Percutaneous primary jejunostomy tubes inserted using fluoroscopic guidance: comparison to laparoscopically inserted jejunostomy tubes

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.