Efficacy and safety of enteral nutrition with jejunostomy tube versus nasojejunal tube after radical resection of esophageal cancer: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

BAI Xiangdou ¹ , ZENG Weiqiang ¹ , CUI Baiqiang ¹ , YANG Ning ¹ , HE Xiaoyang ¹ , ZHANG Siyuan ¹ , JIN Dacheng ² ,  GOU Yunjiu ^1,2

1. The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
2. Department of Thoracic Surgery, The Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;

Corresponding?author：

GOU Yunjiu, Email: gouyunjiu@163.com

Keywords：

Jejunostomy; nasojejunal tube; radical resection of esophageal cancer; enteral nutrition; curative effects; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202111015

Video：

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Objective To systematically evaluate the efficacy and safety of jejunostomy tube versus nasojejunal tube for enteral nutrition after radical resection of esophageal cancer. Methods PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP and CBM databases were searched to collect the clinical effects of jejunostomy tube versus nasojejunal nutrition tube after radical resection of esophageal cancer from inception to October 2021. Meta-analysis was performed using RevMan 5.4 software. Results Twenty-six articles were included, including 17 randomized controlled studies and 9 cohort studies, with a total of 35 808 patients. Meta-analysis results showed that: in the jejunostomy tube group, the postoperative exhaust time (MD=–4.27, 95%CI –5.87 to –2.66, P=0.001), the incidence of pulmonary infection (OR=1.39, 95%CI 1.06 to 1.82, P=0.02), incidence of tube removal (OR=0.11, 95%CI 0.04 to 0.30, P=0.001), incidence of tube blockage (OR=0.47, 95%CI 0.23 to 0.97, P=0.04), incidence of nasopharyngeal discomfort (OR=0.04, 95%CI 0.01 to 0.13, P=0.001), the incidence of nasopharyngeal mucosal damage (OR=0.13, 95%CI 0.04 to 0.42, P=0.008), the incidence of nausea and vomiting (OR=0.20, 95%CI 0.08 to 0.47, P=0.003) were significantly shorter or lower than those of the nasojejunal tube group. The postoperative serum albumin level (MD=5.75, 95%CI 5.34 to 6.16, P=0.001) was significantly better than that of the nasojejunal tube group. However, the intraoperative operation time of the jejunostomy tube group (MD=13.65, 95%CI 2.32 to 24.98, P=0.02) and the indent time of the postoperative nutrition tube (MD=17.81, 95%CI 12.71 to 22.91, P=0.001) were longer than those of the nasojejunal nutrition tube. At the same time, the incidence of postoperative intestinal obstruction (OR=6.08, 95%CI 2.55 to 14.50, P=0.001) was significantly higher than that of the nasojejunal tube group. There were no statistical differences in the length of postoperative hospital stay or the occurrence of anastomotic fistula between the two groups (P>0.05). Conclusion In the process of enteral nutrition after radical resection of esophageal cancer, jejunostomy tube has better clinical treatment effect and is more comfortable during catheterization, but the incidence of intestinal obstruction is higher than that of traditional nasojejunal tube.

Citation： BAI Xiangdou, ZENG Weiqiang, CUI Baiqiang, YANG Ning, HE Xiaoyang, ZHANG Siyuan, JIN Dacheng, GOU Yunjiu. Efficacy and safety of enteral nutrition with jejunostomy tube versus nasojejunal tube after radical resection of esophageal cancer: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1475-1482. doi: 10.7507/1007-4848.202111015 Copy

