Benefits of early postoperative jejunal feeding in patients undergoing duodenohemipancreatectomy

AIM： To study whether early postoperative enteral nutrition reduces the incidence of complications and/or improves nutritional status following duodenohernipancre atectomy （DHP）. METHODS： We studied 39 patients who underwent DHP for a peri-ampullary mass. Twenty-three patients received total parental nutrition and then started to have an oral intake of nutrition between postoperative day （POD） 7 and 14 [late postoperative enteral nutrition （LPEN） group]. Sixteen patients started to have enteral feeding through a jejunostomy catheter the day after the operation [early postoperative enteral nutrition （EPEN） group]. The incidence of complications and laboratory data at the early postoperative stage were studied in comparison between LPEN and EPEN groups. RESULTS： Serum levels of albumin and total protein in the EPEN group were significantly higher than those in the LPEN group. The loss of body mass index was significantly suppressed in the EPEN group as compared to the LPEN group. The lymphocyte count decreased immediately after the operation was restored significantly faster in the EPEN group than in the LPEN group. The EPEN group showed significantly fewer incidences of postoperative pancreatic fistulas, as well as a significantly shorter length of hospitalization than the LPEN group. There were no significant differences in the incidences of other postoperative complications between the two groups, such as delayed gastric emptying, surgical site infection, cholangitis, and small bowel obstruction.CONCLUSION： EPEN is a safe and beneficiaopportunity for patients who have undergone DHP for a peri-ampullary mass.

Isolated neutropenia caused by copper deficiency due to jejunal feeding and excessive zinc intake:A case report

BACKGROUND Percutaneous endoscopic gastrostomy with jejunal extension(PEG-J)is often used to treat patients with neurological impairment and difficulty in swallowing.However,these patients often develop copper deficiency.This report describes a case of isolated neutropenia,which is a rare manifestation of copper deficiency.CASE SUMMARY Our patient was a 19-year-old boy with neurological impairment and gastroesophageal reflux.He received PEG-J feeding,including an enteral supplement containing copper and zinc.However,as his serum zinc level was low(53μg/dL)at the age of 19 years and 2 mo,we changed to a zinc-rich supplement containing 22 mg/d of zinc and 1.0 mg/d of copper.The supplement comprised a mixture of isocal 1.0 junior(5 packs/d),Tezon[2 packs(250 mL)/d],and cocoa powder.Seven months later,he had neutropenia(606/mm^(3))with a serum copper level of 16μg/dL.There were no other manifestations of copper deficiency,including anemia.Copper deficiency and neutropenia both improved following the administration of cocoa powder and Tezon.CONCLUSION In patients receiving long-term PEG-J feeds,white blood cell counts,hemoglobin,and serum levels of copper and zinc should be regularly monitored.

Placement of a Jejunal Feeding Tube via an Ultrasound-Guided Antral Progressive Water Injection Method

Background： Jejunal feeding tube allows the nutrition of critical care patients more easy and safe. However, its placement remains a challenge. This study aimed to introduce a jejunal feeding tube through an ultrasound-guided antral progressive water injection method and subsequently to examine its efficacy. Methods： Between April 2016 and April 2017, 54 patients hospitalized in the Department of Critical Care Medicine, Peking Union Medical College Hospital, China who needed nutritional support through a jejunal feeding tube were recruited for this study. Patients who applied ultrasound-guided antral progressive water injection method were classified into the experimental group. Patients who applied conventional method were registered as control group. Results： No significant differences were found in age, body mass index, and Acute Physiology and Chronic Health Evaluation score, but a significant difference in operation time was found between the experimental group and the control group. Of the 24 individuals in the control group, 17 displayed clear catheter sound shadows once the tube entered the esophagus. In comparison, of the 30 individuals in the experimental group, all harbored catheter sound shadows through the esophageal gas injection method. Subsequent observation revealed that in the control group （via ultrasonographic observation）, 15 individuals underwent successthl antral tube entry, for a success rate of 63%. In the experimental group （via antral progressive water injection）, 27 individuals underwent successful antral tube entry, for a success rate of 90%. There was a significant difference between the success rates of the two groups （x2 = 5.834, P= 0.022）. Conclusion： The antral progressive water injection method for the placement of a jejunal feeding tube is more effective than the traditional ultrasonic placement method.