Q17. When or how should post operative tube feeding commence?

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Evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer
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Findlay, M, Bauer, J, Brown, T, Head and Neck Guideline Steering Committee. COSA:Head and neck cancer nutrition guidelines/Nutrition implementation - Surgery/When or how should post op tube feeding commence . In: Evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer. Sydney: Clinical Oncological Society of Australia. [Version URL: https://wiki.cancer.org.au/australiawiki/index.php?oldid=100892, cited 2023 Dec 11]. Available from: https://wiki.cancer.org.au/australia/COSA:Head_and_neck_cancer_nutrition_guidelines.


Last modified:
9 February 2015 13:19:43




Q17. When or how should post operative tube feeding commence?

Summary

There are no specific studies relating to the timing of commencing post operative tube feeding in patients with head and neck cancer, and so refer to the European Society of Parenteral and Enteral Nutrition (ESPEN) Guidelines on Enteral Nutrition: Surgery Including Organ Transplantation [1]. In the literature specific to the head and neck cancer population, there is one level II neutral quality study [2] which examined overnight versus continuous feeding. Whilst overnight feeding was deemed to be more energy efficient, it demonstrated poorer nitrogen balance.

One level III-2 neutral quality study [3] compared method of tube feeding (gravity versus bolus versus pump) on the impact of gastrointestinal tolerance, and found no significant difference.

The remaining studies examined route of enteral feeding. One level III-2 neutral quality study [4] compared outcomes of enteral feeding via nasogastric versus gastrostomy tubes in post-operative patients and found that weight loss was significantly lower in the gastrostomy group, with fewer complications and higher patient acceptance and duration of nutritional support than in the nasogastric group. The final three studies are level IV (1 neutral quality, 2 negative quality) and look at pharyngostomy as a route of enteral feeding [5][6][7]. This was traditionally used in the 1980’s prior to other technology, but has recently been addressed again in the literature in 2006 and 2008, however the complication rates are high, although minor e.g. oesophagitis, tube removal/dislodgement, tube migration.

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Recommendation Grade
Post operative tube feeding should commence within 24 hours in patients in whom oral feeding cannot be established, with individual consideration to patients depending on surgical procedures in collaboration with the multidisciplinary team. 		A
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References

  1. ↑ .
  2. ↑ Campbell IT, Morton RP, Macdonald IA, Judd S, Shapiro L, Stell PM. Comparison of the metabolic effects of continuous postoperative enteral feeding and feeding at night only. Am J Clin Nutr 1990 Dec;52(6):1107-12 Available from: http://www.ncbi.nlm.nih.gov/pubmed/2122715.
  3. ↑ Pesola GE, Hogg JE, Yonnios T, McConnell RE, Carlon GC. Isotonic nasogastric tube feedings: do they cause diarrhea? Crit Care Med 1989 Nov;17(11):1151-5 Available from: http://www.ncbi.nlm.nih.gov/pubmed/2507225.
  4. ↑ Sobani ZU, Ghaffar S, Ahmed BN. Comparison of outcomes of enteral feeding via nasogastric versus gastrostomy tubes in post operative patients with a principle diagnosis of squamous cell carcinoma of the oral cavity. J Pak Med Assoc 2011 Oct;61(10):1042-5 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22356051.
  5. ↑ Patil PM, Warad NM, Patil RN, Kotrashetti SM. Cervical pharyngostomy: an alternative approach to enteral feeding. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006 Dec;102(6):736-40 Available from: http://www.ncbi.nlm.nih.gov/pubmed/17138174.
  6. ↑ .
  7. ↑ John DG, Fielder CP. The feeding pharyngostomy: an alternative approach to enteral feeding. J Laryngol Otol 1991 Jun;105(6):451-3 Available from: http://www.ncbi.nlm.nih.gov/pubmed/1906520.

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