Nutritional supplementation via their jejunostomies for six weeks post hospital discharge, with continued assessment for a further 18 weeks.

No jejunal feeding of patients for six weeks following hospital discharge, with continued assessment for a further 18 weeks

A feeding jejunostomy tube is inserted at the time of surgery to provide enteral nutritional support.

Jejunal feeding

Stephen J Lewis, MBBS, MD

Patients due to undergo surgery for oesophageal and gastric malignancy are often malnourished. Up to 10% of patients preoperative weight may also be lost during the early postoperative period. Following discharge from hospital the mechanics of the surgery leads to a loss of gastric reservoir function, lack of appetite, altered intestinal motility and gastro-oesophageal reflux which usually results in reduced dietary intake and further weight loss. In patients who have undergone upper gastrointestinal resections there are no studies examining the benefit of nutritional supplementation following hospital discharge, however, studies in other groups of surgical patients have failed to show benefit. Despite patients who have undergone upper gastrointestinal surgery being 'at risk' nutritionally, there is no evidence demonstrating the value or not of nutritional supplementation following hospital discharge.

Hypothesis: The postoperative under nutrition seen after upper gastrointestinal surgery will exacerbate the reduced quality of life and fatigue patients' already experience. The investigators hypothesise that improving patient's nutritional intake following hospital discharge will improve their quality of life and fatigue levels.

For patients undergoing upper gastrointestinal (GI) surgery for cancer:

1. Because of the nature of upper gastrointestinal surgery these patients have been shown to suffer undernutrition and weight loss after hospital discharge (up to 3 months) and to a greater extent than other groups of surgical patients. Quality of life and fatigue is a major issue after upper GI surgery.
2. Nutritional supplementation via a jejunostomy after hospital discharge is only done routinely for all patients in 10%, and for selected patients in 20% of United Kingdom (UK) hospitals.
3. Derriford hospital is very unusual in that 85% of patients are given home jejunal feeding.
4. In Devon and Cornwall home enteral nutrition is delivered under contract by Fresenius Kabil (a global health care company).
5. There are no studies of home nutritional supplementation in upper GI surgical patients.
6. Studies of home nutritional supplementation in surgical patients having undergone colorectal surgery have not shown clinical or Quality of Life (QoL) benefit despite weight gain.
7. The process of enteral nutrition may be associated with a reduction in quality of life.
8. There is a need for a clinical trial to establish the benefit of home enteral nutritional supplementation. The results of any such trial may influence the highly variable nutritional present practice and may influence the surgeons desire to place a feeding jejunostomy (or not) at surgery which is associated with clinical complications.

Enteral Feeding in Discharged Patients

Randomised Trial of Enteral Feeding in Patients Discharged From Hospital Following Surgical Resection of an Upper Gastrointestinal Malignancy

The primary outcome will therefore be fatigue as measured by the multidimensional fatigue inventory (MFI-20) score. The MFI-20 is divided into five scales: general fatigue, physical fatigue, reduced activity, reduced motivation and mental fatigue.

We will use the oesophagus specific quality of life (QLQ-OES18) scale. The QLQ-OES18 scale is a disease specific Health-related quality of life (HRQL) questionnaire, designed to examine the influence of upper gastrointestinal pathology on patients and improvement in HRQL following treatment.

Health economic analysis will be based on the EuroQol (EQ 5D) scale 4 (this scale defines health in terms of five dimensions: mobility, self care, usual activities, pain and anxiety).

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Enteral Feeding in Discharged Patients	NCT02155140	Surgical Resect... Nutritional Sup...	Jejunal feeding	18 Years -	University Hospital Plymouth NHS Trust
Enteral Feeding in Discharged Patients	NCT02155140	Surgical Resect... Nutritional Sup...	Jejunal feeding	18 Years -	University Hospital Plymouth NHS Trust

Spots Global Cancer Trial Database for nutritional supplementation via a jejunostomy post discharge from hospital