were discharged while receiving nutrition by means of the percutaneous endoscopic jejunostomy. Ten of them had subsequent removal of the percutaneous endoscopic jejunostomy at a mean of 131 days (range 20-281 days). There were no major percutaneous endoscopic jejunostomy-related complications. Minor complications occurred in 4 patients (19%). CONCLUSION Percutaneous endoscopic jejunostomy placement may be considered in patients with complications after esophagectomy. In these patients, percutaneous endoscopic jejunostomy placement avoids the need for total parenteral nutrition.

[1]  H. Becker,et al.  Direct endoscopic percutaneous jejunostomy (EPJ) , 1994, Surgical Endoscopy.

[2]  P. D. De Leyn,et al.  Anastomotic Complications after Esophagectomy , 2002, Digestive Surgery.

[3]  S. Law,et al.  Analysis of Reduced Death and Complication Rates After Esophageal Resection , 2001, Annals of surgery.

[4]  M. Braga,et al.  Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition , 2001, Critical care medicine.

[5]  J. Macfie,et al.  Enteral versus parenteral nutrition: a pragmatic study. , 2001, Nutrition.

[6]  T. Baron,et al.  Results of direct percutaneous endoscopic jejunostomy, an alternative method for providing jejunal feeding. , 2000, Mayo Clinic proceedings.

[7]  D. Coppola,et al.  Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy. , 2000, Annals of surgery.

[8]  H. Yamamori,et al.  Modulating effects of the feeding route on stress response and endotoxin translocation in severely stressed patients receiving thoracic esophagectomy. , 2000, Nutrition.

[9]  S. Swanson,et al.  Esophagectomy after induction chemoradiation. , 1999, Chest.

[10]  M. Iannettoni,et al.  Transhiatal esophagectomy: clinical experience and refinements. , 1999, Annals of surgery.

[11]  M. Braga,et al.  Complications of Pancreatic Surgery and the Role of Perioperative Nutrition , 1999, Digestive Surgery.

[12]  J. Kirkpatrick,et al.  Prophylactic jejunostomy: a reappraisal. , 1998, Surgery.

[13]  M. Malone,et al.  Cost and outcome analysis of home parenteral and enteral nutrition. , 1998, JPEN. Journal of parenteral and enteral nutrition.

[14]  M. Shike,et al.  Direct percutaneous endoscopic jejunostomy. , 1998, Gastrointestinal endoscopy clinics of North America.

[15]  N. Tchekmedyian.  Pharmacoeconomics of nutritional support in cancer. , 1998, Seminars in oncology.

[16]  K. Kudsk,et al.  Nutritional Support and Infection: Does the Route Matter? , 1998, World Journal of Surgery.

[17]  M. Shike,et al.  Direct percutaneous endoscopic jejunostomies for enteral feeding. , 1996, Gastrointestinal Endoscopy.

[18]  P. Devitt,et al.  Enteral versus parenteral nutrition after oesophagogastric surgery: a prospective randomized comparison. , 1996, The Australian and New Zealand journal of surgery.

[19]  A. Zinsmeister,et al.  Utilization and outcomes of surgical gastrostomies and jejunostomies in an era of percutaneous endoscopic gastrostomy: a population-based study. , 1995, Mayo Clinic proceedings.

[20]  G. Minard.  Invited Review: Enteral Access , 1994 .

[21]  M. Orringer,et al.  Tube jejunostomy as an adjunct to esophagectomy. , 1994, Surgery.

[22]  R. Gorman,et al.  The button jejunostomy for long-term jejunal feeding: results of a prospective randomized trial. , 1993, JPEN. Journal of parenteral and enteral nutrition.

[23]  M. Shike,et al.  Direct percutaneous endoscopic jejunostomies. , 1991, Gastrointestinal endoscopy.

[24]  B. Lewis.  Perform PEJ, not PED. , 1990, Gastrointestinal endoscopy.

[25]  J. Murphy,et al.  Aspiration associated with long-term gastric versus jejunal feeding: a critical analysis of the literature. , 1990, Archives of physical medicine and rehabilitation.

[26]  M. Max,et al.  Feeding jejunostomy: a small bowel stress test? , 1988, American journal of surgery.

[27]  C. Lightdale,et al.  Percutaneous endoscopic jejunostomy in cancer patients with previous gastric resection. , 1987, Gastrointestinal endoscopy.

[28]  G. Seabrook,et al.  Jejunostomy. A rarely indicated procedure. , 1986, Archives of surgery.

[29]  E. Moore,et al.  Massive pneumatosis intestinalis and subcutaneous emphysema: complication of needle catheter jejunostomy. , 1983, JPEN. Journal of parenteral and enteral nutrition.

[30]  Torosian Mh,et al.  Feeding by tube enterostomy. , 1980 .