EJCTS Click here for details of sales representative
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Sanjay Sharma
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Pramesh, C.S.
Right arrow Articles by Sharma, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pramesh, C.S.
Right arrow Articles by Sharma, S.
Related Collections
Right arrow Esophagus - cancer
Right arrow Esophagus - other

Eur J Cardiothorac Surg 2003;23:648-649
© 2003 Elsevier Science NL

Letter to the Editor

Enteral feeding access with feeding jejunostomy is advisable after esophagectomy

C.S. Pramesh*, Rajesh C. Mistry, Ramakant K. Deshpande, Sanjay Sharma

Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai 400012, India

Received 28 December 2002; accepted 3 January 2003.

* Corresponding author. Tel.: +91-22-24177000; fax: +91-22-24146937
e-mail: cspramesh{at}vsnl.net

Key Words: Feeding jejunostomy • Enteral feeding • Esophagectomy

We read with interest the article by Page et al. [1] on a randomized comparison between intravenous hydration and naso-jejunal enteral feeding after esophagectomy. We take exception to the conclusions drawn on two counts. Firstly, the number of patients enrolled for the study is too small to detect any difference between intravenous hydration and enteral feeding. The expected differences, the power of the study and the basis of sample-size calculation are not explained. Randomizing 40 patients into two groups would be inadequate regardless of the expected benefit. The power of the study to detect even a 10% difference between the two groups would be less than 25%.

Besides being methodologically and statistically flawed, the study is also conceptually difficult to understand. The rationale of enteral feeding after major surgery is not only for nutritional reasons, and the major benefit of enteral feeding is seen in patients with complications after esophagectomy. Extrapolating the results of a small cohort of patients with no significant postoperative complications on a much larger and heterogeneous group of patients undergoing esophagectomy (often with significant complications including anastomotic leaks) is erroneous. In patients with anastomotic leaks, for example, prolonged avoidance of oral feeding is mandatory. We routinely perform a feeding jejunostomy after esophagectomy and have had less than 2% procedure-related complications in over 800 patients over the last 5 years. Randomized and observational studies have confirmed these low complication rates [2,3]. We have found a feeding jejunostomy to be invaluable in patients with a complicated postoperative course in whom resumption of oral feeds is delayed. The feeding jejunostomy was used in all patients in the immediate postoperative period, for more than 3 weeks in 11%, and for more than 2 months in 6.9% among 523 patients studied by Orringer's group [2]. They also had a 2.1% complication rate and zero jejunostomy-related mortality. Though a naso-jejunal tube is an alternative to a feeding jejunostomy, its use over a prolonged period would be uncomfortable for the patient. We therefore recommend a routine feeding jejunostomy for all patients undergoing esophagectomy.

References

  1. Page R.D., Oo A.Y., Russell G.N., Pennefather S.H. Intravenous hydration versus naso-jejunal feeding after esophagectomy: a randomized study. Eur J Cardiothorac Surg 2002;22:666-672.[Abstract/Free Full Text]
  2. Gerndt S.J., Orringer M.B. Tube jejunostomy as an adjunct to esophagectomy. Surgery 1994;115:164-169.[Medline]
  3. Baigrie R.J., Devitt P.G., Watkin D.S. Enteral versus parenteral nutrition after esophagogastric surgery: a prospective randomized comparison. Aust N Z Surg 1996;66:668-670.




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Sanjay Sharma
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Pramesh, C.S.
Right arrow Articles by Sharma, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pramesh, C.S.
Right arrow Articles by Sharma, S.
Related Collections
Right arrow Esophagus - cancer
Right arrow Esophagus - other

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS