Efficacy and safety of enteral nutrition with jejunostomy tube versus nasojejunal tube after radical resection of esophageal cancer: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

BAI Xiangdou ¹ , ZENG Weiqiang ¹ , CUI Baiqiang ¹ , YANG Ning ¹ , HE Xiaoyang ¹ , ZHANG Siyuan ¹ , JIN Dacheng ² ,  GOU Yunjiu ^1,2

1. The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
2. Department of Thoracic Surgery, The Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;

Corresponding author：

GOU Yunjiu, Email: gouyunjiu@163.com

Keywords：

Jejunostomy; nasojejunal tube; radical resection of esophageal cancer; enteral nutrition; curative effects; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202111015

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically evaluate the efficacy and safety of jejunostomy tube versus nasojejunal tube for enteral nutrition after radical resection of esophageal cancer. Methods PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP and CBM databases were searched to collect the clinical effects of jejunostomy tube versus nasojejunal nutrition tube after radical resection of esophageal cancer from inception to October 2021. Meta-analysis was performed using RevMan 5.4 software. Results Twenty-six articles were included, including 17 randomized controlled studies and 9 cohort studies, with a total of 35 808 patients. Meta-analysis results showed that: in the jejunostomy tube group, the postoperative exhaust time (MD=–4.27, 95%CI –5.87 to –2.66, P=0.001), the incidence of pulmonary infection (OR=1.39, 95%CI 1.06 to 1.82, P=0.02), incidence of tube removal (OR=0.11, 95%CI 0.04 to 0.30, P=0.001), incidence of tube blockage (OR=0.47, 95%CI 0.23 to 0.97, P=0.04), incidence of nasopharyngeal discomfort (OR=0.04, 95%CI 0.01 to 0.13, P=0.001), the incidence of nasopharyngeal mucosal damage (OR=0.13, 95%CI 0.04 to 0.42, P=0.008), the incidence of nausea and vomiting (OR=0.20, 95%CI 0.08 to 0.47, P=0.003) were significantly shorter or lower than those of the nasojejunal tube group. The postoperative serum albumin level (MD=5.75, 95%CI 5.34 to 6.16, P=0.001) was significantly better than that of the nasojejunal tube group. However, the intraoperative operation time of the jejunostomy tube group (MD=13.65, 95%CI 2.32 to 24.98, P=0.02) and the indent time of the postoperative nutrition tube (MD=17.81, 95%CI 12.71 to 22.91, P=0.001) were longer than those of the nasojejunal nutrition tube. At the same time, the incidence of postoperative intestinal obstruction (OR=6.08, 95%CI 2.55 to 14.50, P=0.001) was significantly higher than that of the nasojejunal tube group. There were no statistical differences in the length of postoperative hospital stay or the occurrence of anastomotic fistula between the two groups (P>0.05). Conclusion In the process of enteral nutrition after radical resection of esophageal cancer, jejunostomy tube has better clinical treatment effect and is more comfortable during catheterization, but the incidence of intestinal obstruction is higher than that of traditional nasojejunal tube.

Citation： BAI Xiangdou, ZENG Weiqiang, CUI Baiqiang, YANG Ning, HE Xiaoyang, ZHANG Siyuan, JIN Dacheng, GOU Yunjiu. Efficacy and safety of enteral nutrition with jejunostomy tube versus nasojejunal tube after radical resection of esophageal cancer: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1475-1482. doi: 10.7507/1007-4848.202111015 Copy

