Feeding Jejunostomy Tube Placement in Patients Undergoing Pancreaticoduodenectomy: An Ongoing Dilemma

Daniel P. Nussbaum, Sabino Zani, Kara Penne, Paul J. Speicher, Sandra S. Stinnett, Bryan M. Clary, Rebekah R. White, Douglas S. Tyler, Dan G. Blazer

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Background: Concomitant placement of feeding jejunostomy tubes (FJT) during pancreaticoduodenectomy is common, yet there are limited data regarding catheter-specific morbidity and associated outcomes. This information is crucial to appropriately select patients for feeding tube placement and to optimize perioperative nutrition strategies.

Methods: A review of all patients undergoing pancreaticoduodenectomy with FJT placement was completed. Patients were grouped by the occurrence of FJT-related morbidity. Multivariable logistic regression was performed to identify predictors of FJT morbidity; these complications were then further defined. Finally, associated postoperative outcomes were compared between groups.

Results: In total, 126 patients were included, of which 18 (14 %) had complications directly related to their FJT, including pericatheter infection (n = 6), pneumatosis intestinalis (n = 4), severe tube feed intolerance (n = 3), and primary catheter malfunction (n = 7). Following adjustment with logistic regression, preoperative hypoalbuminemia was identified as the only independent predictor of FJT complications (OR 2.23, p = 0.035). Patients with FJT complications were more likely to be initiated on total parenteral nutrition (TPN; 55.6 vs. 7.4 %, p −0.035) and to require TPN at discharge (16.7 vs. 0 %, p = 0.003). Correspondingly, these patients resumed an oral diet later (14 vs. 8 days, p = 0.06). Both reoperation (50.0 vs. 6.5 %, p < 0.001) and readmission (50.0 vs. 22.4 %, p = 0.041) rates were higher among patients with FJT complications.

Conclusions: FJT-related morbidity is common among patients undergoing pancreaticoduodenectomy and is associated with inferior outcomes and other performance metrics. Preoperative malnutrition appears to predict FJT complications, creating an ongoing dilemma regarding FJT placement. In the future, it will be important to better define criteria for FJT placement during pancreaticoduodenectomy.

Original languageEnglish (US)
Pages (from-to)1752-1759
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume18
Issue number10
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

Keywords

  • Feeding tube
  • Jejunostomy feeding tube
  • Nutrition
  • Outcomes
  • Pancreaticoduodenectomy
  • Whipple

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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