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Patients undergoing esophagectomy often receive jejunostomy tubes (j-tubes) for nutritional supplementation. We hypothesized that j-tubes are associated with increased post-esophagectomy readmissions.We identified esophagectomies for malignancy with (EWJ) or without (EWOJ) j-tubes using the 2010-2015 Nationwide Readmissions Database. Outcomes include readmission, inpatient mortality, and complications. Outcomes were compared before and after propensity score matching (PSM).Of 22,429 patients undergoing esophagectomy, 16,829 (75.0%) received j-tubes. Patients were similar in age and gender but EWJ were more likely to receive chemotherapy (24.2% vs. 15.1%, p 0.01). EWJ was associated with decreased 180-day inpatient mortality (HR 0.72 [0.52-0.99]) but not with higher readmissions at 30- (15.2% vs. 14.0%, p = 0.16; HR 0.9 [0.77-1.05]) or 180 days (25.2% vs. 24.3%, p = 0.37; HR 0.94 [0.79-1.10]) or increased complications (p = 0.37). These results were confirmed in the PSM cohort.J-tubes placed in the setting of esophagectomy do not increase inpatient readmissions or mortality.

Clinically relevant postoperative pancreatic fistula and delayed gastric emptying cause substantial morbidity after pancreatoduodenectomy. Per international guidelines, the placement of jejunostomy tubes may be considered for patients at risk for malnutrition, such as those with a high risk for clinically relevant postoperative pancreatic fistula and related complications. This study determined predictors and postoperative outcomes of jejunostomy tube placement.Patients undergoing pancreatoduodenectomy in 2014 to 2015 were identified using the American College of Surgeons National Surgical Quality Improvement Program and Procedure-Targeted Pancreatectomy Participant Use Files. Multivariable logistic regressions were used to identify factors associated with concurrent jejunostomy tube placement and postoperative outcomes.Of 3,600 patients, 8.9% underwent jejunostomy tube placement. Patients given a jejunostomy tube were more likely white (odds ratio 1.46, P = .016), to have low preoperative serum albumin levels (odds ratio 2.13, P.001), to have received neoadjuvant radiotherapy (odds ratio 2.14, P.001), and to have received an intraoperative transfusion (odds ratio 1.50, P = .004). We observed no association between jejunostomy tube placement and an increasing number of risk factors for clinically relevant postoperative pancreatic fistula (P = .96) or delayed gastric emptying (P = .54). Overall, jejunostomy tube placement was associated with increased morbidity (odds ratio 1.34, P = .020) and duration of stay (P.001), but not mortality (P = .12). Among patients with low serum albumin or those who developed clinically relevant postoperative pancreatic fistula or delayed gastric emptying, jejunostomy tube utilization was not associated with morbidity or mortality.Jejunostomy tube placement during pancreatoduodenectomy was not driven by risk factors for clinically relevant postoperative pancreatic fistula or delayed gastric emptying, suggesting that practice patterns play a role. Among patients with at-risk preoperative albumin or who developed these complications, jejunostomy tube placement was not associated with worse outcomes, supporting selective utilization per guideline recommendations.

Gastrostomy tubes and other iterations of direct enteral feeding, such as gastrojejunostomy and jejunostomy tubes, offer a safe and effective means for continued nutrition for patients who cannot meet their minimum caloric requirement through oral intake alone. There are numerous methods for placement as well as options for types of tubes to be used. This review will briefly discuss the various options of tubes and techniques, as well as practical information regarding placement and common management issues.

