TITLE OF CASE
Nutrition management for Post Total Esophagectomy
BACKGROUND
Patient who undergoes esophagectomy need extensive dietary modification due to the surgical intervention done. Patient usually requires nutrition support to supplement macronutrient and micronutrient adequately during postoperative period.
CLIENT HISTORY
34 years old Chinese male, a habitual drug user with no other known comorbidity, was admitted to hospital due to corrosive esophageal stricture. Total esophagectomy surgery was done along with colon conduit and Roux-En-Y reconstruction.
ASSESSMENT (Anthopometry, Food nutrition history)
Patients BMI was 27.8kg/m2, Ideal body weight 73kg and mNUTRIC score was 4. Jejunostomy tube was inserted before surgery. Patient’s feeding was withheld after surgery. He was on IV dextrose saline 5% 40ml per hour. Energy intake was 193 kcal and 0 g of protein. Energy requirement was 1825 – 2190 kcal and protein 109.5g based on 25-30kcal/kg and protein 1.5g/kg.
NUTRITION DIAGNOSIS
Inadequate energy intake related to altered GI function as evidence by patient received IV dextrose saline 5% 40ml per hour as energy intake per day was 193kcal post esophagectomy.
OBJECTIVE OF MANAGEMENT & NUTRIENT PRESCRIPTION
To optimize nutrition intake to promote wound healing and to prevent loss of lean body mass. Nutrient prescription was continuous jejunostomy feeding, peptide based enteral nutrition (EN) with initial rate of 20ml per hour and maximum feeding of 90 ml per hour (2160 kcal and 87 g of protein).
OUTCOME AND FOLLOW UP
Patient did not tolerate feeding well as evidence by vomiting and high gastric residual volume: 600ml. Trophic jejunostomy feeding was planned and the remaining nutrients needs were supplemented through parenteral nutrition.
DISCUSSION
Jejunostomy feeding is commonly used as route of nutrient delivery for patient post esophagectomy as patient will be more likely to increase or maintain weight . Placing percutaneous endoscopic gastrostomy (PEG) tube was not suggested as it may cause defects on the conduit.
LEARNING POINTS/TAKE HOME MESSAGES
• Jejunostomy is the preferred route for post esophagectomy feeding.
• Poor nutrition management with post-esophagectomy will cause malnutrition and increase the risk of clinical complications.
• Combination of EN and PN may be needed to optimize nutrient while preserve gut function.
