The role of feeding jejunostomy on supportive enteral nutrition for resectable esofago-gastric junction adeno carcinoma undergoing total gastrectomy and esofago jejunostomy reconstruction: a case series


  • Budhi Ida Bagus Department of Surgery, Sebelas Maret University, Indonesia



Feeding jejunostomy, Enteral nutrition, Esofago-gastric adeno carcinoma


As a part of enhanced recovery after surgery protocols (ERAS), early gut feeding has been applicated in most of gastrointestinal surgery including major resection of distal esophageal and esofago-gastric junction adeno carcinoma. Early gut feeding could be applicated not only in minimally invasive procedure, but also in conventional open technique. Many enteral feeding option can be chosen as a post-operative enteral nutrition for the patients. One of them is feeding jejunostomy tube placement, we will evaluate the safety and effectivity of this enteral route on resectable esofago-gastric cancer resection. We will evaluate the clinical outcome of resectable esofago-gastric cancer patients and reconstruction, feeding jejunostomy tube has been placed as post-operative enteral route for nutrition. The patient with history of neoadjuvant therapy will be excluded. The post-operative evaluation including morbidity associated with jejunostomy tube will be recorded. We reported 4 cases, all of them had stage III esofago-gastric adeno carcinoma and conventional laparotomy technique was done. Feeding jejunostomy was tolerated well by the patients, enteral feeding can be started during the first 24 hours after surgery. No post-operative ileus and surgical site infection has been reported. Tube site infection was not found during this study. Although it still remains controversial, feeding jejunostomy tube was safe, feasible and has been tolerated well on esofago-gastric cancer patients undergoing resection and reconstruction.


Low DE, Allum W, De Manzoni G, Ferri L, Immanuel A, Kuppusamy M, et al. Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations. World J Surg. 2019;43(2):299-330.

Rubinkiewicz M, Witowski J, Su M, Major P, Pędziwiatr M. Enhanced recovery after surgery (ERAS) programs for esophagectomy. J Thorac Dis. 2019;11(5):S685-91.

Liu F, Wang W, Wang C, Peng X. Enhanced recovery after surgery (ERAS) programs for esophagectomy protocol for a systematic review and meta-analysis. Medicine (Baltimore). 2018;97(8):e0016.

Ashok A, Niyogi D, Ranganathan P, Tandon S, Bhaskar M, Karimundackal G, et al. The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection. Surg Today. 2020;50(4):323-34.

Parise P, Ferrari C, Cossu A, Puccetti F, Elmore U, De Pascale S, et al. Enhanced Recovery After Surgery (ERAS) Pathway in Esophagectomy: Is a Reasonable Prediction of Hospital Stay Possible? Ann Surg. 2019;270(1):77-83.

Findlay JM, Gillies RS, Millo J, Sgromo B, Marshall RE, Maynard ND. Enhanced recovery for esophagectomy: a systematic review and evidence-based guidelines. Ann Surg. 2014;259(3):413-31.

Berkelmans GH, van Workum F, Weijs TJ, Nieuwenhuijzen GA, Ruurda JP, Kouwenhoven EA, et al. The feeding route after esophagectomy: a review of literature. J Thorac Dis. 2017;9(8):S785-91.

Huang ZD, Gu HY, Zhu J, Luo J, Shen XF, Deng QF, et al. The application of enhanced recovery after surgery for upper gastrointestinal surgery: Meta-analysis. BMC Surg. 2020;20(1):3.

Zhang C, Zhang M, Gong L, Wu W. The effect of early oral feeding after esophagectomy on the incidence of anastomotic leakage: an updated review. Postgrad Med. 2020;132(5):419-25.

Findlay JM, Tustian E, Millo J, Klucniks A, Sgromo B, Marshall RE, et al. The effect of formalizing enhanced recovery after esophagectomy with a protocol. Dis Esophagus. 2015;28(6):567-73.






Case Series