Routine placement of jejunostomy tubes (JT) during pancreaticoduodenectomy (PD) is controversial.A retrospective chart review of patients undergoing PD from 1/1/08 through 12/31/14 was performed. The patients were divided into groups by placement of JT. Outcome measures were 90-day morbidity, 90-day mortality, length of stay, rate of delayed gastric emptying (DGE), and JT-specific complications.256 patients were included. There were no significant differences in 90-day morbidity (39.9% vs. 37.9%, p = 0.747), 90-day mortality (3.9% vs. 1.0%, p = 0.247) or TPN use (24.8 vs. 25.2%, p = 0.941) between those with and without JT, respectively. Patients with a JT had a higher rate of DGE (p 0.001), longer hospital stay (14.3 vs. 11.6, p 0.001), and longer time to solid intake (9.4 vs. 7.3, p 0.001). Eleven patients (7.2%) with JT had tube-related morbidity.Routine placement of JT at the time of PD should be abandoned with efforts focused on preoperative nutrition optimization and early oral diet trials.

OBJECTIVE To compare pursestring, Witzel (seromuscular inversion), and seromuscular incision jejunostomy tube placement techniques in vitro. SAMPLE Jejunal specimens from 10 dogs. PROCEDURES Jejunal segments (50 cm) were harvested immediately prior to euthanasia from 10 mixed-breed dogs Specimens were harvested with the orad and aborad ends clamped and stored in saline (0.9% NaCl) solution–soaked towels during instrumentation. Three jejunostomy tubes were placed via 3 techniques (pursestring, Witzel, and seromuscular incision), and 2 double lumen central venous catheters were placed at each intestinal end for luminal filling and leak testing. Intestinal luminal area was measured ultrasonographically with specimens suspended in a warm undyed saline solution bath with the intestinal lumen filled with dyed saline solution (intraluminal pressure, 6 mm Hg). Leak testing was performed by means of infusion of dyed saline solution (4 mL/min) until each jejunostomy site failed. Intestinal luminal area and leakage pressure were compared between the 3 tube placement techniques. RESULTS The Witzel and seromuscular incision techniques decreased the intestinal luminal area measured at the tube insertion site, albeit nonsignificantly. For the seromuscular incision technique, a significant decrease in intestinal luminal area at the intraluminal site of measurement was found. For 2/30 specimens (1/10 pursestring and 1/10 seromuscular incision), failure occurred at pressures within the range of previously reported peak peristaltic pressure for dogs. Failure occurred at supraphysiologic peristaltic pressures for the remaining 28 specimens, including all 10 specimens for the Witzel technique. CONCLUSIONS AND CLINICAL RELEVANCE In this in vitro study, all specimens for the Witzel technique withstood physiologic peristaltic pressures during leak testing. Both tunneling techniques (Witzel and seromuscular incision) created a decrease in intestinal luminal area. Further investigation, including in vivo testing, is indicated to evaluate the clinical relevance of these findings.

Aim There are limited data on home enteral nutrition patients in NSW because of the lack of a state-wide or national registry in Australia. The present study aimed to report on the trends in home enteral nutrition at a tertiary teaching hospital in NSW Australia, from 2005 to 2013. Methods A 9-year retrospective study (2005–2013) on the trends of home enteral nutrition was performed by retrieving data from a database set up specifically for home enteral nutrition patients at the study hospital. Results The number of home enteral nutrition patients at the study hospital is increasing; however, the rate of expansion has slowed down. Mean age ranged from 52.3 to 55.7 years during the study period and the most common primary diagnosis of patients remained cancer, non-malignant respiratory disease and neurological disorders. Over time there has been a notable increase in patients requiring oral nutrition support, and a corresponding decrease in patients requiring enteral tube feeding. Gastrostomy tubes remained the most common type of enteral access device for tube fed patients; however, an increase in jejunostomy tubes was observed. Death was the principal reason for discharge from the service followed by completion of home enteral nutrition. Conclusions The use of home enteral nutrition has increased in the last 9 years at the study hospital. Most patients were registered for oral nutrition support and had an underlying cancer diagnosis, which may have contributed to the high rate of death observed in this patient population.

Introduction Although not many veterinary research articles are available to prove the benefits of enteral nutrition in critically ill veterinary patients, it is widely accepted that providing nutrition improves outcome in these patients. In many cases patients do not voluntarily consume adequate levels of energy and feeding tubes are used to facilitate feeding. These include naso-enteric tubes, oesophagostomy tubes, gastrostomy tubes and jejunostomy tubes. This article gives a brief overview of the practical use and management of enteral feeding tubes and the technique for placement of naso-enteric tubes.

