Routine use of jejunostomy tubes after esophagectomy: The good, the bad, and the ugly!

Abstract

Objective

The study objective was to assess adverse events, readmissions, and resource use associated with routine jejunostomy tube placement after esophagectomy.

Methods

From September 2018 to October 2021, 215 patients, with a median age of 65 years and a median body mass index of 27 kg/m², underwent routine jejunostomy tube placement during esophagectomy. J-tube–related adverse events were collected from date of surgery to date of removal and categorized as (1) nonserious, resource-nonintensive (eg, skin irritations, discomfort); (2) nonserious, resource-intensive (eg, infection, clogged, and dislodged tubes); and (3) serious, resource-intensive (eg, bowel obstruction, volvulus, tube feed intolerance). Esophagectomy and jejunostomy tube–related readmissions and nutritional markers were also assessed during the jejunostomy tube indwelling time.

Results

Of the 215 patients, 177 experienced 459 events documented during 372 healthcare encounters. Nonserious adverse events occurred within 4 to 6 weeks after surgery with the peak at 3 to 4 weeks. Serious adverse events (4, 0.9%) were rare and occurred mostly in the acute postoperative period. Thirty-five patients (16%) were readmitted during their jejunostomy tube indwelling time, of whom 14 (7%) were readmitted due to jejunostomy tube–related issues. Jejunostomy tube–related events were not predictors for readmission. Nutritional status stabilized within 30 days of surgery.

Conclusions

Serious adverse events after routine jejunostomy tube placement postesophagectomy are rare and occur mostly in the immediate postoperative period. Nonserious adverse events are more common and can be resource-intensive, providing an opportunity for improvement. Readmissions for jejunostomy tube complications are low. Nutritional status is appropriately maintained with supplemental jejunostomy tube feeding postesophagectomy. These findings suggest that routine jejunostomy tube placement at the time of esophagectomy can be a reasonable management strategy as part of a delayed feeding algorithm.