1.	Thrift AP. Global burden and epidemiology of Barrett oesophagus and oesophageal cancer. Nat Rev Gastroenterol Hepatol, 2021, 18(6): 432-443.
2.	劉宗超, 李哲軒, 張陽, 等. 2020全球癌癥統計報告解讀. 腫瘤綜合治療電子雜志, 2021, 7(2): 1-13.
3.	Watanabe M, Otake R, Kozuki R, et al. Correction to: Recent progress in multidisciplinary treatment for patients with esophageal cancer. Surg Today, 2020, 50(4): 425.
4.	Li PF, Wang YL, Fang YL, et al. Effect of early enteral nutrition on outcomes of trauma patients requiring intensive care. Chin J Traumatol, 2020, 23(3): 163-167.
5.	Palm NM, McKinzie B, Ferguson PL, et al. Pharmacologic stress gastropathy prophylaxis may not be necessary in at-risk surgical trauma ICU patients tolerating enteral nutrition. J Intensive Care Med, 2018, 33(7): 424-429.
6.	Roveron G, Antonini M, Barbierato M, et al. Clinical practice guidelines for the nursing management of percutaneous endoscopic gastrostomy and jejunostomy (PEG/PEJ) in adult patients: An executive summary. J Wound Ostomy Continence Nurs, 2018, 45(4): 326-334.
7.	徐琛, 陶夏, 蔣莉, 等. 空腸造瘺術聯合Ivor-Lewis或McKeown術治療中下段食管癌效果評價的回顧性隊列研究. 中國胸心血管外科臨床雜志, 2021, 28(10): 1216-1221.
8.	Holmén A, Hayami M, Szabo E, et al. Nutritional jejunostomy in esophagectomy for cancer, a national register-based cohort study of associations with postoperative outcomes and survival. Langenbecks Arch Surg, 2021, 406(5): 1415-1423.
9.	Koterazawa Y, Oshikiri T, Hasegawa H, et al. Routine placement of feeding jejunostomy tube during esophagectomy increases postoperative complications and does not improve postoperative malnutrition. Dis Esophagus, 2020, 33(1): doz021.
10.	Klevebro F, Johar A, Lagergren J, et al. Outcomes of nutritional jejunostomy in the curative treatment of esophageal cancer. Dis Esophagus, 2019, 32(7): doy113.
11.	Zhuang W, Wu H, Liu H, et al. Utility of feeding jejunostomy in patients with esophageal cancer undergoing esophagectomy with a high risk of anastomotic leakage. J Gastrointest Oncol, 2021, 12(2): 433-445.
12.	Akiyama Y, Iwaya T, Endo F, et al. Evaluation of the need for routine feeding jejunostomy for enteral nutrition after esophagectomy. J Thorac Dis, 2018, 10(12): 6854-6862.
13.	Gong L, Yan B, Chen Y, et al. Alternative method for jejunostomy in Ivor-Lewis esophagectomy. Thorac Cancer, 2015, 6(3): 296-302.
14.	Jenkins TK, Lopez AN, Sarosi GA, et al. Preoperative enteral access is not necessary prior to multimodality treatment of esophageal cancer. Surgery, 2018, 163(4): 770-776.
15.	Watson M, Trufan S, Benbow JH, et al. Jejunostomy at the time of esophagectomy is associated with improved short-term perioperative outcomes: Analysis of the NSQIP database. J Gastrointest Oncol, 2020, 11(2): 421-430.
