SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2021 | VOLUME 19 | ISSUE 2 | 44 Confirmation of Early Economic Benefits of Nasojejunal Feeding Introduction: Patients with gastric feed intolerance and a functional and accessible small bowel will benefit from enteric feeds via a nasojejunal tube (NJT). Methods: In this retrospective audit of patients presenting between 1st March 2018 and 30th April 2020 at Groote Schuur Hospital for endoscopic placement of NJTs, patient demographics, NJT indication and tube patency duration were assessed. A cost comparison was performed evaluating cost of NJT insertion and enteral feeds versus central venous catheter (CVC) insertion and parenteral nutrition (PN) over 28 days. The aim was to determine the duration of NJT utilization needed to economically surpass CVC insertion and PN. Results: A total of 109 NJTs were attempted endoscopically in 74 patients (mean age 47 years; 39 (52.7%) male) with 102 successful insertions (93.6%). Indications were gastric outlet obstruction (40%), anastomotic leaks (12.7%), severe acute pancreatitis (11.8%) and trauma (10.9%). The average duration of tube usage prior to removal or replacement was 15.8 ± 13.8 days (1 – 68 days, IQR: 7 – 19 days). The most common tube-related complication was blockage, with 33 blockage episodes in 28 tubes recorded. Unblocking was successful in 16 (55.2%) of the episodes. NJT insertion and daily enteral feed costs (state R4 985.90; private R10 132.50) are initially higher compared to CVC and PN costs (state R1 379.26; private R5 581.14). NJT usage becomes cost-effective after two days and three days of use in state and private practice respectively. The cost-effectiveness is more pronounced after 28 days with R35 942.74 and R42 408.00 saved with NJT utilization in state and private practice respectively. Conclusion: The physiological benefits of enteral feeding are well documented. The economic benefits of NJTs are seen within 2 to 3 days of placement. Patients requiring long-term nutritional support, with an accessible and functional small bowel, should preferentially receive enteral feeding where feasible. I Kippie 1 , A du Toit 2 , M Scriba 3 , E Jonas 3 , G Chinnery 3 Khayalitsha District Hospital 1 , Department of Dietetics, Groote Schuur Hospital 2 , Department of Surgery, Groote Schuur Hospital 3 Spindle cell subtype gastric GISTS dominate the proximal stomach. A Retrospective Audit on Gastric Gastrointestinal Stromal Tumours presenting to Groote Schuur Hospital S Kuhn 1 , G Chinnery 1 , M Scriba 1 , E Jonas 1 , B Robertson 2 Department of Surgery, Groote Schuur Hospital 1 , Department of Oncology, Groote Schuur Hospital 2 Introduction: Gastrointestinal stromal tumours (GIST) are the most common tumours of mesenchymal origin, accounting for a very small percentage of gastrointestinal tract tumours and favouring the stomach. Methods: In this retrospective audit of GISTs presenting to the Groote Schuur Hospital surgical and oncological multidisciplinary team (MDT) between 2004 – 2019, gastric GISTs were evaluated as regards presentation, gastric anatomical position, histological subtype with risk stratification, management and outcomes. Results : Of 126 GIST tumours presenting to this MDT, 82 originated in the stomach. Complete histopathological records could be obtained for 64. With an average of 59 years (50 male: 32 female), 18 (28%) presented with a herald bleed. Other common presentations included anaemia, epigastric mass and pain. The tumours were predominantly found in the body and fundus (64%), with a spindle cell subtype predominance (41%). The association between cancer cell subtype and gastric position was not significantly different (p=0.728). Cystic degeneration was found on 11 (17%) analysed and cell necrosis on 12 (18%). These findings were not related to larger tumor size or prognosis. Five required downstaging with Imatinib prior to surgery. Thirty-seven patients underwent a surgical procedure, commonest being wedge resections in 24 and anatomical resections in 12 patients. Risk stratification was performed with the modified Fletcher score. 28 Cases had inaccurate mitotic counts and couldn’t be scored, 17 scored high risk, 9 intermediate risk, 9 low risk and 1 very low risk. Ten patients died of metastatic disease, 34 were discharged with no disease progression after 3 years, 1 patient with disease progression currently remains on Imatinib, and 19 were lost to follow up. Conclusion: Gastric GISTs appear to have a predilection for the proximal stomach; it is unsure whether this is purely due the greater surface area. The spindle cell subtype dominated in the proximal gastric GISTs. Cystic degeneration and cell necrosis did not seem to be related to larger tumours or outcomes. SAGES