We wish to commend the authors for high-lighting an extremely important aspect in managing patients after oesophagectomy. However, no indication was given regarding the type of resection performed in the centres surveyed. In Exeter, we currently offer minimally invasive oesophagectomy (MIO) to all patients suitable for resection and, this procedure has specific diet-related issues which are important to high-light:
In the absence of significant postoperative discomfort and morbidity following MIO, patients were inadvertently taking large portions of hospital food when commenced on oral intake after the fifth postoperative day. This resulted in excessive gastric distension, and subsequent anastomotic leak in two patients. As a consequence, we have now introduced an enforced, structured postoperative diet with no further problems.
The authors do not mention the route of postoperative jejunal feeding used. We use fine bore nasojejunal feeding tubes placed endoscopically during surgery. These are well tolerated, and rapidly weaned after the commencement of oral intake on postoperative day 5/6 by virtue of the rapid restoration of gastrointestinal function after MIO. This avoids the inherent morbidity associated with percutaneous jejunostomy tubes.1
Footnotes
Reference
- 1.Pearce CB, Duncan HD. Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: its indications and limitations. Postgrad Med J. 2002;78:198–204. doi: 10.1136/pmj.78.918.198. [DOI] [PMC free article] [PubMed] [Google Scholar]