16.	Zheng R, Rios-Diaz AJ, Liem S, et al. Is the placement of jejunostomy tubes in patients with esophageal cancer undergoing esophagectomy associated with increased inpatient healthcare utilization? An analysis of the National Readmissions Database. Am J Surg, 2021, 221(1): 141-148.
17.	陸超敬, 楊立信, 陳和忠, 等. CORFLO營養管在胸腔鏡Ivor Lewis食管癌及賁門癌根治術中的應用. 中國胸心血管外科臨床雜志, 2016, 23(12): 1154-1157.
18.	秦苗苗. 比較空腸造瘺營養管與鼻空腸營養管行腸內營養在食管癌根治術后的護理效果. 世界最新醫學信息文摘, 2016, 16(65): 317, 333.
19.	呂愛霞, 蔡曉慧. 比較空腸造瘺營養管與鼻空腸營養管行腸內營養在食管癌根治術后的治療效果. 世界最新醫學信息文摘, 2016, 16(40): 41-42.
20.	張丹丹, 陳紅, 陳圓圓, 等. 改良空腸造瘺在食管癌術后的應用和護理體會. 中西醫結合護理(中英文), 2016, 2(12): 90-91, 94.
21.	葛凌霞. 經空腸造瘺營養管對接受食管癌根治術的患者進行腸內營養支持的效果. 當代醫藥論叢, 2018, 16(21): 22-23.
22.	劉曉青. 經皮置入空腸造瘺管在食管癌術后家庭照護中的應用. 結直腸肛門外科, 2018, 24(S2): 98-99.
23.	章靚, 徐邦英, 郭文霞, 等. 空腸造瘺管與鼻腸管在胸腹腔鏡聯合食管癌手術患者腸內營養應用的效果比較. 中華現代護理雜志, 2017, 23(11): 1482-1485.
24.	劉軍. 空腸造瘺營養管與鼻空腸營養管在食管癌根治術中的應用. 中西醫結合心血管病電子雜志, 2017, 5(36): 60-61.
25.	趙松, 吳彬, 齊宇, 等. 空腸造瘺營養管與鼻空腸營養管在食管癌根治術中的應用. 中國老年學雜志, 2014, 34(10): 2740-2741.
26.	胡顏江, 陳曦, 楊純杰, 等. 空腸造瘺營養管與鼻空腸營養管在食管癌根治術中的應用對比分析. 現代診斷與治療, 2015, 26(23): 5352-5353.
27.	潘安娜, 張志敏, 王錦寅. 空腸造瘺營養管與鼻空腸營養管在食管癌根治術中的應用效果比較. 中國醫藥科學, 2019, 9(22): 206-209.
28.	王偵偉, 楊景先, 陳曉峰. 空腸造瘺營養管與鼻空腸營養管在食管癌根治術中的應用效果比較. 白求恩醫學雜志, 2015, 13(6): 646-647.
29.	樊友強. 空腸造瘺與鼻飼營養在食管癌術后腸內營養中的應用比較. 淮海醫藥, 2019, 37(5): 483-485.
30.	陸小月, 羌燕, 李曉旭, 等. 兩種不同腸內營養管置管法在食管癌術后營養治療中的應用觀察. 中國腫瘤外科雜志, 2017, 9(6): 405-407.
31.	張滿, 靳智勇, 王宇飛, 等. 食管癌Ivor-Lewis術中營養管置入新方法的評價. 中華胸部外科電子雜志, 2018, 5(2): 91-95.
32.	崔愛芝, 王愛華. 食管癌術后不同途徑腸內營養效果的比較. 當代護士(下旬刊), 2013, (12): 43-44.
33.	張玉麗, 林青. 食管癌術后不同途徑腸內營養效果的比較. 中國實用醫藥, 2010, 5(1): 60-61.
34.	楊剛華, 張雷, 王林, 等. Ivor-Lewis術式與Sweet術式治療胸段食管癌的療效比較. 現代腫瘤醫學, 2021, 29(24): 4328-4332.
35.	Hirahara N, Matsubara T, Kaji S, et al. A safe and simple technique for nasogastric tube insertion in patients with thoracic esophageal cancer surgery. World J Surg Oncol, 2021, 19(1): 317.
36.	Watanabe M, Otake R, Kozuki R, et al. Recent progress in multidisciplinary treatment for patients with esophageal cancer. Surg Today, 2020, 50(1): 12-20.
37.	陳浩, 白利君, 張揚. 腸內營養聯合數字減影血管造影引導下經皮胃造瘺術對食管癌伴吞咽困難患者營養狀態的影響. 中國臨床醫生雜志, 2021, 49(10): 1207-1209.
38.	施慶彤, 刁亞利, 姚光懷. 鼻飼流質對改善食管癌患者術后營養狀況和胃腸道耐受性的作用. 中華胸部外科電子雜志, 2017, 4(2): 87-91.
39.	Choi AH, O'Leary MP, Merchant SJ, et al. Complications of feeding jejunostomy tubes in patients with gastroesophageal cancer. J Gastrointest Surg, 2017, 21(2): 259-265.
40.	Blakely AM, Ajmal S, Sargent RE, et al. Critical analysis of feeding jejunostomy following resection of upper gastrointestinal malignancies. World J Gastrointest Surg, 2017, 9(2): 53-60.
41.	Shen X, Zhuo ZG, Li G, et al. Is the routine placement of a feeding jejunostomy during esophagectomy worthwhile?—A systematic review and meta-analysis. Ann Palliat Med, 2021, 10(4): 4232-4241.

