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PubMed1993

Risk of abdominal septic complications after feeding jejunostomy placement in patients undergoing splenectomy for trauma.

Compared with total parenteral nutrition, enteral feeding via jejunostomy reduces septic complications in patients with severe trauma. However, violation of the bowel with insertion of a jejunostomy tube may increase the risk of intra-abdominal abscess (IAA), particularly if no simultaneous gastrointestinal tract injury exists. The records of 123 patients requiring splenectomy for trauma at a level I trauma center during a 6-year period (1986 to 1992) were reviewed to examine the incidence of IAA in patients with and without simultaneous jejunostomy placement in the presence and absence of gastrointestinal tract injuries. Thirty patients had jejunostomies placed (J), and 93 did not (NoJ). There were no significant differences between the groups in age, Abdominal Trauma Index, Injury Severity Score, or transfusion requirements. The incidence of IAA was not significantly different between the J and NoJ groups in the presence or absence of gastrointestinal tract injuries. Thus, jejunostomy placement does not increase the incidence of IAA after splenectomy regardless of the presence of a gastrointestinal tract injury.

Abdomen↗
PubMed1988

Needle catheter jejunostomy: an unappreciated and misunderstood advance in the care of patients after major abdominal operations.

We evaluated the use of a needle catheter jejunostomy in 83 consecutive patients who underwent complicated abdominal operations. We used the needle catheter jejunostomy to deliver immediate postoperative nutrition (mean, 1,700 kcal/day) in 66 patients for a range of 4 to 80 days. In addition, the needle catheter jejunostomy was used to provide all maintenance fluid and electrolyte needs and to administer almost all required medications. No serious complications were related to use of the needle catheter jejunostomy, although easily controlled diarrhea occurred in 16 patients (19%). We concluded that the needle catheter jejunostomy is a safe and cost-effective means of delivering postoperative nutrition, fluid and electrolytes, and most medications in selected patients undergoing high-risk abdominal operations.

Adult↗
PubMedDate not supplied

Percutaneous replacement jejunostomy after esophagogastrectomy.

A surgically placed jejunostomy tube is a safe and effective means of delivering nutritional support for the postesophagogastrectomy patient. We have previously described a method that permits percutaneous replacement of surgically placed jejunostomy feeding tubes, and now present our results with the use of this technique in 350 consecutive esophagogastrectomy patients. Replacement jejunostomy as required in 17 patients (4.9%). All patients had successful percutaneous jejunostomy replacement. There were no procedural complications or deaths. The timing of feeding tube replacement following esophagogastrectomy was predictive of the indication. Before 16 weeks, the indication for feeding tube replacement was intubation and inability to eat (1 patient) or anorexia with weight loss and dehydration (7 patients). At or after 16 weeks, the indications for feeding tube replacement were all related to symptoms resulting from recurrent carcinoma. We conclude that the technique of percutaneous jejunostomy allows the surgeon tremendous flexibility in the management of the postesophagogastrectomy patient as it preserves the advantages of an adjuvant surgically placed feeding tube over the lifetime of the patient. The technique is safe, and the success rate is excellent.

Aged↗
PubMed1996

Ciprofloxacin absorption is impaired in patients given enteral feedings orally and via gastrostomy and jejunostomy tubes.