1.	Thrift AP. Global burden and epidemiology of Barrett oesophagus and oesophageal cancer. Nat Rev Gastroenterol Hepatol, 2021, 18(6): 432-443.
2.	刘宗超, 李哲轩, 张阳, 等. 2020全球癌症统计报告解读. 肿瘤综合治疗电子杂志, 2021, 7(2): 1-13.
3.	Watanabe M, Otake R, Kozuki R, et al. Correction to: Recent progress in multidisciplinary treatment for patients with esophageal cancer. Surg Today, 2020, 50(4): 425.
4.	Li PF, Wang YL, Fang YL, et al. Effect of early enteral nutrition on outcomes of trauma patients requiring intensive care. Chin J Traumatol, 2020, 23(3): 163-167.
5.	Palm NM, McKinzie B, Ferguson PL, et al. Pharmacologic stress gastropathy prophylaxis may not be necessary in at-risk surgical trauma ICU patients tolerating enteral nutrition. J Intensive Care Med, 2018, 33(7): 424-429.
6.	Roveron G, Antonini M, Barbierato M, et al. Clinical practice guidelines for the nursing management of percutaneous endoscopic gastrostomy and jejunostomy (PEG/PEJ) in adult patients: An executive summary. J Wound Ostomy Continence Nurs, 2018, 45(4): 326-334.
7.	徐琛, 陶夏, 蒋莉, 等. 空肠造瘘术联合Ivor-Lewis或McKeown术治疗中下段食管癌效果评价的回顾性队列研究. 中国胸心血管外科临床杂志, 2021, 28(10): 1216-1221.
8.	Holmén A, Hayami M, Szabo E, et al. Nutritional jejunostomy in esophagectomy for cancer, a national register-based cohort study of associations with postoperative outcomes and survival. Langenbecks Arch Surg, 2021, 406(5): 1415-1423.
9.	Koterazawa Y, Oshikiri T, Hasegawa H, et al. Routine placement of feeding jejunostomy tube during esophagectomy increases postoperative complications and does not improve postoperative malnutrition. Dis Esophagus, 2020, 33(1): doz021.
10.	Klevebro F, Johar A, Lagergren J, et al. Outcomes of nutritional jejunostomy in the curative treatment of esophageal cancer. Dis Esophagus, 2019, 32(7): doy113.
11.	Zhuang W, Wu H, Liu H, et al. Utility of feeding jejunostomy in patients with esophageal cancer undergoing esophagectomy with a high risk of anastomotic leakage. J Gastrointest Oncol, 2021, 12(2): 433-445.
12.	Akiyama Y, Iwaya T, Endo F, et al. Evaluation of the need for routine feeding jejunostomy for enteral nutrition after esophagectomy. J Thorac Dis, 2018, 10(12): 6854-6862.
13.	Gong L, Yan B, Chen Y, et al. Alternative method for jejunostomy in Ivor-Lewis esophagectomy. Thorac Cancer, 2015, 6(3): 296-302.
14.	Jenkins TK, Lopez AN, Sarosi GA, et al. Preoperative enteral access is not necessary prior to multimodality treatment of esophageal cancer. Surgery, 2018, 163(4): 770-776.
15.	Watson M, Trufan S, Benbow JH, et al. Jejunostomy at the time of esophagectomy is associated with improved short-term perioperative outcomes: Analysis of the NSQIP database. J Gastrointest Oncol, 2020, 11(2): 421-430.