1. Thrift AP. Global burden and epidemiology of Barrett oesophagus and oesophageal cancer. Nat Rev Gastroenterol Hepatol, 2021, 18(6): 432-443.
2. 劉宗超, 李哲軒, 張陽, 等. 2020全球癌癥統計報告解讀. 腫瘤綜合治療電子雜志, 2021, 7(2): 1-13.
3. Watanabe M, Otake R, Kozuki R, et al. Correction to: Recent progress in multidisciplinary treatment for patients with esophageal cancer. Surg Today, 2020, 50(4): 425.
4. Li PF, Wang YL, Fang YL, et al. Effect of early enteral nutrition on outcomes of trauma patients requiring intensive care. Chin J Traumatol, 2020, 23(3): 163-167.
5. Palm NM, McKinzie B, Ferguson PL, et al. Pharmacologic stress gastropathy prophylaxis may not be necessary in at-risk surgical trauma ICU patients tolerating enteral nutrition. J Intensive Care Med, 2018, 33(7): 424-429.
6. Roveron G, Antonini M, Barbierato M, et al. Clinical practice guidelines for the nursing management of percutaneous endoscopic gastrostomy and jejunostomy (PEG/PEJ) in adult patients: An executive summary. J Wound Ostomy Continence Nurs, 2018, 45(4): 326-334.
7. 徐琛, 陶夏, 蔣莉, 等. 空腸造瘺術聯合Ivor-Lewis或McKeown術治療中下段食管癌效果評價的回顧性隊列研究. 中國胸心血管外科臨床雜志, 2021, 28(10): 1216-1221.
8. Holmén A, Hayami M, Szabo E, et al. Nutritional jejunostomy in esophagectomy for cancer, a national register-based cohort study of associations with postoperative outcomes and survival. Langenbecks Arch Surg, 2021, 406(5): 1415-1423.
9. Koterazawa Y, Oshikiri T, Hasegawa H, et al. Routine placement of feeding jejunostomy tube during esophagectomy increases postoperative complications and does not improve postoperative malnutrition. Dis Esophagus, 2020, 33(1): doz021.
10. Klevebro F, Johar A, Lagergren J, et al. Outcomes of nutritional jejunostomy in the curative treatment of esophageal cancer. Dis Esophagus, 2019, 32(7): doy113.
11. Zhuang W, Wu H, Liu H, et al. Utility of feeding jejunostomy in patients with esophageal cancer undergoing esophagectomy with a high risk of anastomotic leakage. J Gastrointest Oncol, 2021, 12(2): 433-445.
12. Akiyama Y, Iwaya T, Endo F, et al. Evaluation of the need for routine feeding jejunostomy for enteral nutrition after esophagectomy. J Thorac Dis, 2018, 10(12): 6854-6862.
13. Gong L, Yan B, Chen Y, et al. Alternative method for jejunostomy in Ivor-Lewis esophagectomy. Thorac Cancer, 2015, 6(3): 296-302.
14. Jenkins TK, Lopez AN, Sarosi GA, et al. Preoperative enteral access is not necessary prior to multimodality treatment of esophageal cancer. Surgery, 2018, 163(4): 770-776.
15. Watson M, Trufan S, Benbow JH, et al. Jejunostomy at the time of esophagectomy is associated with improved short-term perioperative outcomes: Analysis of the NSQIP database. J Gastrointest Oncol, 2020, 11(2): 421-430.
16. Zheng R, Rios-Diaz AJ, Liem S, et al. Is the placement of jejunostomy tubes in patients with esophageal cancer undergoing esophagectomy associated with increased inpatient healthcare utilization? An analysis of the National Readmissions Database. Am J Surg, 2021, 221(1): 141-148.
