title: Feeding duodenostomy decreases the incidence of mechanical obstruction after radical esophageal cancer surgery.
abstract: BACKGROUND
  Nutritional support influences the outcome of gastroenterological surgery, and enteral nutrition effectively mitigates postoperative complications in highly invasive surgery such as resection of esophageal cancer. However, feeding via jejunostomy can cause complications including mechanical obstruction, which could be life threatening. From 2009, we began enteral feeding via duodenostomy to reduce the likelihood of complications. In this study, we compared duodenostomy with the conventional jejunostomy feeding, mainly looking at the catheter-related complications.
  
  
  METHODS
  The database records of 378 patients with esophageal cancer who underwent radical esophagectomy with retrosternal or posterior mediastinal gastric tube reconstruction in our department from January 1998 to December 2012 were examined. Of the 378 patients, 111 underwent feeding via duodenostomy (FD) and 267 underwent feeding via jejunostomy (FJ), and their records were reviewed for the following catheter-related complications: site infection, dislodgement, peritonitis, and mechanical obstruction.
  
  
  RESULTS
  Mechanical obstruction occurred in 12 patients in the FJ group but none in the FD group (4.5 % vs. 0 %, P = 0.023). Of the 12 cases, 7 (58.3 %) required surgery of which 2 had bowel resection due to strangulated mechanical obstruction. Catheter site infection was seen in 14 cases in the FJ group, of which 2 (14.2 %) had peritonitis following catheter dislocation, while only one case of site infection was seen in the FD group (5.2 % vs. 0.9 %, P = 0.078).
  
  
  CONCLUSIONS
  Feeding via duodenectomy could be the procedure of choice since neither mechanical obstruction nor relaparotomy was seen during enteral feeding through this technique.
authors: Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya, 466-8550, Japan.
authors: Hisaharu
authors: H
authors: Oya
authors: Masahiko
authors: M
authors: Koike
authors: Naoki
authors: N
authors: Iwata
authors: Daisuke
authors: D
authors: Kobayashi
authors: Koji
authors: K
authors: Torii
authors: Yukiko
authors: Y
authors: Niwa
authors: Mitsuro
authors: M
authors: Kanda
authors: Chie
authors: C
authors: Tanaka
authors: Suguru
authors: S
authors: Yamada
authors: Tsutomu
authors: T
authors: Fujii
authors: Goro
authors: G
authors: Nakayama
authors: Hiroyuki
authors: H
authors: Sugimoto
authors: Shuji
authors: S
authors: Nomoto
authors: Michitaka
authors: M
authors: Fujiwara
authors: Yasuhiro
authors: Y
authors: Kodera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D055499:Catheter-Related Infections / Q000209:etiology; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004385:Duodenostomy / Q000009:adverse effects* / Q000379:methods; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D004868:Equipment Failure; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D007582:Jejunostomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology; D012189:Retrospective Studies