Background:Free jejunal flap reconstruction is the main treatment for patients after pharyngoesophagectomy. During the preparation of flaps, the intestine is unavoidably subjected to ischemia which, along with the subsequent reperfusion, results in serious mucosal injury. Traditionally, these patients would be treated postoperatively with intravenous fluid infusion for 6 days followed by enteral feeding. The purpose of this study was to determine whether early enteral feeding has any beneficial effects on the ischemia/reperfusion injured flap mucosa.
Materials and Methods:This series comprised of 18 consecutive free jejunal flap reconstructions after pharyngoesophagectomy in Chang-Gung Memorial Hospital and E-Da Hospital, Taiwan. Informed written consent was obtained from each patient before operation. Patients were divided into (1) control group: patients received intravenous fluid infusion for 6 postoperative days followed by enteral feeding, (2) early enteral-fed group: in addition to regular intravenous fluid infusion, administration of 5% glucose (25 ml/h) via jejunostomy tube was initiated 6 hours after surgery and lasted for 7 days. Fluid secreted from the monitor loop of the flap was collected daily. Blood and tissue samples were harvested at different time points. Plasma and luminal levels of interleukin (IL)-6, IL-10, epidermal growth factor (EGF), secretory Ig A (sIgA) were measured.
Results: There were no significant differences in either plasma or flap luminal concentrations of IL-6, IL-10 at different time points between groups. Also, the luminal sIgA levels in both groups were similar. In the control group, the luminal EGF level reduced markedly from 3rd postoperative day and the initiation of enteral feeding did not alter this decrease. In contrast, early enteral feeding successfully maintained the luminal EGF concentrations throughout the 8-day study period. Histological examinations are currently underway and the correlations between histological alterations and other measured parameters will be assessed.
Conclusions: Early enteral feeding with 5% glucose has no significant influence on the secretions of IL-6, IL-10 and sIgA; nevertheless, the present observations suggest that it does exert effect(s) to maintain the flap luminal release of EGF, a cytoprotective hormone.