The use of Duodopa ® Levodopa-Carbidopa intestinal gel offers patients with advanced Parkinson’s disease (PD) an effective alternative therapy for the treatment of severe motor fluctuations and dyskinesia. This therapy requires the use of percutaneous endoscopic gastrostomy/jejunostomy tube (PEG/J) to deliver gel directly into the jejunum which poses new challenges for neuroscience nurses for the care and management of patients with PD. Due to the reported number of complications associated with PEG/J our facility opted to use a direct jejunostomy tube for the first of two PD patients which resulted in an adverse outcome for our 80 year old patient. This experience highlighted that the neuroscience nurses need to increase knowledge and understanding of PEG/J and jejunostomy care as more future patients will be treated with Duodopa, and that future studies regarding the safety and value of the direct jejunostomy tubes are warranted.

To evaluate technical success and long-term outcomes of percutaneous primary jejunostomy tubes for postpyloric enteral feeding compared with percutaneous gastrojejunostomy (GJ) tubes.Over a 25-month interval, 41 consecutive patients (26 male; mean age, 55.9 y) underwent attempted fluoroscopy-guided direct percutaneous jejunostomy tube insertion. Insertions at previous jejunostomy tube sites were excluded. The comparison group consisted of all primary GJ tube insertions performed over a 12-month interval concomitant with the jejunostomy tube interval (N = 169; 105 male; mean age, 59.4 y). Procedural, radiologic, and clinical data were retrospectively reviewed. Intervention rates were expressed as events per 100 catheter-days.The technical success rate for percutaneous jejunostomy tube insertion was 96%, versus 93% for GJ tubes (P = .47). Mean fluoroscopy times were similar for jejunostomy and GJ tubes (9.8 vs 10.0 min, respectively; P value not significant). Jejunostomy tubes exhibited a lower rate of catheter dysfunction than GJ tubes, with catheter exchange rates of 0.24 versus 0.93, respectively, per 100 catheter-days (P = .045). GJ tube tip retraction into the stomach occurred in 9.5% of cases, at a rate of 0.21 per 100 catheter-days. Intervention rates related to leakage were 0.19 and 0.03 for jejunostomy and GJ tubes, respectively (P.01). Jejunostomy and GJ tubes exhibited similar rates of catheter exchange for occlusion and replacement as a result of inadvertent removal. No major complications were encountered in either group.Percutaneous insertion of primary jejunostomy tubes demonstrated technical success and complication rates similar to those of GJ tubes. Jejunostomy tubes exhibited a lower dysfunction rate but a higher leakage rate compared with GJ tubes.

Objective: To evaluate the postoperative complication rate associated with jejunostomy tubes (J-tubes) placed using the interlocking box (ILB) technique, and to test whether the ILB technique offers the advantage of early tube removal without additional complications in comparison with other jejunopexy methods. Design: Retrospective study. Setting: Veterinary Teaching Hospital. Interventions: None. Measurements and main results: Seventy dogs and 6 cats had J-tubes placed during 1999–2003. Fifty-three tubes were placed using the ILB technique and 23 tubes were placed using a non-ILB technique. The overall tube-related complication rate was 33/76 (43.4%). The complication rate was slightly, but not significantly, lower in the ILB group (40% versus 52%; P= 0.556). In the majority of cases, (24/76, 31.5%), complications were considered mild. Moderate complications were noted in 4/76 cases (5.2%) and severe complications in 5/76 cases (6.5%). The mean time the tube remained in place and the mean time of tube usage were significantly shorter in the ILB group (5.2 versus 7.6 days, P=0.008, and 3.3 versus 5.8 days, P=0.013, respectively). Hospitalization time was also significantly shorter in the ILB group (mean of 8.1 days versus 10.5 days, P=0.014). The shorter period of tube presence in the ILB group did not result in an increase of the overall complication rate; however, inflammation around the tube exit site was more prevalent in the ILB group. Tubes that were not used for nutritional support in the ILB group stayed in place for a mean of 3.7 days and were removed with no significant complications. More complications were identified in the first 2 years of the study compared with the last 2. Conclusions: The ILB technique is not associated with a higher complication rate compared with other jejunopexy methods, and offers the advantage of safe, early removal if the tube is no longer needed for nutritional support.

