Introduction: Sleeve gastrectomy is the most common surgical procedure for weight loss. Gastric leaks may occur at the staple line which are difficult to manage. Endoscopic therapy is a potential option for leak management but requires the patient to be placed on supplemental nutrition. The purpose of this study was to determine which type of nutritional support, tube feeds (TF) or total parenteral nutrition (TPN) was optimal in achieving the patient’s nutritional goals.
Methods: A retrospectively maintained prospectively gathered database identified patients who underwent endoscopic therapy for gastric leak from a sleeve gastrectomy. The patient's supplemental nutrition was collected. Primary endpoints included mean length of stay (LOS), nutrition days, % kcal met, % protein met, and albumin.
Results: A total of 28 patients (7 male, 21 female) met the inclusion criteria for the study. 5 patients received tube feeds (TF), 11 patients received total parenteral nutrition (TPN), and 12 patients received both. Patients who received TPN met their daily kcal goals unlike patients who received TF (97.4%% vs 55.4%, p < 0.01). Patients who received TPN also met their daily protein goals unlike patients who received TF (105.9% vs 58.7%, p < 0.01). Albumin trends revealed that patients who only received TPN had higher albumin levels on the day of admission and were able to maintain this for 20 days, compared to the tube feed cohort. However, both groups were below the normal reference range 3.4-5.0.
Conclusion: TPN delivered the most optimal results by helping patients achieve their nutritional goals where the TF failed to meet them. Patients undergoing endoscopic therapy for leak management may experience greater benefits from receiving TPN as opposed to TF.