Twenty-six hospitalized patients participated in a randomized crossover study to evaluate the effect of enteral feedings on ciprofloxacin absorption when given orally or via gastrostomy or jejunostomy tubes. Patients in the oral group received an intact 500-mg ciprofloxacin tablet alone or ciprofloxacin plus three oral doses of Sustacal (240 ml given 8 h before, with, and 4 h after ciprofloxacin administration). Patients with gastrostomy or jejunostomy tubes received 500 mg of crushed ciprofloxacin in 60 ml water via the feeding tube. After a washout period, the patients received ciprofloxacin with a continuous enteral formula (Jevity) given at 60 to 90 ml/h beginning 6 h before drug administration and continuing for 10 h. Serial blood samples were analyzed for ciprofloxacin concentration by high-performance liquid chromatography. The maximum ciprofloxacin concentrations in serum for ciprofloxacin given and for ciprofloxacin plus enteral feeding for the oral, gastrostomy, and jejunostomy groups were (mean +/- standard deviation) 2.59 +/- 1.24 versus 1.43 +/- 0.61 micrograms/ml (P < 0.05), 3.68 +/- 1.36 versus 2.27 +/- 0.67 micrograms/ml (P < 0.05), and 3.78 +/- 1.87 versus 1.45 +/- 0.48 micrograms/ml (P < 0.05), respectively. Corresponding values for area under the concentration-time curve were 13.4 +/- 8.32 versus 9.44 +/- 4.74 micrograms/h/ml (P < 0.05) 15.9 +/- 6.62 versus 7.44 +/- 3.16 (micrograms/h/ml (P < 0.05), and 18.1 +/- 9.37 versus 5.82 +/- 2.63 micrograms.h/ml (P < 0.05). We conclude that enteral feedings given orally or via gastrostomy or jejunostomy tubes resulted in a 27 to 67% reduction in the mean bioavailability of ciprofloxacin in hospitalized patients. The decreased absorption may be clinically important, especially when the enteral feeding is coadministered with ciprofloxacin by the oral and jejunostomy tube routes. Reductions in maximum levels of ciprofloxacin in serum as a result of feedings given via a gastrostomy tube are similar to those following oral administration on an empty stomach, making a clinically important interaction by this route less likely.

Adult↗
PubMedDate not supplied

Clinically significant pneumatosis intestinalis with postoperative enteral feedings by needle catheter jejunostomy: an unusual complication.

We evaluated the incidence of clinically significant pneumatosis intestinalis and intestinal necrosis with the use of needle catheter jejunostomy in 217 consecutive patients who had undergone complicated abdominal operations or selected bariatric procedures. The needle catheter jejunostomy was used to deliver immediate postoperative nutrition, maintenance, and replacement fluids, and selected medications. In this group, no serious complications requiring surgical intervention were related to the use of needle catheter jejunostomies. Clinically significant pneumatosis intestinalis was encountered in two of 217 patients (1%). With the needle catheter jejunostomy in place, both patients improved rapidly when enteral feedings were discontinued and parenteral antibiotics were administered. None of the 217 patients developed ischemic intestinal necrosis. We conclude that 1) clinically significant pneumatosis is a rare complication of enteric feeding via needle catheter jejunostomy when the intrajejunal feeding is begun with a diluted, hypoosmolar solution with stepwise increases in osmolality, and 2) patients who do develop clinically significant pneumatosis (n = 2) seem to respond rapidly to a temporary stoppage of enteral feedings and administration of parenteral antibiotics.

Catheterization↗
PubMed2000

Modified technique for introducer-type percutaneous endoscopic gastrostomy and jejunostomy: assisted by a novel trocar and fasteners.

BACKGROUND AND PURPOSE: Commercially available kits for percutaneous endoscopic gastrostomy (PEG) and jejunostomy comprise a substantial proportion of the cost of patients for this procedure. A modified introducer-type technique and new instrumentation for PEG and jejunostomy that substantially reduces the cost of the kit were tested for efficacy and safety. METHODS: This technique was tested on 10 pigs as a pilot study, and then applied to seven consecutive patients undergoing gastrostomy and three patients undergoing gastrostomy with jejunostomy. The endoscopy and site selection for gastrostomy were the same as in standard PEG. Two novel fasteners for fixing the gastric wall to the abdominal wall and a guide-wire in the selected site were inserted separately into the stomach through 15-gauge needles. A stainless steel trocar with a detachable sheath was introduced into the stomach over the guide-wire. After the inner stylet was removed, a 24-French Foley catheter was inserted as a feeding tube. Gastrostomy was completed after balloon inflation and external fixation. If jejunostomy was indicated, a 12-French nasogastric tube was inserted through the gastrostomy. The procedure time, complications, and costs were compared with those for another 15 consecutive patients who underwent the conventional pull-through method of PEG and jejunostomy using commercially available kits. RESULTS: No significant difference was found in procedure time between patients who underwent the modified or conventional gastrostomy procedures (mean +/- standard deviation, 15.4 +/- 5.6 min). There was a similar incidence of short-term complications in the two treatment groups. The feeding catheters required replacement more quickly than did those in the commercial kits (80 +/- 58 vs 217 +/- 140 d). The cost to patients was much less with the new method than with conventional PEG. CONCLUSIONS: The new gastrostomy method achieves the same medical quality at far less cost for patients.