The charts of children with gastrostomy or jejunostomy tubes followed in the Tube Feeding Clinic at the Children’s Hospital of Wisconsin from January 1999 to June 2002 were reviewed. Prevalence of selected nutrient deficiencies were determined and their association with growth and caloric intake was measured. One hundred fifty patients (60% male) met the inclusion criteria. The mean age of children was 7 years 6 months (SD ± 5 years 4 months). As a proportion of total caloric intake, the mean percentage of calories from formula was 92% (± 15). No deficiencies of vitamins D or E were found. Ferritin concentration below lower limits of the age-appropriate range of normal (LLN) was found in 30 of 122 (25%) and hemoglobin was below LLN in 12 of 139 (9%). One patient each had vitamin A, calcium, phosphorus, and magnesium serum concentrations below LLN. Below normal serum zinc was found in 43 of 142 (30%). Ninety-one of 134 patients (68%) had below normal selenium levels, and 29 of 126 (23%) had both zinc and selenium deficiency. A significant association was found between percentage of recommended daily allowance (RDA) of calories received and selenium concentration below LLN. Patients with selenium deficiency received a mean of 75% (± 21) of the RDA of calories for age, whereas patients without deficiency received a mean of 91% (± 19) of the RDA of calories for age (p < 0.0001). There was a negative association between deficiency and weight for age: patients with selenium deficiency were 33% mean weight for age percentile (± 30), compared to 21% (± 27, p < 0.05) for those without selenium deficiency. There was a negative correlation between the percentage of RDA of calories and height for age, weight for age, and weight for height (p < 0.05).

The first successful gastrostomy was performed 130 years ago. Although it is difficult to ascertain the exact number of gastrostomy or jejunostomy tubes placed annually in the United States, it is estimated approximately 230,000 gastrostomy procedures were performed in U.S. hospitals in 2001. Of these, 11,000 were performed in children. Despite the many years gastrostomy tubes have been in use, they are not free from complications. The purpose of this article is to review the authors' experience with pediatric patients who have undergone radiographic placement of gastrostomy or jejunostomy tubes.

The use of gastrostomy and/or jejunostomy tubes is now commonplace in paediatric practice. These tubes are most often placed by those in the surgical, gastroenterology or radiology departments, but troubleshooting and ongoing monitoring of these tubes usually falls to the primary care physician or general paediatrician. This form of management of enterostomy tube problems can be frustrating. To help address some of the commonly encountered questions surrounding these tubes, a practical approach, drawing on the large experience in their use at The Hospital for Sick Children, is presented.

Percutaneous endoscopic gastrostomy (PEG) tubes are common enteral access devices for long-term enteral nutrition. Jejunostomy tubes (J-tubes) are able to provide postpyloric enteral access in patients who are not PEG tube candidates. There is a scarcity of literature comparing complication rates of J-tubes to PEG tubes.To compare and characterize J-tube and PEG tube complications requiring tube replacement.A retrospective chart review was performed on 560 patients discharged from the Northern Alberta Home Enteral Nutrition Support Program (NAHENSP) from January 2010 to December 2011. Patients were followed for 3 years from initial tube insertion or until discharge from the NAHENSP, whichever was earliest. Comparisons were made in terms of complications requiring tube replacement, tube patency to first replacement, and indications for tube replacement.A total of 64 J-tube patients were identified and compared with 65 PEG tube patients. Tube replacement rates for the J-tube group included 3.2 cases per 1000 patient days compared with 0.86 cases per 1000 patient days in the PEG group (P.001). The mean ± SEM duration to first tube replacement for J-tube and PEG tube patients was 160 ± 26.3 days and 331 ± 53.6 days, respectively (P = .010). The most common causes for tube replacement in J-tube patients were dislodgement (35.6%) and obstruction (22.2%) compared with routine replacement (54.5%) and dislodgement (27.2%) in the PEG tube group.J-tubes are associated with higher complication rates requiring tube replacement compared with PEG tubes. The main causes of J-tube replacement are dislodgement and obstruction.

