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PubMed1986

Paracetamol absorption from a feeding jejunostomy.

Disposition of paracetamol oral elixir was determined in two male patients after administration via feeding jejunostomy and compared with four male controls who received the same dose by mouth. Area under the plasma concentration-time curve, elimination half-life, and time to maximum concentration were similar in both groups after 650 mg paracetamol elixir. The absolute amounts and ratio of paracetamol glucuronide to sulphate, the major urinary metabolites after therapeutic paracetamol doses, were similar after jejunal administration as compared to oral administration. Paracetamol is absorbed and biotransformed in a similar manner after either jejunal or oral administration. Therefore, it may be administered effectively via jejunostomy tube in patients who require this route of administration.

Acetaminophen↗

PubMed1985

Pneumatosis intestinalis associated with enteral feeding by catheter jejunostomy.

Pneumatosis intestinalis is an unusual, but potentially serious, postoperative complication. The differential diagnosis includes life-threatening conditions, such as intestinal necrosis, that may require immediate surgical intervention. The authors describe a case of pneumatosis intestinalis occurring postoperatively in a seriously ill patient with advanced ovarian cancer. The cause of pneumatosis intestinalis was attributed to enteral feeding by catheter jejunostomy, and a successful outcome is reported after conservative management. As the use of enteral feeding through catheter jejunostomies will likely increase, this cause of pneumatosis intestinalis must be recognized.

Aged↗

PubMed1985

[Catheter jejunostomy in elective abdominal surgery].

Needle catheter jejunostomy is used to a varying extent today. Therefore, the need for nutritional support was evaluated following elective abdominal surgery and compared to experiences with postoperative enteral feeding. Oesophagectomy, total gastrectomy and the Whipple procedure were identified as good indications for catheter jejunostomy, whereas with other types of operation an individual decision is required.

Catheters, Indwelling↗

PubMed1985

[Total duodenal diversion by fundo-jejunostomy with Roux-Y-loop in the treatment of severe postoperative recurrent reflux esophagitis].

Fundo-jejunostomy with a 60 cm long Roux-en-Y loop removes almost all symptoms in severe postoperative recurrent reflux esophagitis. We analysed 12 own cases and compared them with those published in literature. 90% of most satisfactory results were obtained. Nevertheless indication for fundo-jejunostomy must be discussed and limited to those cases, which do not respond to medical treatment.

Duodenum↗

PubMed1984

Reinsertion of a catheter for feeding jejunostomy.

A simple technique for the reinsertion of a feeding jejunostomy after its breakdown is described. The catheter of the old jejunostomy was used as a guide for the new one. This technique allows the old catheter to be changed by nonoperative means, thus avoiding a second laparotomy. No complications occurred following this procedure.

Catheterization↗

PubMed1984

A three year experience with needle catheter jejunostomy in a community hospital.

Sixty-one needle catheter jejunostomy procedures have been performed in a community hospital setting with no morbidity. The procedure has been used as an adjunct to a variety of surgical procedures. Upon review of patients receiving a needle catheter jejunostomy, we believe that there should be a wider application of this technique especially in the area of trauma and malignant disease.

Catheterization↗

PubMed1983

[Minimal jejunostomy for early postoperative enteral feeding: technic and results].

From March 1980 to December 1982, at the 2nd Surgical Clinic of the University of Milan, 47 jejunostomies were performed at the conclusion of a major gastrointestinal surgery to provide immediate post-operative enteral nutrition. A fine needle catheter jejunostomy technique according to Delaney (10) was employed in all cases, using a polythene catheter with an internal diameter of 2.5 mm. inserted into the proximal jejunum using a stainless-steel needle. An elemental diet (13) was adopted and fed through a volumetric infusion pump. Enteral nutrition was usually initiated on the second postoperative day and on average lasted 12 days. No complications connected to positioning, permanence or removal of the catheter were observed. The only inconvenience was represented by obstruction of the catheter with food concretion thus feeding was discontinued in 3 patients. Collateral effects were observed in 9 patients: diarrhoea (5 cases), hyperperistaltis (2 cases), abdominal distension and nausea (1 case). This method of nutritional intake allowed us to: maintain body weight at pre-operative values; obtain a positive nitrogen balance on average the sixth postoperative day; reduce the volume of parenteral support, early suspension and a significant reduction in complications connected with this method.

