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At least 145 records · Page 8Linked to original sources
PubMed1994

Long-acting somatostatin analogue therapy and protein metabolism in patients with jejunostomies.

BACKGROUND/AIMS: Previous studies have shown that secretory losses in patients with end jejunostomy syndrome (EJS) on home parenteral nutrition (HPN) can be suppressed by the somatostatin analogue, octreotide, thus facilitating fluid balance. However, the hormone also has antianabolic actions that may interfere with the use of infused amino acids. METHODS: Amino acid metabolism, pancreatic enzyme synthesis and secretion, and mucosal protein turnover were measured by primed/continuous intravenous infusion of [1-14C] leucine tracer, duodenal aspiration, and endoscopic mucosal biopsy techniques during hormonal stimulation with pentagastrin and cholecystokinin 8. RESULTS: In comparison with normal healthy controls, baseline measurements of amino acid metabolism were normal in patients with EJS/HPN, but pancreatic enzyme synthesis and secretion were elevated. Octreotide therapy improved fluid balance but suppressed gut hormone (insulin, gastrin, glucagon, peptide YY) levels in blood and the uptake of amino acids into pancreatic enzyme and mucosal proteins, increasing oxidative losses. CONCLUSIONS: Octreotide improves fluid balance in patients who have undergone jejunostomy but reduces the use of amino acids for splanchnic protein synthesis. This may interfere with the physiological process of adaptation to intestinal resection.

Adult↗
PubMed1992

Laparoscopic feeding jejunostomy tube in oncology patients.

Laparoscopic-guided feeding jejunostomy tubes are being utilized in two specific groups of patients: (i) patients with resectable or locally advanced adenocarcinoma of the pancreas treated on a protocol of preoperative chemoradiation, who may require nutritional support, and (ii) patients with metastatic or obstructing foregut tumours who require a route for delivery of fluid and medication. The technique, rationale and results for our first 17 patients who underwent laparoscopic placement of a tube jejunostomy are described. Laparoscopic feeding tube placement is a safe and cost-effective method to gain enteral access and stage the oncology patient's disease. This procedure is less invasive than standard surgery for tumour staging and feeding tube placement, and facilitates formula advancement and the patient's early hospital release without morbidity or mortality.

Aged↗
PubMedDate not supplied

Percutaneous jejunostomy and stent placement for treatment of malignant Roux-en-Y obstruction: a case report.

Nineteen months after a Whipple procedure for pancreatic carcinoma, a 79-year-old woman developed recurrent tumoral strictures of the bile ducts and afferent Roux-en-Y limb with resultant jaundice, cholangitis, and liver abscess. Transhepatic abscess and biliary drainages were performed first. Afferent loop obstruction was too far from biliary anastomosis to be crossed via the transhepatic route. Percutaneous jejunostomy and stenting were performed to relieve the malignant afferent loop syndrome. After initial relief of symptoms, jaundice recurred in relation to peritoneal carcinomatosis progression and was treated with percutaneous jejunostomy drainage until patient's death. Therapeutic options of tumoral occlusion of afferent loops are reviewed.

Aged↗
PubMed2004

A prospective cohort study of feeding needle catheter jejunostomy in an upper gastrointestinal surgical unit.

BACKGROUND & AIM: Feeding jejunostomy is recommended to facilitate early enteral nutrition after major upper gastrointestinal surgery. We aimed to determine the benefits and risks associated with routine practice of feeding needle catheter jejunostomy (NCJ) in high-risk upper gastrointestinal surgery. METHOD: This is a prospective consecutive cohort study of 84 patients underwent feeding NCJ over a 3 years period in an Upper Gastrointestinal Surgical Unit. RESULTS: Feeding NCJ was placed after two-stage oesophago-gastrectomy in 24 patients (28.6%), after gastrectomy in 29 patients (34.5%), after liver resections in 7 patients (8.3%), pancreatic resection in 6 patients (7.1%), bile duct reconstruction in 8 patients (9.5%) and other operations in 10 patients (12%). The mean (SE) estimated nutritional requirement per 24 h was 1791 (31)kcal. Eighty-two patients (98%) started enteral feed on day 1 after surgery. Fifty-seven patients (68%) achieved the target nutritional requirements in 3 days. Four patients were discharged home on jejunal feed whilst only two patients required parenteral nutrition support. The rest tolerated full oral diet. There was no procedure related mortality. The morbidity related to feeding tube and feeding were 12.9% and 20%, respectively. CONCLUSIONS: Routine practice of feeding NCJ is safe. Their benefits outweigh the risks in a specialist centre.

