title: Routes for early enteral nutrition after esophagectomy. A systematic review.
abstract: Early enteral feeding following surgery can be given orally, via a jejunostomy or via a nasojejunal tube. However, the best feeding route following esophagectomy is unclear.
  
  
  
  To determine the best route for enteral nutrition following esophagectomy regarding anastomotic leakage, pneumonia, percentage meeting the nutritional requirements, weight loss, complications of tube feeding, mortality, patient satisfaction and length of hospital stay.
  
  
  
  A systematic literature review following PRISMA and MOOSE guidelines.
  
  
  
  There were 17 eligible studies on early oral intake, jejunostomy or nasojejunal tube feeding. Only one nonrandomized study (N = 133) investigated early oral feeding specifically following esophagectomy. Early oral feeding was associated with a reduced length of stay with delayed oral feeding, without increased complication rates. Postoperative nasojejunal tube feeding was not significantly different from jejunostomy tube feeding regarding complications or catheter efficacy in the only randomised trial on this subject (N = 150). Jejunostomy tube feeding outcome was reported in 12 non-comparative studies (N = 3293). It was effective in meeting short-term nutritional requirements, but major tube-related complications necessitated relaparotomy in 0-2.9% of patients. In three non-comparative studies (N = 135) on nasojejunal tube feeding only minor complications were reported, data on nutritional outcome was lacking. Data on patient satisfaction and long-term nutritional outcome were not found for any of the feeding routes investigated.
  
  
  
  It is unclear what the best route for early enteral nutrition is after esophagectomy. Especially data regarding early oral intake are scarce, and phase 2 trials are needed for further investigation.
  
  
  
  International prospective register of systematic reviews, CRD42013004032.
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, The Netherlands; Department of Surgery, University Medical Center Utrecht, The Netherlands. Electronic address: teus.weijs@cze.nl.
authors.forename: Teus J
authors.initials: TJ
authors.lastname: Weijs
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
authors.forename: Gijs H K
authors.initials: GH
authors.lastname: Berkelmans
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
authors.forename: Grard A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: Jelle P
authors.initials: JP
authors.lastname: Ruurda
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: van Hillegersberg
authors.affiliation: Department of General Surgery, Academic Hospital Maastricht, The Netherlands.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Soeters
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
authors.forename: Misha D P
authors.initials: MD
authors.lastname: Luyer
mesh_terms: D057868:Anastomotic Leak; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D016629:Esophagectomy; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods; D007582:Jejunostomy; D007583:Jejunum; D007902:Length of Stay; D016239:MEDLINE; D009751:Nutritional Requirements; D017060:Patient Satisfaction; D011014:Pneumonia; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Delayed oral intake; Early oral intake; Esophagectomy; Jejunostomy; Nasojejunal tube; Nutrition