Purpose: Following major upper gastrointestinal surgeries, patients often struggle to eat after discharge from hospital. Home jejunal feeding is a potential nutrition support method, but few studies have explored such practice. The aim of this study is to quantitatively and qualitatively assess the feasibility of home jejunal feeding. Methods: Thirteen people having had major upper gastrointestinal surgeries were recruited and randomised into one of two isocaloric nutrition support interventions; oral supplement (OS) or jejunal feeding (JF), for one month post-discharge at home. Anthropometric, patient-generated subjective global assessment, food intake and quality of life surveys were collected at baseline, one month and three months post-discharge. Qualitative interviews were conducted with 6 participants after the three month review. Results: No statistically significant baseline differences were found between the two groups. At one month post-discharge, median weight loss was found to be significantly greater in OS group compared to JF group, 7.7% (inter-quartile range (IQR) = 7.3) and 0.5% (IQR = 3.5) respectively (p = 0.035). No significant differences were found in other parameters. Qualitative interviews showed positive feelings towards JF, while OS was deemed as not very helpful. Conclusions: This preliminary research shows the use of home JF is feasible when compared to oral nutrition support. This parallels with the limited existing literature, which indicate that JF is clinically beneficial. Larger studies are required to validate clinical and quality of life outcomes.
KeywordsJejunal FeedingGastrectomyOesophagectomyNutritional SupportQualitative Research
Bragelmann, R., Armbrecht, U., Rosemeyer, D., Schneider, B., Zilly, W. and Stockbrugger, R.W. (1996) Nutrient Malassimilation Following Total Gastrectomy. Scandinavian Journal of Gastroenterology, 31, 26-33. https://doi.org/10.3109/00365529609094727
Haverkort, E.B., Binnekade, J.M., Busch, O.R.C., Henegouwen, M.I.V., de Haan, R.J. and Gouma, D.J. (2010) Presence and Persistence of Nutrition-Related Symptoms during the First Year Following Esophagectomy with Gastric Tube Reconstruction in Clinically Disease-Free Patients. World Journal of Surgery, 34, 2844-2852. https://doi.org/10.1007/s00268-010-0786-8
Carey, S., Storey, D., Biankin, A.V., Martin, D., Young, J. and Allman-Farinelli, M. (2011) Long Term Nutritional Status and Quality of Life Following Major Upper Gastrointestinal Surgery—A Cross-Sectional Study. Clinical Nutrition, 30, 774-779. https://doi.org/10.1016/j.clnu.2011.03.003
Haverkort, E.B., Binnekade, J.M., de Haan, R.J., Busch, O.R.C., Henegouwen, M.I.V. and Gouma, D.J. (2012) Suboptimal Intake of Nutrients after Esophagectomy with Gastric Tube Reconstruction. Journal of the Academy of Nutrition and Dietetics, 112, 1080-1087. https://doi.org/10.1016/j.jand.2012.03.032
Caro, M.M.M., Laviano, A. and Pichard, C. (2007) Impact of Nutrition on Quality of Life during Cancer. Current Opinion in Clinical Nutrition and Metabolic Care, 10, 480-487. https://doi.org/10.1097/MCO.0b013e3281e2c983
Martin, L., Lagergren, J., Lindblad, M., Rouvelas, I. and Lagergren, P. (2007) Malnutrition after Oesophageal Cancer Surgery in Sweden. British Journal of Surgery, 94, 1496-1500. https://doi.org/10.1002/bjs.5881
Elliott, J.A., Docherty, N.G., Eckhardt, H.G., Doyle, S.L., Guinan, E.M., Ravi, N., Reynolds, J.V. and le Roux, C.W. (2017) Weight Loss, Satiety, and the Postprandial Gut Hormone Response after Esophagectomy: A Prospective Study. Annals of Surgery, 266, 82-90. https://doi.org/10.1097/SLA.0000000000001918
Bae, J.M., Park, J.W., Yang, H.K. and Kim, J.P. (1998) Nutritional Status of Gastric Cancer Patients after Total Gastrectomy. World Journal of Surgery, 22, 254-261. https://doi.org/10.1007/s002689900379
Liedman, B., Andersson, H., Bosaeus, I., Hugosson, I. and Lundell, L. (1997) Changes in Body Composition after Gastrectomy: Results of a Controlled, Prospective Clinical Trial. World Journal of Surgery, 21, 416-421. https://doi.org/10.1007/PL00012264
Strong, V.E., Gholami, S., Shah, M.A., Tang, L.H., Janjigian, Y.Y., Schattner, M., Selby, L.V., Yoon, S.S., Salo-Mullen, E., Stadler, Z.K., Kelsen, D., Brennan, M.F. and Coit, D.G. (2017) Total Gastrectomy for Hereditary Diffuse Gastric Cancer at a Single Center: Postsurgical Outcomes in 41 Patients. Annals of Surgery, 266, 1006-1012. https://doi.org/10.1097/SLA.0000000000002030
Brenkman, H.J.F., Roelen, S.V.S., Steenhagen, E., Ruurda, J.P. and van Hillegersberg, R. (2017) Postoperative Complications and Weight Loss Following Jejunostomy Tube Feeding after Total Gastrectomy for Advanced Adenocarcinomas. Chinese Journal of Cancer Research, 29, 333-340. https://doi.org/10.21147/j.issn.1000-9604.2017.04.06
Barlow, R., Price, P., Reid, T.D., Hunt, S., Clark, G.W., Havard, T.J., Puntis, M.C. and Lewis, W.G. (2011) Prospective Multicentre Randomised Controlled Trial of Early Enteral Nutrition for Patients Undergoing Major Upper Gastrointestinal Surgical Resection. Clinical Nutrition, 30, 560-566. https://doi.org/10.1016/j.clnu.2011.02.006
Couper, G. (2011) Jejunostomy after Oesophagectomy: A Review of Evidence and Current Practice. Proceedings of the Nutrition Society, 70, 316-320. https://doi.org/10.1017/S0029665111000553
Carey, S., Laws, R., Ferrie, S., Young, J. and Allman-Farinelli, M. (2013) Struggling with Food and Eating-Life after Major Upper Gastrointestinal Surgery. Supportive Care in Cancer, 21, 2749-2757. https://doi.org/10.1007/s00520-013-1858-8
Baker, M.L., Halliday, V., Robinson, P., Smith, K. and Bowrey, D.J. (2017) Nutrient Intake and Contribution of Home Enteral Nutrition to Meeting Nutritional Requirements after Oesophagectomy and Total Gastrectomy. European Journal of Clinical Nutrition, 71, 1121-1128. https://doi.org/10.1038/ejcn.2017.88
Zeng, J., Hu, J., Chen, Q.X. and Feng, J.G. (2017) Home Enteral Nutrition’s Effects on Nutritional Status and Quality of Life after Esophagectomy. Asia Pacific Journal of Clinical Nutrition, 26, 804-810.