Catheterization↗
PubMed2005

Gastrostomy and jejunostomy placement: the urban hospital perspective pertinent to nursing home care.

OBJECTIVES: In nursing home settings, providers often think that most percutaneous endoscopic gastrostomy (PEG) tubes are placed in older people, some perhaps inappropriately. We sought to describe the relationships between patient age and the indications for, the decision making behind, and the outcomes of gastrostomy and jejunostomy placement in an urban hospital to give perspective to those of us working in long-term care settings. DESIGN: Retrospective, observational study. SETTING: Urban hospital. PARTICIPANTS: Two hundred thirty-nine inpatients who underwent gastrostomy or jejunostomy (G/J) placement. MEASUREMENTS: Hospital records were reviewed for patient demographics, disease process, decision making, and short-term outcomes associated with G/J placement. Mortality at 30 days and 1 year was obtained by a search of the National Death Index. The prevalence of these variables in those aged 65 years and older was compared to the prevalence in those younger than 65 with associations calculated both unadjusted and adjusted for gender, place of residence, underlying condition, and Charlson comorbidity index. RESULTS: Patients who were aged 65 years and older were more likely to be female with more comorbid illnesses and were more likely to have had a stroke that precipitated their difficulty eating. They were more likely to have been referred by a medical specialist, to have been seen by a speech pathologist, and to have had their procedure without general anesthesia. The older patients had a shorter mean hospital length of stay with fewer complications but had higher mortality rates at 30 days and 1 year. CONCLUSION: Patient age was associated with gender and type of disease process and may have influenced the decisions made during the hospital stay. Despite a higher burden of chronic illness, older patient age was not associated with adverse short-term outcomes but was associated with higher mortality rates after discharge.

Adult↗
PubMed1992

Percutaneous endoscopic gastrostomy or jejunostomy and the incidence of aspiration in 79 patients.

Percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic jejunostomy (PEJ) are well-accepted procedures for long-term enteral alimentation. PEG has replaced surgical gastrostomy at many institutions because of its safety and ease. This study was undertaken to evaluate the indications for PEG and PEJ, as well as their success rates, complications with special attention to aspiration, and long-term follow-up. We were specifically interested in reviewing the problem of aspiration in patients with PEG and PEJ. A retrospective review of 79 patients at Brooke Army Medical Center over a 3-year period was done. PEG or PEJ was successful in 79 of 81 patients (97%). The most common indications were neurologic disorders in 46 patients (58%) and cancer in 20 (25.3%). Complications other than aspiration occurred in 11 patients (14%). Aspiration occurred in nine patients after PEG or PEJ (11.4%); six patients had experienced aspiration prior to PEG or PEJ. Six patients had a jejunostomy tube placed through the PEG for prevention of aspiration, and three died of continued aspiration. We conclude that aspiration is not prevented by PEJ, continues to be a major problem after PEJ, and becomes manifest for the first time after PEG.

Adolescent↗
PubMed1999

A simplified technique for laparoscopic jejunostomy and gastrostomy tube placement.

BACKGROUND: Percutaneous endoscopic gastrostomy and jejunostomy tube placement have long been considered the standard for supplying enteral nutrition when oral intake is not possible. Both have well-documented roles and limitations and are associated with a higher than generally appreciated incidence of aspiration. A distally placed tube in the jejunum decreases the chance of this morbid complication. Additionally, when percutaneous endoscopic gastrostomy is indicated but cannot be done for technical reasons, a minimally invasive alternative is desirable. METHODS: In prior series, the techniques suggested for laparoscopic enteral access have characteristics that are either difficult for the average surgeon to duplicate, or use nonstandard anchoring techniques of the bowel to the abdominal wall. A simple, laparoscopically directed, percutaneous technique utilizing cost-effective appliances is described, and suggested indications are outlined. RESULTS: This technique has been successfully applied in 46 patients with minimal complications. CONCLUSIONS: A simplified technique for laparoscopic jejunostomy and gastrostomy tube placement is described. This has been successfully deployed in 46 patients with minimal morbidity. The procedure lessens the need for sophisticated suturing skills and duplicates standard small bowel to abdominal wall fixation methods.