Adult↗
PubMed1979

Fine needle catheter jejunostomy--an assessment of a new method of nutritional support after major gastrointestinal surgery.

The results of our experience with the technique of fine needle catheter jejunostomy and early postoperative feeding through the catheter over a 12-month period are presented. Of the 43 patiening with an elemental diet without complications, 3 (7 per cent) were not fed for different reasons and 13 (30 per cent) developed complications that led to temporary or permanent cessation of the feeding. One patient in this group died of inhalation pneumonia. The voluntary food intake of 12 of the patients who were fed by jejunostomy after major colorectal surgery was assessed daily for 2 weeks after operation and compared with that of 12 control patients who did not have nutritional support. No significant difference in voluntary food intake was found between the two groups. The changes in body composition and plasma proteins and the clinical outcome of 20 of the patients fed by jejunostomy after major colorectal surgery were also compared with those of 20 matched controls. Body weight and lean body mass (as assessed by total body potassium and arm muscle circumference) and plasma prealbumin fell significantly in the control patients but not in those fed by jejunostomy. However, plasma transferrin decreased in both groups and there was no significant difference in clinical outcome in terms of complication rate or duration of postoperative hospital stay. The study would suggest that this technique of jejunostomy feeding should be reserved for selected cases where it may prove to be of real value, rather than being used routinely.

Aged↗
PubMed1987

Indications for needle catheter jejunostomy in elective abdominal surgery.

Needle catheter jejunostomy for postoperative nutritional support is now employed worldwide. However, there is a large discrepancy regarding indications for this technique which this study attempts to rectify. The need for nutritional support after elective abdominal procedures in 464 patients was analyzed and compared with the experience with needle catheter jejunostomy in 42 patients. The results show that needle catheter jejunostomy is indicated after extensive operations of the upper gastrointestinal tract, for example, esophagectomy, total gastrectomy, and the Whipple procedure. With minor upper gastrointestinal operations, or procedures of the lower gastrointestinal tract, needle catheter jejunostomy should be performed only in patients with poor nutritional status or in the presence of postoperative chemotherapy or radiotherapy. In an unclear situation, liberal insertion of the needle catheter jejunostomy and a postponed decision on enteral feeding is recommended, as there is no significant catheter-related morbidity.

Abdomen↗
PubMed1987

Immediate postoperative jejunostomy feeding. Clinical and metabolic results in a prospective trial.

A prospective clinical trial was designed to evaluate the efficacy of postoperative jejunostomy feedings using high (44 percent) and low (15 percent) branched-chain amino acid elemental diet formulations compared with no jejunostomy feedings in a homogeneous surgical population. Twenty-eight patients undergoing radical cystectomy and ileal diversion were randomized to the high branched-chain amino acid formula (11 patients) or the low branched-chain amino acid formula (9 patients). Eight patients received a 5 percent dextrose in water solution intravenously and served as a control group. Mean caloric intake per day in each group was 1,543 calories, 1,697 calories, and 550 calories, respectively; whereas the mean nitrogen intake of each group was 6.5 +/- 2.1 g/day, 8.2 +/- 2.4 g/day, and 0 g/day, respectively. Mean weight changes were minus 0.7 percent, 0.7 percent, and minus 0.3 percent, respectively. The mean daily nitrogen balance was minus 1.6 +/- 3.5 g/day, minus 1.1 +/- 4.4 g/day, and minus 6.6 +/- 1 g/day (p less than 0.001). Five patients (25 percent) in the jejunostomy groups progressed to an oral diet more rapidly than the control group, but gastrointestinal complications occurred in 11 patients (55 percent). Immediate postoperative jejunostomy feedings resulted in improved nitrogen balance compared with the control group values, but no metabolic advantage was noted by infusing a high branched-chain amino acid formula. Improved return to normal gastrointestinal function was noted in 25 percent of jejunostomy patients, but the gastrointestinal complications noted limited the overall usefulness of this technique.

