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Feeding gastrostomy and duodenostomy using the round ligament of the liver versus conventional feeding jejunostomy after esophagectomy: a meta-analysis.

  • Yasuda, Tomohiko1
  • Matsuda, Akihisa2
  • Arai, Hiroki1
  • Kakinuma, Daisuke1
  • Hagiwara, Nobutoshi2
  • Kawano, Youichi1
  • Minamimura, Keisuke1
  • Matsutani, Takeshi3
  • Watanabe, Masanori1
  • Suzuki, Hideyuki1
  • Yoshida, Hiroshi2
  • 1 Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan. , (Japan)
  • 2 Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan. , (Japan)
  • 3 Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, Kawasaki-shi, Kanagawa Japan. , (Japan)
Published Article
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
Publication Date
Sep 01, 2023
DOI: 10.1093/dote/doac105
PMID: 36607133


Esophageal cancer patients require enteral nutritional support after esophagectomy. Conventional feeding enterostomy to the jejunum (FJ) is occasionally associated with small bowel obstruction because the jejunum is fixed to the abdominal wall. Feeding through an enteral feeding tube inserted through the reconstructed gastric tube (FG) or the duodenum (FD) using the round ligament of the liver have been suggested as alternatives. This meta-analysis aimed to compare short-term outcomes between FG/FD and FJ. Studies published prior to May 2022 that compared FG or FD with FJ in cancer patients who underwent esophagectomy were identified via electronic literature search. Meta-analysis was performed using the Mantel-Haenszel random-effects model to calculate Odds Ratios (ORs) with 95% confidence intervals (CIs). Five studies met inclusion criteria to yield a total of 1687 patients. Compared with the FJ group, the odds of small bowel obstruction (OR 0.09; 95% CI, 0.02-0.33), catheter site infection (OR 0.18; 95% CI, 0.06-0.51) and anastomotic leakage (OR 0.53; 95% CI, 0.32-0.89) were lower for the FG/FD group. Odds of pneumonia, recurrent laryngeal nerve palsy, chylothorax and hospital mortality did not significantly differ between the groups. The length of hospital stay was shorter for the FG/FD group (median difference, -10.83; 95% CI, -18.55 to -3.11). FG and FD using the round ligament of the liver were associated with lower odds of small bowel obstruction, catheter site infection and anastomotic leakage than FJ in esophageal cancer patients who underwent esophagectomy. © The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: [email protected].

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