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Clinical Nutrition

Nutrient intake and contribution of home enteral nutrition to meeting nutritional requirements after oesophagectomy and total gastrectomy

European Journal of Clinical Nutrition volume 71, pages 1121–1128 (2017)Cite this article

Subjects

Abstract

Background/Objectives:

This study evaluated nutrition after oesophago-gastric resection and the influence of home jejunostomy feeding in the six months after surgery.

Subjects/Methods:

Data on nutritional intake and physiologic measures were collected as part of a randomised trial with measurements taken before and up to six months after surgery.

Results:

A total of 41 participants (32 oesophagectomy, 9 total gastrectomy) received home jejunostomy feeding (n=18) or usual care without feeding (n=23). At hospital discharge, oral intakes were adequate for energy and protein in 9% and 6%, respectively. By three and six months, these values had increased to 61% and 55%, 94% and 77% respectively. Six participants (26%) who received usual care required rescue feeding. Six weeks after hospital discharge, energy intakes were met in those who received jejunal feeding because of the contribution of enteral nutrition. Jejunal feeding did not affect oral intake, being similar in both groups (fed: 77% estimated need, usual care: 79%). At three months, inadequate micronutrient intakes were seen in over one third. Compared to baseline values, six weeks after surgery, weight loss exceeding 5% was seen in 5/18 (28%) who received feeding, 14/17 (82%) who received usual care and 5/6 (83%) of those who required rescue feeding, P=0.002. Weight loss averaged 4.1% (fed), 10.4% (usual care) and 9.2% (rescue fed), P=0.004. These trends persisted out to six months.

Conclusions:

Supplementary jejunostomy feeding made an important contribution to meeting nutrition after oesophago-gastric resection. Importantly, oral nutritional intake was not compromised dispelling the assertion that jejunal feeding deincentivises patients from eating.

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Acknowledgements

Clinical Trials.Gov Reference # NCT01870817. UK Comprehensive Research Network Reference #12447

Author contributions

Conception and study design: MLB, VH, KS, DJB, PR. Analysis and interpretation: MLB, VH, KS, DJB, Drafting the paper: MLB, VH, DJB, Critically reviewed and approved submission: MLB, VH, KS, DJB, PR.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Leicester Hospitals NHS Trust, Leicester, UK

    M L Baker & D J Bowrey

  2. School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK

    V Halliday

  3. Home Enteral Nutrition Service, Leicestershire Partnership Trust, Leicester, UK

    P Robinson

  4. Department of Health Sciences, University of Leicester, Leicester, UK

    K Smith

  5. Department of Cancer Studies, University of Leicester, Leicester, UK

    D J Bowrey

Authors
  1. M L Baker
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  2. V Halliday
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  4. K Smith
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  5. D J Bowrey
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Corresponding author

Correspondence to M L Baker.

Ethics declarations

Competing interests

This article presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit Programme (Grant Reference Number PB-PG-0610-22480. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. DJB has received departmental funding support from Fresenius-Kabi for work unrelated to this submission. Some of the out of hospital costs associated with feeding and associated consumables were defrayed by Nutricia.

Additional information

Presented in part to (i) The Association of Upper Gastrointestinal Surgeons of Great Britain & Ireland 2014. Abstract published in British Journal of Surgery 2014;101(Suppl 6): 38, (ii) The British Association for Parenteral and Enteral Nutrition 2015. Abstract published in Gut 2015; 64(Suppl 1): A56-A57.

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Baker, M., Halliday, V., Robinson, P. et al. Nutrient intake and contribution of home enteral nutrition to meeting nutritional requirements after oesophagectomy and total gastrectomy. Eur J Clin Nutr 71, 1121–1128 (2017). https://doi.org/10.1038/ejcn.2017.88

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