16.	Zheng R, Rios-Diaz AJ, Liem S, et al. Is the placement of jejunostomy tubes in patients with esophageal cancer undergoing esophagectomy associated with increased inpatient healthcare utilization? An analysis of the National Readmissions Database. Am J Surg, 2021, 221(1): 141-148.
17.	陆超敬, 杨立信, 陈和忠, 等. CORFLO营养管在胸腔镜Ivor Lewis食管癌及贲门癌根治术中的应用. 中国胸心血管外科临床杂志, 2016, 23(12): 1154-1157.
18.	秦苗苗. 比较空肠造瘘营养管与鼻空肠营养管行肠内营养在食管癌根治术后的护理效果. 世界最新医学信息文摘, 2016, 16(65): 317, 333.
19.	吕爱霞, 蔡晓慧. 比较空肠造瘘营养管与鼻空肠营养管行肠内营养在食管癌根治术后的治疗效果. 世界最新医学信息文摘, 2016, 16(40): 41-42.
20.	张丹丹, 陈红, 陈圆圆, 等. 改良空肠造瘘在食管癌术后的应用和护理体会. 中西医结合护理(中英文), 2016, 2(12): 90-91, 94.
21.	葛凌霞. 经空肠造瘘营养管对接受食管癌根治术的患者进行肠内营养支持的效果. 当代医药论丛, 2018, 16(21): 22-23.
22.	刘晓青. 经皮置入空肠造瘘管在食管癌术后家庭照护中的应用. 结直肠肛门外科, 2018, 24(S2): 98-99.
23.	章靓, 徐邦英, 郭文霞, 等. 空肠造瘘管与鼻肠管在胸腹腔镜联合食管癌手术患者肠内营养应用的效果比较. 中华现代护理杂志, 2017, 23(11): 1482-1485.
24.	刘军. 空肠造瘘营养管与鼻空肠营养管在食管癌根治术中的应用. 中西医结合心血管病电子杂志, 2017, 5(36): 60-61.
25.	赵松, 吴彬, 齐宇, 等. 空肠造瘘营养管与鼻空肠营养管在食管癌根治术中的应用. 中国老年学杂志, 2014, 34(10): 2740-2741.
26.	胡颜江, 陈曦, 杨纯杰, 等. 空肠造瘘营养管与鼻空肠营养管在食管癌根治术中的应用对比分析. 现代诊断与治疗, 2015, 26(23): 5352-5353.
27.	潘安娜, 张志敏, 王锦寅. 空肠造瘘营养管与鼻空肠营养管在食管癌根治术中的应用效果比较. 中国医药科学, 2019, 9(22): 206-209.
28.	王侦伟, 杨景先, 陈晓峰. 空肠造瘘营养管与鼻空肠营养管在食管癌根治术中的应用效果比较. 白求恩医学杂志, 2015, 13(6): 646-647.
29.	樊友强. 空肠造瘘与鼻饲营养在食管癌术后肠内营养中的应用比较. 淮海医药, 2019, 37(5): 483-485.
30.	陆小月, 羌燕, 李晓旭, 等. 两种不同肠内营养管置管法在食管癌术后营养治疗中的应用观察. 中国肿瘤外科杂志, 2017, 9(6): 405-407.
31.	张满, 靳智勇, 王宇飞, 等. 食管癌Ivor-Lewis术中营养管置入新方法的评价. 中华胸部外科电子杂志, 2018, 5(2): 91-95.
32.	崔爱芝, 王爱华. 食管癌术后不同途径肠内营养效果的比较. 当代护士(下旬刊), 2013, (12): 43-44.
33.	张玉丽, 林青. 食管癌术后不同途径肠内营养效果的比较. 中国实用医药, 2010, 5(1): 60-61.
34.	杨刚华, 张雷, 王林, 等. Ivor-Lewis术式与Sweet术式治疗胸段食管癌的疗效比较. 现代肿瘤医学, 2021, 29(24): 4328-4332.
35.	Hirahara N, Matsubara T, Kaji S, et al. A safe and simple technique for nasogastric tube insertion in patients with thoracic esophageal cancer surgery. World J Surg Oncol, 2021, 19(1): 317.
36.	Watanabe M, Otake R, Kozuki R, et al. Recent progress in multidisciplinary treatment for patients with esophageal cancer. Surg Today, 2020, 50(1): 12-20.
37.	陈浩, 白利君, 张扬. 肠内营养联合数字减影血管造影引导下经皮胃造瘘术对食管癌伴吞咽困难患者营养状态的影响. 中国临床医生杂志, 2021, 49(10): 1207-1209.
38.	施庆彤, 刁亚利, 姚光怀. 鼻饲流质对改善食管癌患者术后营养状况和胃肠道耐受性的作用. 中华胸部外科电子杂志, 2017, 4(2): 87-91.
39.	Choi AH, O'Leary MP, Merchant SJ, et al. Complications of feeding jejunostomy tubes in patients with gastroesophageal cancer. J Gastrointest Surg, 2017, 21(2): 259-265.
40.	Blakely AM, Ajmal S, Sargent RE, et al. Critical analysis of feeding jejunostomy following resection of upper gastrointestinal malignancies. World J Gastrointest Surg, 2017, 9(2): 53-60.
41.	Shen X, Zhuo ZG, Li G, et al. Is the routine placement of a feeding jejunostomy during esophagectomy worthwhile?—A systematic review and meta-analysis. Ann Palliat Med, 2021, 10(4): 4232-4241.

