title: Feeding jejunostomy tubes placed during esophagectomy: are they necessary?
abstract: BACKGROUND
  Jejunostomy tubes (JT) are routinely placed at the time of esophagectomy and can be associated with low--but not insignificant--morbidity. Increased emphasis on evidence-based medicine prompted this critical review of JT use during esophagectomy and factors that predict the absolute need for JT.
  
  
  METHODS
  All esophagectomies performed at one tertiary care institution from 1995 through 2009 were retrospectively reviewed. Statistical analyses were performed to determine preoperative variables that would assist in selecting patients who should receive a JT.
  
  
  RESULTS
  A total of 143 JTs were placed in 151 patients undergoing esophagectomy for carcinoma (83.4%), high-grade dysplasia (13.2%), and perforation (2.6%). Of these, 110 patients (76.9%) had returned to oral intake before discharge (median, 7 days), whereas 33 patients (23.1%) still required tube feedings. Of 8 patients who did not undergo intraoperative JT placement, 6 had resumed oral intake at discharge. Two patients were discharged on total parenteral nutrition. Logistic regression analysis of preoperative variables showed a body mass index of less than 18.5 kg/m2 conferred a likelihood of requiring a JT at discharge (odds ratio, 7.56; p<0.05). Age, sex, albumin level, type of esophagectomy, histology, stage, preoperative neoadjuvant therapy, and type of cancer were not significant predictors of JT need at discharge.
  
  
  CONCLUSIONS
  The only absolute indication for JT placement after esophagectomy was a body mass index of less than 18.5 kg/m2. Other patients may have selective JT placement based on the surgeon's judgment.
authors.affiliation: Department of Surgery, William Beaumont Hospitals, Royal Oak, Michigan 48073-6769, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Fenton
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Bergeron
authors.forename: Michael
authors.initials: M
authors.lastname: Coello
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Welsh
authors.forename: Gary W
authors.initials: GW
authors.lastname: Chmielewski
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D015992:Body Mass Index; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D015331:Cohort Studies; D004750:Enteral Nutrition / Q000009:adverse effects; D004935:Esophageal Diseases / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D019564:Unnecessary Procedures