A cat with pancreatitis, diagnosed using abdominal ultrasonography, fine-needle aspirate cytopathology, and increased concentration of serum trypsin-like immunoreactive substance, was treated successfully using jejunal alimentation provided through a percutaneous gastrojejunostomy tube. This method of jejunal feeding is less technically difficult, less stressful for the patient, and has fewer complications than surgically placed jejunostomy tubes. Nutritional support with jejunal feeding is superior to total parenteral nutrition, as it maintains gut integrity, decreases septic complications, and may reduce exogenous insulin requirements. The methods of tube insertion and maintenance, and the physiological advantages over other feeding methods are described.

Drugs prepared by pharmacist may sometimes clog the nasogastric tubes, gastrostomy tubes or jejunostomy tubes during drug administration. As a result, such drugs were examined regarding their possibility of clogging. Consequently, 11% of the capsulated drugs (89 drugs) could not be used with tubes due to the fact that they did not come in a dispenser that can be used with tubes. In addition, 15% of the drugs clogged the thin tubes (8Fr.). 7% of the fine granules and granules (94 drugs) could not be used with tubes, 10% of them clogged the thin tubes.On the other hand, in order to decrease the amount of loss due to crushing the tablets, as well as to prevent health hazards, the tablets were dispersed in water. Experiments were performed to obtain data on the disintegration of the tablets in the water. As a result, 74% of 514 tablets were found to be appropriate for administration using this method, and this rate was higher than for crushable tablets (53%).The results were complied and the list of the drugs that could be successfully administered by feeding tubes was made. Accordingly, the problems in crushing were solved and tube clogging could thus be successfully prevented thus resulting in an improved QOL for the patients.

Delivery of adequate parenteral nutrition requires secure and reliable access to the gastrointestinal tract. In most circumstances, the percutaneous endoscopic gastrostomy (PEG) tube offers reliable access with low morbidity. There are situations, however, in which PEG is not advisable or possible, and an alternate means of obtaining gastrointestinal access is necessary; these include patients who do not tolerate direct intragastric feeds, those with some types of aerodigestive cancers, and clinical scenarios in which the stomach may later be used for an operative conduit. Open and laparoscopic gastrostomy and jejunostomy tubes are alternatives to PEG. Each technique has its own advantages and disadvantages. An individualized approach to enteral access usually works best.

Placement of surgical and percutaneous gastrostomy and jejunostomy tubes for enteral feeding is routinely done with the patient in a supine position. This may result in a tube exit site located in an abdominal fold or the belt line, near a bony prominence, or beneath a pendulous breast. Poor location can cause discomfort, skin irritation, leakage, and difficulty in stabilizing the tube. A tube exit site that is not easily visibile to the patient can limit resumption of self-care and independence. Two methods of preplacement marking for feeding tube locations are described. Selecting optimal gastrostomy and jejunostomy tube sites decreases complications and promotes patient independence.

Enteral feeding through jejunostomy is an established nutritional support for patients with esophageal cancer. Mechanical problems are common during long-term enteral nutrition, and jejunostomy tube dislodgment is one of the most flequent. 1 Dislodged jejunostomy tubes should be replaced as promptly as possible to maintain feeding access and require meticulous attention to obviate surgical substitution. Replacement under fluoroscopic guidance is considered safe and simple, and it is the preferred method in several centers; however, surgery remains the last option when endoscopic and radiologic methods are not successful. 2 Here we report a case of percutaneous sonographically guided needle jejunostomy after fluoroscopically guided replacement failures.