1. Thrift AP. Global burden and epidemiology of Barrett oesophagus and oesophageal cancer. Nat Rev Gastroenterol Hepatol, 2021, 18(6): 432-443.
2. 刘宗超, 李哲轩, 张阳, 等. 2020全球癌症统计报告解读. 肿瘤综合治疗电子杂志, 2021, 7(2): 1-13.
3. Watanabe M, Otake R, Kozuki R, et al. Correction to: Recent progress in multidisciplinary treatment for patients with esophageal cancer. Surg Today, 2020, 50(4): 425.
4. Li PF, Wang YL, Fang YL, et al. Effect of early enteral nutrition on outcomes of trauma patients requiring intensive care. Chin J Traumatol, 2020, 23(3): 163-167.
5. Palm NM, McKinzie B, Ferguson PL, et al. Pharmacologic stress gastropathy prophylaxis may not be necessary in at-risk surgical trauma ICU patients tolerating enteral nutrition. J Intensive Care Med, 2018, 33(7): 424-429.
6. Roveron G, Antonini M, Barbierato M, et al. Clinical practice guidelines for the nursing management of percutaneous endoscopic gastrostomy and jejunostomy (PEG/PEJ) in adult patients: An executive summary. J Wound Ostomy Continence Nurs, 2018, 45(4): 326-334.
7. 徐琛, 陶夏, 蒋莉, 等. 空肠造瘘术联合Ivor-Lewis或McKeown术治疗中下段食管癌效果评价的回顾性队列研究. 中国胸心血管外科临床杂志, 2021, 28(10): 1216-1221.
8. Holmén A, Hayami M, Szabo E, et al. Nutritional jejunostomy in esophagectomy for cancer, a national register-based cohort study of associations with postoperative outcomes and survival. Langenbecks Arch Surg, 2021, 406(5): 1415-1423.
9. Koterazawa Y, Oshikiri T, Hasegawa H, et al. Routine placement of feeding jejunostomy tube during esophagectomy increases postoperative complications and does not improve postoperative malnutrition. Dis Esophagus, 2020, 33(1): doz021.
10. Klevebro F, Johar A, Lagergren J, et al. Outcomes of nutritional jejunostomy in the curative treatment of esophageal cancer. Dis Esophagus, 2019, 32(7): doy113.
11. Zhuang W, Wu H, Liu H, et al. Utility of feeding jejunostomy in patients with esophageal cancer undergoing esophagectomy with a high risk of anastomotic leakage. J Gastrointest Oncol, 2021, 12(2): 433-445.
12. Akiyama Y, Iwaya T, Endo F, et al. Evaluation of the need for routine feeding jejunostomy for enteral nutrition after esophagectomy. J Thorac Dis, 2018, 10(12): 6854-6862.
13. Gong L, Yan B, Chen Y, et al. Alternative method for jejunostomy in Ivor-Lewis esophagectomy. Thorac Cancer, 2015, 6(3): 296-302.
14. Jenkins TK, Lopez AN, Sarosi GA, et al. Preoperative enteral access is not necessary prior to multimodality treatment of esophageal cancer. Surgery, 2018, 163(4): 770-776.
15. Watson M, Trufan S, Benbow JH, et al. Jejunostomy at the time of esophagectomy is associated with improved short-term perioperative outcomes: Analysis of the NSQIP database. J Gastrointest Oncol, 2020, 11(2): 421-430.
16. Zheng R, Rios-Diaz AJ, Liem S, et al. Is the placement of jejunostomy tubes in patients with esophageal cancer undergoing esophagectomy associated with increased inpatient healthcare utilization? An analysis of the National Readmissions Database. Am J Surg, 2021, 221(1): 141-148.