Abdomen↗
PubMed1983

The influence of dietary fat on jejunostomy output in patients with severe short bowel syndrome.

The effect of diet on jejunostomy output of fluid, fat, sodium, potassium, calcium, magnesium, zinc, and copper was studied in five metabolically stable, home parenteral nutrition patients. Three isocaloric diets were compared; one low in fat (30% kcal) but high in complex carbohydrate (55% kcal), and two high in fat (60% kcal) but low in carbohydrate (25% kcal). The polyunsaturated/saturated fatty acid ratios of the two high fat diets were 1:4 and 1:1. Although increasing the percentage of fat in the diet increased the amount of steatorrhea, altering the polyunsaturated/saturated fatty acid ratio had no clearly beneficial effect on the amount of fat absorbed. Neither the amount of fat, nor the type of fat, had any consistent influence on jejunostomy volume. The sodium and potassium concentration of the jejunostomy fluid stayed remarkably constant and hence net monovalent cation losses reflected jejunostomy volume rather than the fatcarbohydrate content of the diet eaten. The most consistent effect of the high fat diet was a marked increase in ostomy losses of divalent cations; calcium, magnesium, zinc, and copper. Most of the time a net divalent cation secretion on the high fat diet was converted into a net absorption on the low fat, high carbohydrate diet. Altering the polyunsaturated/saturated fatty acid ratio had no consistent effect on divalent cation losses. In conclusion, the proportion of fat versus carbohydrate calories does not appear to influence ostomy volume or monovalent cation loss in extreme short bowel, end jejunostomy patients; however, a high fat intake causes a significant net secretion of divalent cations.

Adult↗
PubMed1985

Comparison of needle catheter versus standard tube jejunostomy.

It is commonly stated that needle catheter jejunostomy (NCJ) is associated with fewer complications than standard tube jejunostomy (STJ). We compared the morbidity of NCJ versus STJ performed as adjunctive procedures in 90 patients from 1977 to 1983. NCJ was performed in 55 patients and STJ in 35 patients. The two groups were similar with respect to age, sex, diagnosis, and operation performed. The overall postoperative morbidity was 35 per cent for the NCJ group and 62 per cent for the STJ group. Mortality was 19 per cent and 35 per cent, respectively. Minor complications related to the jejunostomy occurred in 16 per cent of the NCJ group and 9 per cent of the STJ group. Diarrhea and abdominal distention occurred with equal frequency in the two groups. One NCJ patient required reoperation for intestinal obstruction at the catheter exit site, and one STJ patient required operative closure of a fistula following tube removal for major complications rates of 1.8 per cent and 2.8 per cent, respectively. The statement that STJ is associated with more jejunostomy-related complications than NCJ is not substantiated by this study. Because of greater ease of insertion, NCJ remains our procedure of choice for adjunctive feeding jejunostomy.

Catheterization↗
PubMed2006

Optimal enteral feeding in children with gastric dysfunction: surgical jejunostomy vs image-guided gastrojejunal tube placement.

