title: Efficacy and complications of enteral feeding tube insertion after liver transplantation.
abstract: BACKGROUND
  Adequate nutritional support for patients undergoing major surgery significantly affects postoperative recovery. Data on enteral feeding after liver transplantation (LT) are scarce. The aim of this work was to determine the efficacy and complications of feeding tubes inserted with the use of fluoroscopic assistance, endoscopic assistance, or transperitoneal jejunostomy in patients who underwent LT.
  
  
  METHODS
  From January 2008 to August 2013, 2,058 LTs were performed at Asan Medical Center, Seoul, Korea. Enteral feeding tubes were inserted in 155 patients (7.5%) after LT: with the use of fluoroscopic placement in 81 (52%), endoscopic placement in 49 (32%), and transperitoneal jejunostomy in 25 (16%). We retrospectively analyzed the efficacy and complications of enteral feeding tubes.
  
  
  RESULTS
  The median age was 55 years (interquartile range [IQR] 49-60). Enteral feeding indications were a high risk of gastric aspiration (n = 90), gastric stasis (n = 27), pneumonia (n = 23), gastrointestinal bleeding (n = 12), and bowel rest (n = 3). Median enteral feeding durations were 14.5 days (IQR 8.0-30.7) for fluoroscopic placement, 20.0 days (IQR 8.0-40.0) for endoscopic placement, and 37.5 days (IQR 18.2-86.2) for transperitoneal jejunostomy. Times to establishment of oral feeding were 13.0 days (IQR 6.2-25.7) for fluoroscopic placement, 24.0 days (IQR 10.5-43.5) for endoscopic placement, and 37.0 days (IQR 17.0-64.2) for transperitoneal jejunostomy. After tube insertion, tube dislocation and blockage occurred in 34 patients (22%) and 16 patients (25%), respectively.
  
  
  CONCLUSIONS
  Enteral feeding tube insertion in patients who can not maintain a nasogastric tube or start oral intake for a long time is important for nutritional support after LT. Proper feeding method selection according to patient condition can help patients by improving nutritional support after major operations such as LT.
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Chun
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
authors.forename: J Y
authors.initials: JY
authors.lastname: Ahn
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea. Electronic address: hyjung@amc.seoul.kr.
authors.forename: H-Y
authors.initials: HY
authors.lastname: Jung
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
authors.forename: H
authors.initials: H
authors.lastname: Jung Park
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
authors.forename: G H
authors.initials: GH
authors.lastname: Kim
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
authors.forename: K-S
authors.initials: KS
authors.lastname: Choi
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
authors.forename: K W
authors.initials: KW
authors.lastname: Jung
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
authors.forename: D H
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
authors.forename: K D
authors.initials: KD
authors.lastname: Choi
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Song
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
authors.forename: G H
authors.initials: GH
authors.lastname: Lee
authors.affiliation: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Asan Research Institute of Radiology, Seoul, Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Liver Transplantation and Hepatobiliary Surgery, University of Ulsan College of Medicine, Asan Medical Center, Asan Research Institute of Surgery, Seoul, Korea.
authors.forename: G W
authors.initials: GW
authors.lastname: Song
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D016099:Endoscopy, Gastrointestinal; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D007582:Jejunostomy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011182:Postoperative Care / Q000379:methods*; D015641:Radiography, Interventional; D012189:Retrospective Studies