title: Randomized clinical trial: nasoenteric tube or jejunostomy as a route for nutrition after major upper gastrointestinal operations.
abstract: BACKGROUND
  Curative treatment of upper gastrointestinal tract neoplasms is complex and associated with high morbidity and mortality. In general, the patients are already malnourished, and early postoperative enteral nutrition is recommended. However, there is no consensus concerning the best enteral access route in these cases.
  
  
  METHODS
  A prospective randomized trial was performed from 2008 to 2012 with 59 patients who underwent esophagectomy, total gastrectomy, or pancreaticoduodenectomy. In all, 4 patients declined to participate, and 13 did not meet the inclusion criteria and were excluded. Of the 42 included patients, 21 had nasoenteric tubes, and 21 had a jejunostomy.
  
  
  RESULTS
  The two groups were similar in demographic and clinical aspects. The nasoenteric (NE) and jejunostomy groups underwent early enteral therapy in 71 and 62 % of cases (p > 0.05), respectively. The median length of enteral therapy use was less in the NE group (5.0 vs. 8.5 days), but the difference was not statistically significant. The NE group required introduction of parenteral therapy more frequently than the jejunostomy group (p < 0.05). Complications related to the enteral route occurred in 38.0 and 28.5 % of patients (p > 0.05) in the NE and jejunostomy groups, respectively. In the NE group, there were four losses and four tube obstructions. In the jejunostomy group, there were two losses, four obstructions, and two cases of leakage around the tube. In the latter group, patients who underwent therapy for a longer time had tubal complications (p < 0.05) and longer intensive care unit and hospital stays (p < 0.05).
  
  
  CONCLUSIONS
  The two enteral routes were associated with the same number of complications. However, the presence of a jejunostomy allowed enteral therapy for longer periods, especially in patients with complications, thus avoiding the need for parenteral nutrition.
authors.affiliation: Governador Israel Pinheiro Hospital, Belo Horizonte, Minas Gerais, Brazil, luizgonzagatorres@gmail.com.
authors.forename: Luiz Gonzaga
authors.initials: LG
authors.lastname: Torres Júnior
authors.forename: Fernando Augusto
authors.initials: FA
authors.lastname: de Vasconcellos Santos
authors.forename: Maria Isabel Toulson Davisson
authors.initials: MI
authors.lastname: Correia
mesh_terms: D000368:Aged; D057785:Catheters / Q000009:adverse effects; D004067:Digestive System Neoplasms / Q000601:surgery*; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D004868:Equipment Failure; D016629:Esophagectomy / Q000009:adverse effects; D005743:Gastrectomy / Q000009:adverse effects; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D007582:Jejunostomy / Q000009:adverse effects*; D007902:Length of Stay; D008875:Middle Aged; D009752:Nutritional Status; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D010288:Parenteral Nutrition; D011446:Prospective Studies; D013997:Time Factors