PURPOSE: Long-term feeding access in children who fail initial gastrostomy is a management quandary. Although image-guided gastrojejunal feeding tube placement (IGJ) is becoming the access of choice in many centers, few studies have compared long-term results with surgical jejunostomy (SJ). The authors compare outcomes with these 2 techniques. METHOD: A retrospective review of 20 children requiring jejunal feeding access after failing initial gastrostomy was done. Procedures were performed at a tertiary referral center by interventional radiologists (IGJ) or board-certified pediatric surgeons (SJ). RESULTS: Initially, patients underwent IGJ (n = 14) or SJ (n = 6). Image-guided gastrojejunal feeding tube placement patients required gastrostomy at an average age of 23.8 months, with conversion to IGJ an average of 17.2 months later. SJ patients required gastrostomy at average age of 16.2 months, with conversion to SJ 30.7 months later. Of 14 patients undergoing IGJ, 7 (50%) eventually required SJ because of recurring tube management issues. Thus, 13 patients ultimately had SJ, with 11 (85%) Roux-en-Y jejunostomies. Mean operating time for SJ was 158 minutes, with an average of 5.1 days to initiation of feeds, 11 days to full feeds, and 19.9 days to discharge (range, 3-66 days). Image-guided gastrojejunal feeding tube placement patients averaged 4.6 tube adjustments per year requiring fluoroscopic guidance. Surgical jejunostomy averaged 1.5 tube adjustments per year requiring outpatient hospital visits. Image-guided gastrojejunal feeding tube placement patients averaged 3.9 hospital d/y secondary to feeding tube management issues, whereas SJ patients averaged 1.4 hospital days per year. CONCLUSION: In this group of children with long-term jejunal feeding access, half of those with IGJ eventually required SJ. Surgical jejunostomy required fewer adjustments and hospitalizations per year. Although initially more invasive than IGJ, SJ may provide more stable feeding access with fewer complications. This represents the first published report comparing long-term outcomes between IGJ and SJ.

Adolescent↗
PubMed1997

A modified feeding Roux-en-Y jejunostomy in the neurologically damaged child.

PURPOSE: Feeding tube access with an antireflux procedure is frequently necessary in children with severe neurological deficits. Fundoplication in this particular group of patients has many complications and a reported failure rate of 40% to 50%. Recently, the use of a feeding Roux-en-Y jejunostomy has been advocated in this population. METHODS: Since December 1993, over a 6-month period, the authors performed 12 Roux-en-Y jejunostomies. All children had documented gastroesophageal reflux. One patient had a prior failed Nissen fundoplication, and none of these patients were feeding significantly by mouth. Postoperative follow-up has been 12 months. RESULTS: There were no deaths in this series. One patient required early revision of the stoma because of marked prolapse. One 11-month-old infant required reoperation 7 days postoperatively because of tube dislodgment. Eight of the 12 patients required out-patient procedures to unplug or replace the jejunostomy tube. CONCLUSION: The operation may be beneficial in a subset of neurologically impaired children who will never be able to ingest significant calories by mouth. It may also be useful after a failed fundoplication. The main postoperative complications were plugging and dislodgment of the jejunostomy tube, which if they occurred early, required x-ray confirmation for catheter placement.

Anastomosis, Roux-en-Y↗
PubMed2004

T-tube jejunostomy feeding after pancreatic surgery: a safe adjunct.

OBJECTIVE: Patients with pancreatic disease are often malnourished because of biliary and gastric outlet obstruction or the catabolic response to sepsis or cancer. In this study, we reviewed our experience of providing enteral nutrition through a T-tube jejunostomy in these patients. METHODS: The records of a consecutive series of 36 patients who had undergone pancreatic operations during the last 4 years were reviewed. Data were collected on preoperative nutritional status and postoperative feeding. RESULTS: All patients had partially hydrolysed feeds administered through a T-tube jejunostomy, placed during pylorus-preserving proximal pancreatoduodenectomy (21 patients), Whipple's procedure (4), debridement of pancreatic necrosis (3), palliative bypass (2), distal pancreatectomy (2), cyst-jejunostomy (3) or accessory sphincteroplasty (1). Tube feeding was employed for a mean of 18 days. There were no related deaths. Eight patients had complications directly attributable to the tube, including blockage (4), dislodgement (2), pericatheter leakage (2) and peritonitis (1). Twenty patients had complications related to feeds that included transient diarrhoea (13), abdominal distension (8), nausea or vomiting (6) and pain (6). Consequently, nitrogen and energy needs were completely fulfilled in only 19 patients. CONCLUSION: Despite many minor shortcomings, jejunostomy tube feeding appears to be a safe adjunct to pancreatic surgery.

Adult↗
PubMed1999

Clinical experience of feeding through a needle catheter jejunostomy after major abdominal operations.

