Early Enteral Nutrition Via Feeding Jejunostomy Following Major Upper Gastrointestinal SURGERY - A Prospective Observational Study

Abstract

Background: Major upper gastrointestinal (UGI) operations are frequently followed by a period of reduced oral intake and increased nutritional demand. When adequate oral feeding is not expected, early enteral nutrition can provide nutritional support while maintaining gastrointestinal feeding. Feeding jejunostomy offers a post-pyloric route, although its invasive nature and access-related complications require careful patient selection.

Methods: This prospective observational study included 50 adult patients undergoing elective major UGI surgery-esophagectomy, gastrectomy, or pancreaticoduodenectomy-with an intraoperative feeding jejunostomy. Enteral feeding was commenced within 24–48 hours after surgery when the patient was clinically stable. The principal outcomes were successful establishment of early enteral feeding and feeding jejunostomy-related complications. Postoperative hospital stay, return of bowel function, and jejunostomy-attributable mortality were assessed as secondary outcomes.

Results: Early enteral feeding was successfully established in 42 of 50 patients (84.0%). Eight patients (16.0%) did not meet the predefined early-feeding endpoint. Feeding jejunostomy-related complications occurred in 8 patients (16.0%); tube blockage and local site infection were the predominant reported problems. All reported complications were managed conservatively. No bowel perforation, peritonitis, or jejunostomy-related reoperation occurred. Mean postoperative hospital stay was 10.2 ± 2.2 days. No mortality was attributed to the feeding jejunostomy.

Conclusion: In this prospective single-arm cohort, early enteral nutrition through feeding jejunostomy could be established in most patients after major UGI surgery. The observed complications were predominantly minor, although the procedure is not risk-free. Because there was no comparator group, the study demonstrates feasibility and describes safety outcomes but cannot establish a causal reduction in postoperative morbidity or hospital stay.