As the frequency of placement of the percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy tubes in patients who require nutritional support increases, it is imperative that nurses become familiar with the methods and how they impact on patient care. Nurses must be knowledgeable in this area so that patients are prepared correctly prior to the placement, the appropriate care is rendered after placement, and patients are well educated in catheter care. The success of the procedure depends on attention to detail in the placement and care of the tube. This article provides an overview of the care required in the placement of percutaneous endoscopic gastrostomy and jejunostomy tubes.

To determine the success rate for reinsertion of interventional radiology-placed catheters that were accidentally removed by using the existing percutaneous track and to investigate factors that influence success rate.The authors performed a retrospective analysis of 225 patients who presented with dislodged catheters (24 tunneled central venous catheters, 170 gastrostomy/jejunostomy tubes, 25 nephrostomy catheters, five biliary catheters, and one transhepatic hemodialysis catheter) and underwent attempts for reinsertion between 1999 and 2007. Data obtained from the radiology information system included the type of catheter and the indwelling and reinsertion times.The overall success rate for reinsertion was 87%. Success of reinsertion was associated with longer catheter indwelling times compared to patients who failed reinsertion (254 vs 100 days, P.01). Success of reinsertion was associated with shorter reinsertion times compared to patients who failed reinsertion (1.1 vs 2.7 days, P.05).Reinsertion of catheters by using the cutaneous track can be performed successfully during the first days after dislodgement. Success rates vary on the basis of catheter type and indwelling and reinsertion times.

Gastroesophageal reflux disease (GERD) is a motility disorder that occurs more frequently in children with neurological disease and in children with congenital esophageal anomalies or diaphragmatic hernia. Feeding difficulties and asthma may be caused by GER. Pharmacological and surgical treatment are successful in most cases. The authors describe 6 children with severe GER and asthma, who were treated with long-term jejunostomy feeding. Median length of treatment was 6 months (range, 5–12), for a total of 44 months. The parents were trained to replace dislodged jejunostomy tubes. All replacements of tubes at home by the parents were successfully carried out. Vomiting and emergency admissions for asthma were decreased in all children.

Purpose To evaluate the success rate, complications, and long term outcomes of primary percutaneous jejunostomy(J)-tubes inserted under fluoroscopic guidance in comparison to surgical J-tubes inserted under laparoscopic guidance. Materials and Methods Between 6/2010 and 8/2012, 48 patients (28 males, mean age 57 years) underwent percutaneous insertion of a primary J-tube using fluoroscopic guidance. Insertions at prior J-tube sites were excluded. For comparison, we reviewed all laparoscopic J-tube insertions from 1/2006 to 6/2011 in the absence of a concurrent major abdominal surgery, revealing 85 patients (45 males, mean age 56 years). Procedural, radiologic, and clinical notes were retrospectively reviewed. Results All J-tubes inserted with fluoroscopic guidance were performed using moderate sedation, whereas general anesthesia was required for all laparoscopic J-tubes. The technical success rate for radiologic J-tube insertion was 98% (47/48) compared to 95% (81/85) for laparoscopic J-tubes (p=0.65). One major periprocedural complication was encountered with fluoroscopic J-tube insertion (fluid collection that resolved with antibiotics) with zero major long term complications. With laparoscopic J-tube insertion, 3 patients had a major periprocedural complication (hemorrhage, extraluminal positioning, and bowel obstruction) and one had a major long-term complication (necrotizing fasciitis/abscess). Tract infection occurred in 3 patients after fluoroscopic J-tube insertion compared to 4 patients after laparoscopic J-tube insertion (p=0.71). Pericatheter leakage occurred in 13% (6/47) of fluoroscopic J-tubes compared to 14% (11/81) of laparoscopic J-tubes (p=1.0). The rate of tube exchange due to clogging for radiologic and laparoscopic J-tubes was 2.3 and 0.9 per 1000 patient days respectively. The rate of inadvertent tube dislodgement was 1.9 and 3.5, respectively. Conclusion Fluoroscopically inserted primary J-tubes demonstrated a very high technical success rate comparable to laparoscopically inserted J-tubes, with a very low major complication rate. However, whereas all surgically inserted J-tubes utilized general anesthesia, all fluoroscopically inserted J-tubes were performed using moderate sedation.

