Background

Many surgeons preferably place a trans-nasal feeding tube or a feeding enterostomy for post-operative nutritional management after esophagectomy. Various types of tubes (such as nasogastric, transgastric, transduodenal, or transjejunal tubes) have been used for enteral feeding; however, the appropriate enteral feeding routes have not yet been proposed. Therefore, this study aimed to evaluate the feasibility and safety of button-type jejunostomy.

Methods

We reviewed 201 patients who underwent esophagectomy with placement of a button-type jejunostomy at the Jikei University Hospital (Tokyo, Japan) between 2008 and 2019. The analyzed variables included clinicopathological characteristics, operative data, jejunostomy-related characteristics, and postoperative complications. Postoperative bodyweight loss was examined 6 months and 1 year after the operation.

Results

Refractory enterocutaneous fistula and bowel obstruction occurred in 13 (6.5%) and 14 (7.0%) patients, respectively. The body mass index at button-type jejunostomy removal was significantly lower and the duration of button-type jejunostomy placement was significantly longer in patients with a refractory enterocutaneous fistula (p = 0.023 and p < 0.001, respectively). Bowel obstruction was significantly more likely to develop in patients with a non-squamous cell carcinoma (p = 0.021) and in patients who underwent open abdominal procedures (p < 0.001). After 1 year, the median bodyweight losses were 12.1% and 15.6% in patients with short and long jejunostomy placement durations (p = 0.642), respectively.

Conclusion

A button-type jejunostomy is durable and allows easy self-management for maintaining the bodyweight without any adverse events. However, it is strongly recommended that the button be removed within a year to prevent refractory enterocutaneous fistula formation.

中文翻译：

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纽扣式空肠造口术201例食管切除术后营养管理评价

背景

许多外科医生更喜欢放置经鼻饲管或饲喂肠造口术，用于食管切除术后的术后营养管理。各种类型的管子（如鼻胃管、经胃管、经十二指肠管或经空肠管）已被用于肠内喂养；然而，尚未提出适当的肠内喂养途径。因此，本研究旨在评估纽扣式空肠造口术的可行性和安全性。

方法

我们回顾了 2008 年至 2019 年在滋庆大学医院（日本东京）接受食管切除术和纽扣式空肠造口术的患者。 分析的变量包括临床病理特征、手术数据、空肠造口术相关特征和术后并发症。术后 6 个月和 1 年检查术后体重减轻情况。

结果

分别有 13 名 (6.5%) 和 14 名 (7.0%) 患者发生难治性肠皮瘘和肠梗阻。在难治性肠皮瘘患者中，纽扣式空肠造口术移除时的体重指数显着降低，纽扣式空肠造口术放置的持续时间显着延长（分别为p  = 0.023 和p  < 0.001）。非鳞状细胞癌患者 ( p  = 0.021) 和接受开腹手术的患者 ( p  < 0.001)更容易发生肠梗阻。1 年后，空肠造口术放置时间短和长的患者的体重减轻中位数分别为 12.1% 和 15.6% ( p  = 0.642)。

结论

纽扣式空肠造口术经久耐用，可以轻松自我管理以保持体重，而不会出现任何不良事件。然而，强烈建议在一年内移除按钮以防止难治性肠皮瘘形成。