17. 陸超敬, 楊立信, 陳和忠, 等. CORFLO營養管在胸腔鏡Ivor Lewis食管癌及賁門癌根治術中的應用. 中國胸心血管外科臨床雜志, 2016, 23(12): 1154-1157.
18. 秦苗苗. 比較空腸造瘺營養管與鼻空腸營養管行腸內營養在食管癌根治術后的護理效果. 世界最新醫學信息文摘, 2016, 16(65): 317, 333.
19. 呂愛霞, 蔡曉慧. 比較空腸造瘺營養管與鼻空腸營養管行腸內營養在食管癌根治術后的治療效果. 世界最新醫學信息文摘, 2016, 16(40): 41-42.
20. 張丹丹, 陳紅, 陳圓圓, 等. 改良空腸造瘺在食管癌術后的應用和護理體會. 中西醫結合護理(中英文), 2016, 2(12): 90-91, 94.
21. 葛凌霞. 經空腸造瘺營養管對接受食管癌根治術的患者進行腸內營養支持的效果. 當代醫藥論叢, 2018, 16(21): 22-23.
22. 劉曉青. 經皮置入空腸造瘺管在食管癌術后家庭照護中的應用. 結直腸肛門外科, 2018, 24(S2): 98-99.
23. 章靚, 徐邦英, 郭文霞, 等. 空腸造瘺管與鼻腸管在胸腹腔鏡聯合食管癌手術患者腸內營養應用的效果比較. 中華現代護理雜志, 2017, 23(11): 1482-1485.
24. 劉軍. 空腸造瘺營養管與鼻空腸營養管在食管癌根治術中的應用. 中西醫結合心血管病電子雜志, 2017, 5(36): 60-61.
25. 趙松, 吳彬, 齊宇, 等. 空腸造瘺營養管與鼻空腸營養管在食管癌根治術中的應用. 中國老年學雜志, 2014, 34(10): 2740-2741.
26. 胡顏江, 陳曦, 楊純杰, 等. 空腸造瘺營養管與鼻空腸營養管在食管癌根治術中的應用對比分析. 現代診斷與治療, 2015, 26(23): 5352-5353.
27. 潘安娜, 張志敏, 王錦寅. 空腸造瘺營養管與鼻空腸營養管在食管癌根治術中的應用效果比較. 中國醫藥科學, 2019, 9(22): 206-209.
28. 王偵偉, 楊景先, 陳曉峰. 空腸造瘺營養管與鼻空腸營養管在食管癌根治術中的應用效果比較. 白求恩醫學雜志, 2015, 13(6): 646-647.
29. 樊友強. 空腸造瘺與鼻飼營養在食管癌術后腸內營養中的應用比較. 淮海醫藥, 2019, 37(5): 483-485.
30. 陸小月, 羌燕, 李曉旭, 等. 兩種不同腸內營養管置管法在食管癌術后營養治療中的應用觀察. 中國腫瘤外科雜志, 2017, 9(6): 405-407.
31. 張滿, 靳智勇, 王宇飛, 等. 食管癌Ivor-Lewis術中營養管置入新方法的評價. 中華胸部外科電子雜志, 2018, 5(2): 91-95.
32. 崔愛芝, 王愛華. 食管癌術后不同途徑腸內營養效果的比較. 當代護士(下旬刊), 2013, (12): 43-44.
33. 張玉麗, 林青. 食管癌術后不同途徑腸內營養效果的比較. 中國實用醫藥, 2010, 5(1): 60-61.
34. 楊剛華, 張雷, 王林, 等. Ivor-Lewis術式與Sweet術式治療胸段食管癌的療效比較. 現代腫瘤醫學, 2021, 29(24): 4328-4332.
35. Hirahara N, Matsubara T, Kaji S, et al. A safe and simple technique for nasogastric tube insertion in patients with thoracic esophageal cancer surgery. World J Surg Oncol, 2021, 19(1): 317.
36. Watanabe M, Otake R, Kozuki R, et al. Recent progress in multidisciplinary treatment for patients with esophageal cancer. Surg Today, 2020, 50(1): 12-20.
37. 陳浩, 白利君, 張揚. 腸內營養聯合數字減影血管造影引導下經皮胃造瘺術對食管癌伴吞咽困難患者營養狀態的影響. 中國臨床醫生雜志, 2021, 49(10): 1207-1209.
38. 施慶彤, 刁亞利, 姚光懷. 鼻飼流質對改善食管癌患者術后營養狀況和胃腸道耐受性的作用. 中華胸部外科電子雜志, 2017, 4(2): 87-91.
39. Choi AH, O'Leary MP, Merchant SJ, et al. Complications of feeding jejunostomy tubes in patients with gastroesophageal cancer. J Gastrointest Surg, 2017, 21(2): 259-265.
40. Blakely AM, Ajmal S, Sargent RE, et al. Critical analysis of feeding jejunostomy following resection of upper gastrointestinal malignancies. World J Gastrointest Surg, 2017, 9(2): 53-60.
41. Shen X, Zhuo ZG, Li G, et al. Is the routine placement of a feeding jejunostomy during esophagectomy worthwhile?—A systematic review and meta-analysis. Ann Palliat Med, 2021, 10(4): 4232-4241.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy and safety of enteral nutrition with jejunostomy tube versus nasojejunal tube after radical resection of esophageal cancer: A systematic review and meta-analysis

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