Wu, Z.X., Wu, M., Wang, Q., Zhan, T.W., Wang, L., Pan, S.B. and Chen, G. (2018) Home Enteral Nutrition after Minimally Invasive Esophagectomy Can Improve Quality of Life and Reduce the Risk of Malnutrition. Asia Pacific Journal of Clinical Nutrition, 27, 129-136.
Froghi, F., Sanders, G., Berrisford, R., Wheatley, T., Peyser, P., Rahamim, J. and Lewis, S. (2017) A Randomised Trial of Post-Discharge Enteral Feeding Following Surgical Resection of an Upper Gastrointestinal Malignancy. Clinical Nutrition, 36, 1516-1519. https://doi.org/10.1016/j.clnu.2016.10.022
Donohoe, C.L., Healy, L.A., Fanning, M., Doyle, S.L., Mc Hugh, A., Moore, J., Ravi, N. and Reynolds, J.V. (2017) Impact of Supplemental Home Enteral Feeding Post Esophagectomy on Nutrition, Body Composition, Quality of Life, and Patient Satisfaction. Diseases of the Esophagus, 30, 9. https://doi.org/10.1093/dote/dox063
Wani, M.L., Ahangar, A.G., Lone, G.N., Singh, S., Dar, A., Bhat, M.A., Lone, R.A. and Irshad, I. (2010) Feeding Jejunostomy: Does the Benefit Overweight the Risk? (A Retrospective Study from a Single Centre). International Journal of Surgery, 8, 387-390. https://doi.org/10.1016/j.ijsu.2010.05.009
Patel, S.H., Kooby, D.A., Staley, C.A. and Maithel, S.K. (2013) An Assessment of Feeding Jejunostomy Tube Placement at the Time of Resection for Gastric Adenocarcinoma. Journal of Surgical Oncology, 107, 728-734. https://doi.org/10.1002/jso.23324
Halliday, V., Baker, M., Thomas, A.L. and Bowrey, D. (2017) Patient and Family Caregivers’ Experiences of Living with a Jejunostomy Feeding Tube after Surgery for Esophagogastric Cancer. Journal of Parenteral and Enteral Nutrition, 41, 837-843. https://doi.org/10.1177/0148607115604114
Aaronson, N.K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N.J., Filiberti, A., Flechtner, H., Fleishman, S.B., de Haes, J.C., et al. (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: A Quality-of-Life Instrument for Use in International Clinical Trials in Oncology. Journal of the National Cancer Institute, 85, 365-376. https://doi.org/10.1093/jnci/85.5.365
Fayers, P.M., Aaronson, N. and Bjordal, K. (2001) EORTC QLQ-C30 Scoring Manual. 2nd Edition, European Organization for Research and Treatment of Cancer, Brussels.
Braun, V. and Clarke, V. (2006) Using Thematic Analysis in Psychology. Qualitative Research in Psychology, 3, 77-101. https://doi.org/10.1191/1478088706qp063oa
Guba, E.G. (1981) Criteria for Assessing the Trustworthiness of Naturalistic Inquiries. ECTJ, 29, 75.
Gavizzi, C., Colatruglio, S., Valoriani, F., Mazzaferro, V., Sabbatini, A., Biffi, R., Mariani, L. and Miceli, R. (2010) Impact of Home Enteral Nutrition in Malnourised Patients with Upper Gastrointestinal Cancer: A Multicentre Randomised Clinical Trial. European Journal of Cancer, 64, 107-112. https://doi.org/10.1016/j.ejca.2016.05.032
Bowrey, D.J., Baker, M., Halliday, V., Thomas, A.L., Pulikottil-Jacob, R., Smith, K., Morris, T. and Ring, A. (2015) A Randomised Controlled Trial of Six Weeks of Home Enteral Nutrition versus Standard Care after Oesophagectomy or Total Gastrectomy for Cancer: Report on a Pilot and Feasibility Study. Trials, 16, 531. https://doi.org/10.1186/s13063-015-1053-y