To determine the frequency and nature of abnormalities observed on radiographs after placement of jejunostomy (J) tubes for enteral nutrition.Radiology database review revealed that 280 studies of the J tube or of the small bowel with water-soluble contrast material and/or barium sulfate were performed in patients during 10 years. Review of the radiologic reports revealed abnormalities related to the placement of tubes in 105 (38%) cases. Images were reviewed to determine abnormalities in these 105 cases. Radiologic, medical, and surgical records were also reviewed to determine the clinical course and any subsequent interventions.One or more complications were detected in 40 (14%) of 280 cases: small-bowel obstruction in 17 (6%) cases, nonobstructive small-bowel narrowing in six (2%), extraluminal tracks or collections in seven (2%), extravasation of contrast material to the skin in 11 (4%), jejunal hematomas in five (2%), and intussusceptions in four (1%). Mechanical problems related to the tube were detected in 52 (19%) cases, including coiling, kinking, or knotting of the tube in 38 (14%), malpositioning in five (2%), retrograde flow in four (1%), occlusion in four (1%), and a hole in one (1%). Focal thickening of small-bowel folds was detected in 24 (9%) cases.Radiographs in 280 patients with J tubes revealed one or more complications that resulted from tube placement (40 [14%] cases), mechanical problems related to location or function of the tube (52 [19%] cases), and development of focally thickened small-bowel folds (24 [9%] cases).

TO THE EDITOR: Postpyloric enteral access is often a necessary means of providing nutrition to both children and adults with severe GERD, pulmonary aspiration, and oropharyngeal dysphagia. As confirmed by our study, G-J feeding tubes frequently malfunction, often necessitating several tube replacements, and thereby, precluding this method for providing long-term enteral nurtrition. Jejunostomy tubes can be placed by three methods: surgical, percutaneously with endoscopic guidance (PEJ), and percutaneously with fluoroscopic guidance alone (Dr. Sally E. Mitchell, personal communication).

The authors describe their experience using jejunostomy tubes placed during a primary surgical procedure in 19 adult patients during a 2-year period. All but one patient underwent a laparotomy (the one exception had a thoracotomy) for gastrointestinal cancer, peptic ulcer disease, or trauma. Large-bore (16 or 18 French) red rubber catheters were used for feeding jejunostomies. Patients were fed according to a standard protocol that included (1) use of commercially available formulas, (2) infusion pumps, (3) liberal use of antidiarrheal agents, and (4) initiation of feeding on the second postoperative day. Patients were fed by tube for a mean of 22 days and received a mean of 1850 calories with 62 g of protein per day. Feeding tubes remained in place (insertion to removal) for an average of 59 days. Seven of the 19 patients had the tubes removed during hospitalization; for the remaining patients, tubes were removed after discharge. After removal of the tube, the tract closed spontaneously and uneventfully ...

As alternatives to per os feeding and nutritional support increase in number and complexity, the interventional radiologist has come to play a more significant role in the creation and maintenance of nutritional access. In very difficult access cases, the concerted effort of the nutritional surgeon and the radiologist is often required. We describe several such situations which have been successfully managed at our institution. The indications for and techniques of percutaneous reestablishment of surgically placed jejunostomy tubes, the percutaneous conversion of gastrostomy to jejunostomy tubes with retention of the gastrostomy tube, and percutaneous placement of an inferior vena caval Hickman catheter are all described in detail. (Journal of Parenteral and Enteral Nutrition12:513-520, 1988)

Haphazard and inefficent securing of chronic gastrostomy or jejunostomy tubes causes major complications due to migration of the percutaneous feeding tube, including pyloric or intestinal obstruction, obstructive jaundice, and impaired feeding. These problems associated with current anchoring techniques can be prevented by following an inexpensive, easily learned stabilization method using sterile gauze pads and tape that fixes the tube in position.