17. 陆超敬, 杨立信, 陈和忠, 等. CORFLO营养管在胸腔镜Ivor Lewis食管癌及贲门癌根治术中的应用. 中国胸心血管外科临床杂志, 2016, 23(12): 1154-1157.
18. 秦苗苗. 比较空肠造瘘营养管与鼻空肠营养管行肠内营养在食管癌根治术后的护理效果. 世界最新医学信息文摘, 2016, 16(65): 317, 333.
19. 吕爱霞, 蔡晓慧. 比较空肠造瘘营养管与鼻空肠营养管行肠内营养在食管癌根治术后的治疗效果. 世界最新医学信息文摘, 2016, 16(40): 41-42.
20. 张丹丹, 陈红, 陈圆圆, 等. 改良空肠造瘘在食管癌术后的应用和护理体会. 中西医结合护理(中英文), 2016, 2(12): 90-91, 94.
21. 葛凌霞. 经空肠造瘘营养管对接受食管癌根治术的患者进行肠内营养支持的效果. 当代医药论丛, 2018, 16(21): 22-23.
22. 刘晓青. 经皮置入空肠造瘘管在食管癌术后家庭照护中的应用. 结直肠肛门外科, 2018, 24(S2): 98-99.
23. 章靓, 徐邦英, 郭文霞, 等. 空肠造瘘管与鼻肠管在胸腹腔镜联合食管癌手术患者肠内营养应用的效果比较. 中华现代护理杂志, 2017, 23(11): 1482-1485.
24. 刘军. 空肠造瘘营养管与鼻空肠营养管在食管癌根治术中的应用. 中西医结合心血管病电子杂志, 2017, 5(36): 60-61.
25. 赵松, 吴彬, 齐宇, 等. 空肠造瘘营养管与鼻空肠营养管在食管癌根治术中的应用. 中国老年学杂志, 2014, 34(10): 2740-2741.
26. 胡颜江, 陈曦, 杨纯杰, 等. 空肠造瘘营养管与鼻空肠营养管在食管癌根治术中的应用对比分析. 现代诊断与治疗, 2015, 26(23): 5352-5353.
27. 潘安娜, 张志敏, 王锦寅. 空肠造瘘营养管与鼻空肠营养管在食管癌根治术中的应用效果比较. 中国医药科学, 2019, 9(22): 206-209.
28. 王侦伟, 杨景先, 陈晓峰. 空肠造瘘营养管与鼻空肠营养管在食管癌根治术中的应用效果比较. 白求恩医学杂志, 2015, 13(6): 646-647.
29. 樊友强. 空肠造瘘与鼻饲营养在食管癌术后肠内营养中的应用比较. 淮海医药, 2019, 37(5): 483-485.
30. 陆小月, 羌燕, 李晓旭, 等. 两种不同肠内营养管置管法在食管癌术后营养治疗中的应用观察. 中国肿瘤外科杂志, 2017, 9(6): 405-407.
31. 张满, 靳智勇, 王宇飞, 等. 食管癌Ivor-Lewis术中营养管置入新方法的评价. 中华胸部外科电子杂志, 2018, 5(2): 91-95.
32. 崔爱芝, 王爱华. 食管癌术后不同途径肠内营养效果的比较. 当代护士(下旬刊), 2013, (12): 43-44.
33. 张玉丽, 林青. 食管癌术后不同途径肠内营养效果的比较. 中国实用医药, 2010, 5(1): 60-61.
34. 杨刚华, 张雷, 王林, 等. Ivor-Lewis术式与Sweet术式治疗胸段食管癌的疗效比较. 现代肿瘤医学, 2021, 29(24): 4328-4332.
35. Hirahara N, Matsubara T, Kaji S, et al. A safe and simple technique for nasogastric tube insertion in patients with thoracic esophageal cancer surgery. World J Surg Oncol, 2021, 19(1): 317.
36. Watanabe M, Otake R, Kozuki R, et al. Recent progress in multidisciplinary treatment for patients with esophageal cancer. Surg Today, 2020, 50(1): 12-20.
37. 陈浩, 白利君, 张扬. 肠内营养联合数字减影血管造影引导下经皮胃造瘘术对食管癌伴吞咽困难患者营养状态的影响. 中国临床医生杂志, 2021, 49(10): 1207-1209.
38. 施庆彤, 刁亚利, 姚光怀. 鼻饲流质对改善食管癌患者术后营养状况和胃肠道耐受性的作用. 中华胸部外科电子杂志, 2017, 4(2): 87-91.
39. Choi AH, O'Leary MP, Merchant SJ, et al. Complications of feeding jejunostomy tubes in patients with gastroesophageal cancer. J Gastrointest Surg, 2017, 21(2): 259-265.
40. Blakely AM, Ajmal S, Sargent RE, et al. Critical analysis of feeding jejunostomy following resection of upper gastrointestinal malignancies. World J Gastrointest Surg, 2017, 9(2): 53-60.
41. Shen X, Zhuo ZG, Li G, et al. Is the routine placement of a feeding jejunostomy during esophagectomy worthwhile?—A systematic review and meta-analysis. Ann Palliat Med, 2021, 10(4): 4232-4241.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy and safety of enteral nutrition with jejunostomy tube versus nasojejunal tube after radical resection of esophageal cancer: A systematic review and meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content