Cateter nasoentérico ou jejunostomia como via de nutrição no pós-operatório de grandes procedimentos no trato gastrointestinal superior

Abstract

Procedures for upper gastrointestinal (GI) cancer are complex and associated with high morbidity and mortality. The patients are frequently malnourished, thus early postoperative enteral therapy is recommended. However, there is no consensus concerning the best enteral therapy access in these cases. From 2008 to 2012, a prospective randomized trial in which 59 who undergo esophagectomy, total gastrectomy and cephalic pancreatoduodenectomy were selected. Four of them didn`tagree with randomization and 13 were excluded due to peroperative change of the planned procedures. Therefore 42 patients were included, 21 received nasoenteric tubes (CNE) and 21 jejunostomies. Demographic and clinical aspects were similar in both groups. The CNE and jejunostomy groups were started on early enteral therapy in 71.4% and 61.9% of cases (p>0.05), respectively. The median length of enteral therapy was lesser in the nasoenteric group (8.5 vs 15.3 days), but without statistical significance. However, this group required parenteral therapy more frequently (p<0.05). Complications related to the enteral route occurred in 38,0% and 28,5% of patients (p>0.05) in the CNE and jejunostomy groups, respectively and, none of them caused severe derangements. In CNE group, there were four losses and four tube obstructions. In the jejunostomy group, there were two losses, four obstructions and two cases of leakage around the tube. In this group, patients who had tube complications were those who used it for a longer time (26.5 days) compared to pacients without tube complications (6.5 days) (p<0.05). And had longer ICU and hospital stay (p<0.05). We conclude that both enteral routes are associated with similar number of tube related complications. However, the use of jejunostomy allows longer enteral therapy use, especially in those patients with complications, thus avoiding parenteral therapy.