Adult↗
PubMed1995

Complications of needle catheter jejunostomy in 2,022 consecutive applications.

BACKGROUND: We commonly use needle catheter jejunostomy (NCJ) for early enteral feeding in selected patients. Review of our approach was prompted by the suggestion that enteral feeding represents a "stress test" for the bowel and may be associated with a high complication rate. MATERIALS AND METHODS: We reviewed patients with NCJ inserted over the past 16 years by prospective database, chart review, and conference minutes, with emphasis on complications. RESULTS: During the conduct of 28,121 laparotomies, 2,022 NCJs inserted in 1,938 patients (7.2%) resulted in 34 NCJ-related complications in 29 patients (1.5%) The most common complication was premature loss of the catheter from occlusion or dislodgment (n = 15; 0.74%), and the most serious was bowel necrosis (n = 3; 0.15%). CONCLUSIONS: Needle catheter jejunostomy may be inserted and used with a low complication rate. Most complications were preventable through greater attention to detail and better monitoring of physical examination of patients with marginal gut function.

Catheterization↗
PubMed1987

Permanent enteral feeding in cystic fibrosis: advantages of a replaceable jejunostomy tube.

A feeding jejunostomy constructed by the Witzel technique has been used to supplement 12 wasted patients with cystic fibrosis during 260 patient months. None of the patients has stopped the nocturnal feeding once started on the program. The preferred tube was the Entriflex enteral feeding tube, which, when placed without internal fixation, could be easily changed as necessary. There have been no major complications. Minor complications include tube blockage, dislodgement, local infection, and leakage around the tube causing granuloma formation. We have not lost the use of any of the jejunostomies because of inability to replace the tube when it has been dislodged.

Adolescent↗
PubMed1996

Cutaneous stoma in the roux limb of hepaticojejunostomy (hepaticocutaneous jejunostomy): useful access for intrahepatic stone extraction.

A cutaneous stoma in the Roux limb of hepaticojejunostomy (hepaticocutaneous jejunostomy) was used for stone extraction in two children who had hepatolithiasis (14.5 and 15.5 years, respectively) after operation for choledochal cysts. In constructing the hepaticocutaneous jejunostomy, a short, straight proximal limb from the skin to the bilioenteric anastomosis is mandatory. It provides a pathway, superior to the T-tube tract, for repeated stone extraction, which can be performed under sedation, thus obviating repeat laparotomies. The stoma allows flexible choledochoscopy, balloon dilatation of intrahepatic duct strictures, and extraction of intrahepatic stones using grasping forceps, baskets, and balloons. The electrohydraulic lithotriptor may be applied to fragment larger stones.

Adolescent↗
PubMed1996

Complications of long-term jejunostomy in children.

The authors reviewed 64 jejunostomies performed in 57 patients. Data were collected regarding complications and performance of the catheters. Patient diagnoses were grouped as follows: cystic fibrosis (25), neurological impairment (14), and miscellaneous other (25). Indications were malnutrition (43), inability to feed (17), and gastroesophageal reflux (4). Complications were compared between these groups. The age range was 7 days to 23 years. There were 251 tube changes over 142 years of cumulative site patency, for an average of 1.8 tube changes per year and an average life of 2.2 +/- 2.4 years per site. The longest duration was 11.7 years. Four tube changes resulted in intraperitoneal insertion (6.2% of changes). The overall complication rate was 37.5%. The major and minor complication rates were 21.9% each. Some patients had more than one complication. Stratification of complications by diagnosis showed that the highest incidence was among the neurologically impaired children (64%), followed by those with cystic fibrosis (32%) and then others (28%). Sixty-four percent of major and 54% of minor complications occurred within the first 6 months. The mortality rate was 4.7%. Infections requiring intravenous antibiotics occurred in 9.4% of the sites, at an average site age of 8.7 +/- 7.7 months. Tube dislodgment requiring surgical replacement occurred in 9.4% of the patients. Our mortality and complication rates compare favorably to those of previously reported series. Surgical jejunostomy is a reliable long-term solution to feeding but is associated with a significant risk of complications, especially in neurologically impaired children. The risk is greatest in the first 6 months after insertion, then decreases as the site "matures."

Adolescent↗
PubMed1995

Tube jejunostomy in liver transplant recipients.