Catheterization↗

PubMedDate not supplied

Laparoscopic-guided feeding jejunostomy.

Access for long-term enteral nutrition has long been the job of the surgeon. While percutaneous endoscopic gastrostomy has revolutionized the way we provide gastric feedings, jejunal access usually requires laparotomy. We have developed a technique for placing a laparoscopic guided jejunostomy. Twenty-three patients have undergone this procedure without complication. We believe this technique will be a valuable addition to the surgeon's options for obtaining enteral access.

Adult↗

PubMed1994

Direct endoscopic percutaneous jejunostomy (EPJ). Clinical results.

Direct puncture of the small bowel under endoscopic guidance (direct EPJ) is possible in patients whose stomach has been removed or whose small bowel cannot be punctured by other methods. From January 1990 to June 1992 a total of 39 patients underwent successful direct EPJ at our institution. The indications were malnutrition after partial or total gastrectomy (n = 19), insufficient anastomosis or a stenosis after esophageal resection and esophagojejunostomy (n = 13), esophageal perforation (n = 3), fistulas (n = 2), or severe trauma (n = 2). The tubes were inserted at the bedside under local anesthesia using the string pull-through technique. The procedure was attempted in five other patients but it was technically impossible to insert the tubes in these patients. Postoperative enteral feeding was possible in all 39 patients whose direct EPJ was successful. Complications included tube dysfunction due to plugging and fracture in five patients, pressure-induced enteric ulcers in two, and local infections in three patients. The ulcers and infections were managed conservatively. We conclude that direct EPJ is a safe, effective alternative to surgical catheter-jejunostomy.

Adult↗

PubMed1991

Hemodynamic monitoring and pulse oximetry during percutaneous gastrostomy and jejunostomy: necessity or nuisance?

Hemoglobin desaturation and arrhythmias have been reported during diagnostic gastroscopy and colonoscopy. During endoscopic placement of percutaneous gastrostomy tubes (PEG), the gastroscope is inserted twice and the stomach is markedly distended, thus increasing the potential risk of complications. Also, the procedure is frequently performed in patients exhibiting underlying systemic disease or little respiratory reserve. Patients undergoing PEG or percutaneous endoscopic jejunostomy (PEJ) were studied prospectively. Blood pressure, pulse, pulse oximetry, and lead II ECG tracings were obtained. Measurements were made before sedation, after sedation, at gastroscope insertion, at gastrostomy placement, at gastroscope reinsertion, and at 5 min after the procedure. In all, 50 patients (mean age, 56.8 years; 16 women, 26 men) underwent PEG only (39 cases) or PEG/PEJ (11 cases). The endoscopy suite was the site for the procedure in 38 cases and the intensive care unit was used in 12 cases. The mean time required for PEG and PEG/PEJ was 14.7 +/- 1.1 and 18.9 +/- 2 min, respectively. Blood pressure remained stable throughout the procedure. Sinus tachycardia was observed in 72% of patients. Arterial oxygen saturation decreased after the administration of intravenous sedation but remained constant during the procedure. We reached the following conclusions: (1) desaturation occurs during sedation, (2) saturation remains constant during PEG/PEJ, (3) the mean blood pressure remains constant during PEG/PEJ, and (4) PEG/PEJ are safe procedures and monitoring should be individualized.

Adolescent↗

PubMed2005

[Inspection jejunostomy after complex reconstruction of the central bile duct. Indication, description, and personal experience].

