S A Sethuraman1, V K Dhar2, D A Habib1, J E Sussman2, S A Ahmad2, S A Shah2, B J Tsuei2, J J Sussman2, Daniel E Abbott3. 1. College of Medicine, University of Cincinnati, Cincinnati, OH, USA. 2. Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. 3. Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, K4/742, Madison, WI, 53792, USA. abbott@surgery.wisc.edu.
Abstract
BACKGROUND: Small bowel necrosis after enteral feeding through a jejunostomy tube (tube feed necrosis, TFN) is a rare, serious complication of major abdominal surgery. However, strategies to reduce the incidence and morbidity of TFN are not well established. Here, in the largest series of TFN presented to date, we report our institutional experience and a comprehensive review of the literature. METHODS: Eight patients who experienced TFN from 2000 to 2014 after major abdominal surgery for oncologic indications at the University of Cincinnati were reviewed. Characteristics of post-operative courses and outcomes were reviewed prior to and after a change in tube-feeding protocol. The existing literature addressing TFN over the last three decades was also reviewed. RESULTS: Patients with TFN ranged from 50 to 74 years old and presented with upper gastrointestinal tract malignancies amenable to surgical resection. Six and two cases of TFN occurred following pancreatectomy and esophagectomy, respectively. Prior to TF protocol changes, which included initiation at a low rate, titrating up more slowly and starting at one-half strength TF, three of six cases of TFN (50%) resulted in mortality. With the new TF protocol, there were no deaths, goal TF rate was achieved 3 days later, symptoms of TFN were recognized 3 days earlier, and re-operation was conducted 1 day earlier. CONCLUSION: This case series describes a change in clinical practice that is associated with decreased morbidity and mortality of TFN. Wider implementation and further refinement of this tube-feeding protocol may reduce TFN incidence at other institutions and in patients with other conditions requiring enteral nutrition.
BACKGROUND:Small bowel necrosis after enteral feeding through a jejunostomy tube (tube feed necrosis, TFN) is a rare, serious complication of major abdominal surgery. However, strategies to reduce the incidence and morbidity of TFN are not well established. Here, in the largest series of TFN presented to date, we report our institutional experience and a comprehensive review of the literature. METHODS: Eight patients who experienced TFN from 2000 to 2014 after major abdominal surgery for oncologic indications at the University of Cincinnati were reviewed. Characteristics of post-operative courses and outcomes were reviewed prior to and after a change in tube-feeding protocol. The existing literature addressing TFN over the last three decades was also reviewed. RESULTS:Patients with TFN ranged from 50 to 74 years old and presented with upper gastrointestinal tract malignancies amenable to surgical resection. Six and two cases of TFN occurred following pancreatectomy and esophagectomy, respectively. Prior to TF protocol changes, which included initiation at a low rate, titrating up more slowly and starting at one-half strength TF, three of six cases of TFN (50%) resulted in mortality. With the new TF protocol, there were no deaths, goal TF rate was achieved 3 days later, symptoms of TFN were recognized 3 days earlier, and re-operation was conducted 1 day earlier. CONCLUSION: This case series describes a change in clinical practice that is associated with decreased morbidity and mortality of TFN. Wider implementation and further refinement of this tube-feeding protocol may reduce TFN incidence at other institutions and in patients with other conditions requiring enteral nutrition.
Entities:
Keywords:
Enteral feeding; Mortality; Small bowel; Tube feed necrosis
Authors: David G Jacobs; Danny O Jacobs; Kenneth A Kudsk; Frederick A Moore; Michael F Oswanski; Galen V Poole; Gordon Sacks; L R Tres Scherer; Karlene E Sinclair Journal: J Trauma Date: 2004-09
Authors: Duncan Rc Spalding; Kasim A Behranwala; Peter Straker; Jeremy N Thompson; Robin Cn Williamson Journal: Ann R Coll Surg Engl Date: 2009-06-25 Impact factor: 1.891
Authors: Salvatore Buscemi; Giuseppe Damiano; Vincenzo D Palumbo; Gabriele Spinelli; Silvia Ficarella; Giulia Lo Monte; Antonio Marrazzo; Attilio I Lo Monte Journal: Nutrients Date: 2015-04-30 Impact factor: 5.717
Authors: Richard Zheng; Courtney L Devin; Michael J Pucci; Adam C Berger; Ernest L Rosato; Francesco Palazzo Journal: World J Gastroenterol Date: 2019-08-21 Impact factor: 5.742