BACKGROUND: Nutritional support after liver transplantation most often uses intravenous hyperalimentation followed by nasoduodenal tubes until adequate intake is achieved. Because of difficulties with nasoduodenal tubes, we place jejunostomy tubes (j-tube) at the time of the transplantation, allowing immediate postoperative enteral nutrition. This review analyzes the complications of this procedure in transplant recipients. METHODS: J-tubes were placed in 108 of 119 adults who underwent liver transplantation between October 1989 and June 6, 1994. These patients were retrospectively reviewed for the type and frequency of j-tube-related complications. J-tube feeds with a semielemental formula were started within 24 to 48 hours after transplantation. RESULTS: Eighteen complications occurred in 16 patients. Six were mechanical obstructions of the j-tube because of kinking by the fascia. Six exploratory laparotomies were required, two each for infection, small bowel obstruction, or catheter displacement. Four other infections were treated by local incision and drainage or percutaneous drainage. One tube required surgical removal in the operating room. CONCLUSIONS: Tube jejunostomies can be safely placed at the time of liver transplantation with a low risk of serious complications. We recommend the routine use of j-tubes in patients receiving a liver transplant for the immediate posttransplantation institution of enteral nutrition.

Abscess↗
PubMed2001

Direct percutaneous endoscopic jejunostomy with small bowel enteroscopy and fluoroscopy.

BACKGROUND: Approaches to the creation of a percutaneous jejunostomy (PEJ) include enteroscopy with jejunal transillumination, fluoroscopy with small bowel distension and tract dilation, and jejunal enteral tube placement through a percutaneous endoscopic gastrostomy. Although all have been successful, the combination of enteroscopy and fluoroscopy may improve visualization and the success of PEJ placement. This is a description of such a technique and its successful use in 7 patients. METHODS: The procedure was performed with the patient under conscious sedation in a manner similar to standard PEG placement. The proximal jejunum was visualized and a standard snare was passed though the enteroscope and was opened. A needle and guidewire were directed percutaneously though the snare by using fluoroscopic guidance. Under direct endoscopic visualization the snare was closed around the guidewire. A standard 20F push-type "gastrostomy" tube was passed over the guidewire and through the mouth and the dome seated in the jejunum. A bumper was passed externally over the tube and tightened at the skin. RESULTS: PEJ placement was successful in all 7 patients. The average length of the procedure was 40 minutes (range 22-64 minutes). There were no major complications. Mean follow-up was 124 days (range 28-308 days). Feeding tubes remained functional until removal (2), death (1), or surgical removal for an unrelated reason (1). Three tubes are still in use. CONCLUSIONS: Percutaneous endoscopic jejunostomy tube placement can be performed successfully with enteroscopy and fluoroscopy. This technique is safe and efficient and provides distal enteral nutritional support for patients in whom PEG cannot be used.

Adult↗
PubMed1989

Absorption of cobalamin (vitamin B12) administered via jejunostomy.

Absorption of cobalamin (Cbl) administered via feeding jejunostomy (J) was compared with that given by mouth (PO) to study the role of transgastric passage in its binding to gastric Intrinsic Factor and subsequent ileal absorption. Modified Schilling tests were performed on 10 patients, each patient serving as his own control. A labeled Cbl capsule was dissolved in 10 cc of water, 7 cc (containing approximately 0.4 microCi 57Co) measured in a syringe and administered PO or via J, followed by 30 cc of water. The remaining solution was used for counting. Starting 1 hour later, following 1 mg of IM cyano-Cbl USP to saturate body storage sites of Cbl, urine was accurately collected for 24 hours and a 4-ml aliquot analyzed for 57Co. Results are expressed as % of tracer excreted in the urine (normal: greater than 7%). The test was repeated in 1 week through the alternate route using the identical protocol. In the eight patients in whom results could be analyzed, absorption was 21.18 +/- 5.83% in J group (range: 5.8-51.9%) and 9.75 +/- 2.62% in PO group (range: 1.9-24.2%). This difference was highly significant p = 0.02) using the paired Student's t-test. Route of the first test (PO or J) made no difference. It is concluded that cobalamin (vitamin B12) administered via jejunostomy is absorbed to a degree significantly greater than that given by mouth.