OBJECTIVE: To report our incidence of local and systemic complications after needle-catheter jejunostomy. DESIGN: Retrospective analysis. SETTING: University hospital, Switzerland. RESULTS: 100 patients (70 men and 30 women; mean age 65 years, range 42-90) had needle-catheter jejunostomy for postoperative enteral feeding. 26 developed catheter-related and 18 nutrition-related complications. Most of the complications were minor (lumenal obstruction of the catheter or local cellulitis) and only 3 patients needed reoperation, 2 because the catheter broke with extravasation of the nutrition formula into the subcutaneous tissue, and the other because of a small bowel obstruction. There was no small bowel necrosis and no patient died as a direct result of the jejunostomy. Overall, 92 patients were fed enterally according to the protocol, and 8 required removal of the catheter. CONCLUSION: Needle-catheter jejunostomy gives a safe and effective access for postoperative enteral feeding. Minor technical complications are common and can be reduced by a meticulous insertion technique and careful postoperative management. Regular clinical surveillance may reduce the incidence of nutrition-related complications.

Adult↗
PubMed1999

Complications of surgical feeding jejunostomy in trauma patients.

OBJECTIVE: To determine the complication rate of feeding jejunostomy (FJ) performed as an adjunct to trauma celiotomy. METHODS: Retrospective analysis of 222 patients from January of 1988 to May of 1998. RESULTS: Thirty-seven total FJ-related complications occurred in 22 patients (10%). Major FJ-related complications occurred in nine patients (4%): two small bowel perforations, two small bowel volvuli with infarction, two intraperitoneal leaks, and three small bowel necroses. Patients suffering major FJ-related complications were similar to those without complications, except for the FJ type. Patients with major FJ-related complications were more likely to have had a Witzel tube jejunostomy than a needle catheter jejunostomy (p = 0.03). Three deaths were related to major FJ complications, for a FJ-related mortality rate of 1.4%. CONCLUSIONS: FJ has a major complication rate of 4% in severely injured patients. Major complications occur more frequently with larger, Witzel-type tubes. Needle catheter jejunostomy appears to be a safer method of surgical jejunal access in trauma patients.

Abbreviated Injury Scale↗
PubMed1993

Failure of a feeding jejunostomy.

A healthy 16-year-old female pedestrian was hit by a motor vehicle. She sustained multiple injuries including severe head injury. She was admitted to hospital unconscious. There was no recovery of neurological function. After a short period of time, a jejunostomy was performed for feeding purposes. The major clinical problem continued to be a feeding difficulty, with profuse diarrhoea occurring. At no stage was it possible to adequately nourish her. Hyperperistalsis was noted whilst in hospital. She died just over three months after admission. Autopsy revealed an emaciated body weighing only 25kg. An upper jejunostomy was still present containing a No. 20 French catheter. The bulb had threaded down the small bowel so that it was situated 25cm proximal to the ileocaecal valve. The small bowel was empty. The cause of death was given as malnutrition due to failure of function of a feeding jejunostomy due to small bowel hyperperistalsis in an individual with diffuse brain trauma. This complication of feeding jejunostomy causing death from malnutrition has not previously been described in the English literature.

Accidents, Traffic↗
PubMed1994

Fiber-containing formula and needle catheter jejunostomies: a clinical evaluation.

Despite the high frequency of diarrhea, chemically defined diets have traditionally been used with needle catheter jejunostomies, a common form of postpyloric enteral access, to avoid tube occlusion. We reviewed our experience with 57 patients fed a fiber-containing diet to determine the incidence of catheter occlusion and diarrhea. Eight catheters temporarily occluded but were reopened and remained patent for an additional 6.3 +/- 3.1 days for an overall success rate of 91% (52 of 57). The five remaining occluded catheters were removed after 6.2 +/- 1.8 days. Four of the five patients with occluded catheters tolerated gastric feedings, but one required a permanent jejunostomy. Diarrhea occurred in six (10.5%) of the 57 patients given the fiber-containing formula. We concluded that a fiber-containing formula can be administered through needle catheter jejunostomies if the catheter is irrigated daily and if no medications are given via the catheter. A fiber-containing formula may reduce the incidence of diarrhea in jejunostomy-fed patients compared with patients fed chemically defined diets.

Adult↗