INTRODUCTION: A modified Roux-en-Y hepaticojejunostomy that allows postoperative endoscopic access was first described in 1984. We report our experience with this operative procedure. METHODS: After complicated bile duct resection, reconstruction was performed as a modified Roux-en-Y hepaticojejunostomy, with the 20 cm afferent limb brought up as in terminal jejunostomy in the right upper abdominal quadrant. Postoperative follow-up consisted of endoscopic and radiologic control of the biliary tree every 3 months for 1 year; ileostomy resection was performed 1 year later if the postoperative course was undisturbed. RESULTS: From March 1995 to February 2002, we performed this operation in 17 patients (mean age 56 years). The endoscopic and radiologic (cholangiography) diagnostic procedures--every 3 months postoperatively--were uneventful. CONCLUSIONS: The modified Roux-en-Y hepaticojejunostomy described here permits good control and intervention in complicated surgery for bile duct lesions, tumor resection with unclear resectional margins, and recurrent intrahepatic stone formation.

Adult↗

PubMed1997

Cholescintigraphy in the evaluation of bile flow after Roux-en-Y hepatico-jejunostomy and hepatico-antrostomy in infants with choledochal cysts.

BACKGROUND: The study tests the hypothesis that stasis of bile in the Roux-en-Y hepatico-jejunostomy (RYJS) loop might facilitate biliary reflux and cause cholangitis, whereas quicker transit times in hepatico-antrostomy (HAST) might prevent cholangitis. MATERIALS AND METHODS: Cholescintigraphy was performed using Tc99m-trimethyl-Br-IDA in seven RYJS patients and in five HAST patients. RESULTS: The time to peak (Tmax) within the RYJS loop occurred between 18 and 50 min postinjection in all patients and the mean transit time (MTT) ranged between 42 and 69 min in 5/7 patients. Prolonged clearance of the tracer from the liver was seen in 2/7 RYJS patients, in whom the MTT was 77 and 240 min, respectively. In the HAST group, the Tmax within the anastomosed antrum occurred between 5 and 33 min postinjection, and the MTT ranged between 42 and 44 min in 2/5 patients. Protracted tracer uptake in the liver in one patient and localised tracer retention in the left hepatic bile ducts in 2/5 patients caused prolonged MTTs. Recurrent cholangitis and diarrhoea occurred in 4/7 RYJS patients, but in none of the HAST patients. Elevated gastrin levels after RYJS contrasted sharply to normal gastrin levels after HAST. CONCLUSION: The findings on cholescintigraphy did not differ significantly between RYJS and HAST and provided no explanation for the distinctly different postoperative clinical course of both surgical methods. Nevertheless, we consider cholescintigraphy to be an efficient and cost-effective diagnostic modality for evaluation of the surgical outcome as regards biliary flow.

Anastomosis, Roux-en-Y↗

PubMed2003

Use of pyloric exclusion with a double jejunostomy in the treatment of a serious duodenal lesion in a child.

A 3-year-old male was beaten by his stepfather, resulting in a lesion of the third portion of the duodenum that was treated with an occlusive suture of the pyloric mucosa for pyloric exclusion and a gastric-jejunal anastomosis with a double jejunostomy for alimentation with a good result, no serious complications, and relatively a short hospitalization. This procedure may be an alternative for other similar cases.

Abdomen, Acute↗

PubMed2001

Is there a role for high jejunostomy in the management of severe necrotising enterocolitis?