Administration, Oral↗
PubMed1992

Oral salt supplements to compensate for jejunostomy losses: comparison of sodium chloride capsules, glucose electrolyte solution, and glucose polymer electrolyte solution.

Six patients with jejunostomies and residual jejunal lengths of 105 to 250 cm took the same food and water each day for eight study days. In random order, three methods of salt replacement were tested, each over 48 hours, against a period without added salt. During the three test periods the patients took 120 mmol of sodium chloride daily, as salt in gelatine capsules, as an isotonic glucose electrolyte (280 mOsmol/kg; 30 kcal) solution, and as a glucose polymer (Maxijul) solution (280 mOsmol/kg; 200 kcal). The daily stomal output remained constant for each patient during the four test periods but varied between patients from 0.60 to 2.84 kg (daily intestinal fluid balance 0.74-2.61 kg). Without a salt supplement, three patients lost more sodium from the stoma than they took in by mouth (-25, -94, and -101 mmol/day) and the mean sodium balance for all six subjects was -16 mmol (range -101 to 79) daily. Extra salt was absorbed with each form of supplement (p less than 0.05); no patient with the glucose electrolyte solution (mean 96, range 0 to 226 mmol), but one patient with the glucose-polymer solution (mean 96, range -25 to 164 mmol) and two with the salt capsules (mean 66, range -8 to 145 mmol) were in negative balance. Two patients vomited with the salt capsules. There was only a small increase in energy absorption (mean 115 kcal) with the glucose polymer solution compared with the glucose electrolyte solution. A sipped glucose electrolyte solution seems to be the optimal mode of sodium replacement in patients with a high output jejunostomy.

Adult↗
PubMedDate not supplied

Intestinal obstruction by overdistension of a jejunostomy catheter balloon: a salutary lesson.

Jejunostomy is an alternative method for feeding patients who cannot be fed orally. However, there may be an associated morbidity and potential mortality. In the case presented, overdistension of a jejunostomy catheter balloon led to intestinal obstruction and pressure necrosis (of the small bowel), with subsequent abscess formation leading to death from septicemia.

Aged↗
PubMedDate not supplied

Obstructed feeding jejunostomy tube: a new method of salvage.

The jejunostomy tube is an important means of access for enteral feeding in the surgical and medical patient. A common complication of this technique is tube occlusion. Once a mature tract has formed the tube can be removed and replaced, following by contrast radiologic documentation of its intraluminal position. With an immature tract, this option is not available. We report a safe, simple, and cost-effective method of unblocking a clogged jejunostomy using an arterial embolectomy catheter.

Catheterization↗
PubMedDate not supplied

Octreotide as an adjunct to home parenteral nutrition in the management of permanent end-jejunostomy syndrome.

Intravenous fluid requirements for patients with permanent end-jejunostomy syndrome often exceeds 3 L/d, making rehabilitation difficult. The effect of the somatostatin analogue, octreotide (100 micrograms TID, subcutaneously) in reducing requirements was measured in 10 patients established on home parenteral nutrition. After 10 days of treatment, 72-hour balance measurements demonstrated significant reductions in stomal fluid and electrolyte losses from (mean +/- SE) 8.1 +/- 1.8 to 4.8 +/- 0.7 L/d (p < .03), sodium from 510 +/- 71 to 340 +/- 41 mEq/d (p < .03), chloride from 533 +/- 70 to 315 +/- 32 mEq/d (p < .002), and potassium from 101 +/- 41 to 79 +/- 34 mEq/d (p < .02), permitting an average reduction in intravenous fluid requirements of 1.3 L/d (p < .0003), 118 mEq Na+/d (p < .03), 41 mEq K+/d (p < .02), and 178 mEq Cl-/d (p < .01). This meant that daytime intravenous infusions could be stopped in all patients. Fecal nitrogen losses were decreased (p < .05), but overall there was no significant change in fat and caloric absorption. In addition, hormonal stimulated gastric acid and pancreatic lipase secretions were significantly reduced (p < .05). The effect was most marked in those patients with massive stomal losses and uncontrollable thirst. Continuation of treatment for more than 1 year in 8 of the patients suggested preservation of potency and good tolerance, with the possible exception of accelerated gallstone formation and subacute intestinal obstruction. In conclusion, octreotide has the potential to improve the quality of life of those end-jejunostomy syndrome patients with massive stomal losses, resistant to conventional medical treatment.

Adult↗