Necrotising enterocolitis (NEC) remains a common and severe condition affecting both preterm and term infants. Treatment when NEC involves a large proportion of the gastrointestinal tract remains controversial. We present one surgeon's experience of high jejunostomy (HJ) as the primary procedure in this group of children. HJ was performed in the presence of severe panintestinal disease. In those who survived, a second-look procedure and reconstruction was performed after 6 to 8 weeks. Over a 16-year period, 10 of 113 patients with NEC had a HJ constructed. Two died within 1 day due to persisting instability; the others survived to undergo a second-look laparotomy. Intestinal continuity was restored in all cases with one to five anastomoses. Three patient's died within 1 year from total parenteral nutrition (TPN) related cholestasis and cirrhosis. Five became long-term TPN-free survivors. The HJ as an initial procedure is a useful surgical option in neonates with severe NEC affecting the majority of the intestine. In this high-risk group, we achieved 50% survival from NEC.

Anastomosis, Surgical↗

PubMed2000

Ultrasound-assisted direct percutaneous endoscopic jejunostomy (DPEJ) tube placement.

Direct percutaneous endoscopic jejunostomy (DPEJ) is an effective method of enteral feeding. However, failure rates with this procedure remain high due to various technical problems. We describe a case where modifications in the technique and ultrasound guidance assisted in a difficult DPEJ placement. This technique has the potential to improve the success rate of this procedure in selected cases.

Endoscopy↗

PubMed1987

Percutaneous endoscopic gastrostomy and jejunostomy by a single pass of the endoscope.

A modified Gauderer-Ponsky technique of percutaneous endoscopic gastrostomy has been described. The major advantage is elimination of a second insertion of the endoscope, as well as unnecessary traversing of the esophagus by snares and strings. The result achieved is equal to what has been achieved with the original technique, but the single-pass technique is more expeditious and less uncomfortable for the patient. In addition, it can easily be modified to insert both draining gastrostomy and feeding jejunostomy tubes at the same time, using only one pass of the endoscope.

Gastroscopy↗

PubMed1987

Mortality associated with feeding catheter jejunostomy after radical cystectomy.

Twenty-five patients undergoing cystectomy and diversion for transitional cell carcinoma of the bladder and 8 patients having major surgery for renal and testes neoplasms and trauma have received needle jejunostomy placement at the time of surgery. One patient died secondary to vascular collapse. Postmortem examination revealed necrosis of the entire small bowel except the conduit segment. The implications of these findings are discussed.

Aged↗

PubMed2006

Abdominal CT as a predictor of outcome before attempted direct percutaneous endoscopic jejunostomy.

BACKGROUND: Direct percutaneous endoscopic jejunostomy (DPEJ) placement succeeds in 72% to 86% of attempts. Failure is most often because of inadequate transillumination or gastroduodenal obstruction. Even in failed cases, patients are exposed to the risks of anesthesia, exploratory percutaneous needle punctures, and the cost burden of suboptimal resource utilization. Hence, a preprocedure predictor of outcome would be useful. OBJECTIVE: To evaluate whether review of clinically available abdominal CTs can predict the outcome of subsequent DPEJ attempts. DESIGN: Retrospectively conducted blinded review of abdominal CTs performed within 30 days before attempted DPEJ. Objective anatomic features potentially pertinent to DPEJ success were scored, and a prediction of the anticipated procedural outcome was made. SETTING: A large tertiary referral center. PATIENTS: A total of 115 patients who underwent attempted DPEJ and who also had an abdominal CT in the preceding 30 days. MAIN OUTCOME MEASUREMENTS: Reviewer's overall prediction of success, 3 objective anatomic measurements. RESULTS: For the overall prediction of success, a CT performed poorly, with a sensitivity of 60%, a specificity of 53%, a positive predictive value of 71%, and a negative predictive value of 40%. Mean abdominal-wall thickness was significantly greater in the failures than the successes (27 vs 21 mm, P = .02), and just 39% of the procedures in patients with an abdominal-wall thickness >3 cm were successful. LIMITATIONS: Retrospective. CONCLUSIONS: Failed DPEJ attempts were associated with greater patient abdominal-wall thickness, and this should be taken into consideration before attempted DPEJ. Otherwise, review of existing abdominal CTs appears to have limited utility in predicting DPEJ outcome.

Abdominal Wall↗