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At least 19 recordsLinked to original sources
PubMedDate not supplied

[Needle catheter jejunostomy versus "Witzel" tube jejunostomy for early postoperative enteral nutrition in surgical patients. Prospective randomized study].

Malnutrition in surgical patients can be present since their admission into hospital or can appear in the postoperative period. Early postoperative enteral nutrition (EPEN) is recommended to these patients as often as possible. In cases where the patients are severely malnourished with major digestive surgical interventions which we estimate that will be unable to feed orally efficient minimum 7-10 days postoperatively, we recommend EPEN on jejunostomy. Prospective randomized evaluation of 37 patients (75.6% severely malnourished): 19 with needle catheter jejunostomy (NCJ), group A, respectively 18 with standard "Witzel" tube jejunostomy (STJ), group B. 22 patients presented malignant tumors and 15 serious benign problems. On 7 patients the jejunostomy was done at the reoperation. Postoperative major complications were observed on 54.05% of the patients (independent of the jejunostomy) and the postoperative mortality rate was of 13.33% on the patients that had jejunostomy and EPEN on their first operation, and 57.14 respectively on the patients where jejunostomy was done at the reoperation. The two groups were similar with respect to age, sex, length of EPEN and hospital stay, presence of malnutrition, complications and mortality. Postoperative complications were statistically more frequent in anemic patients (68.8%) respectively anemic and severely malnourished (76.47). Minor complication related to the jejunostomy occurred in 5.6% of the group A and 22.2% of the group B. NCJ was done rapidly the same as STJ (7 min vs. 15 min). In conclusion, EPEN on jejunostomy on surgically malnourished patients, who have suffered major superior digestive interventions is beneficial. Postoperative complications have been more frequent on anemic and severely malnourished. NCJ is easier to perform and safer.

Adolescent↗
PubMed1998

Jejunostomy tube failure: malnutrition caused by intraluminal antegrade jejunostomy tube migration.

Complications occurring with jejunostomy feeding tubes are common and sometimes life-threatening. We describe a case of peristalsis-induced intraluminal antegrade migration of a jejunostomy tube's distal end with concomitant retrograde movement of the small bowel over the tube, which was first discovered at autopsy. This ultimately resulted in the jejunostomy feedings entering the distal ileum, therefore bypassing most of the small intestine. Subsequent malnutrition was a contributing factor in the death of the patient, who had required tube feedings after suffering severe head trauma in a motor vehicle accident 29 months earlier. The only nutritional interventions attempted before death involved various attempts at controlling diarrhea. We discuss the incidence, cause, recognition, and prevention of this rarely reported complication of a "functioning" jejunostomy feeding tube.

Adult↗
PubMed1992

A technique for converting a needle-catheter jejunostomy into a standard jejunostomy.

The benefits of enteral nutrition for surgical patients have been well documented in the literature, and needle catheter jejunostomy is frequently used at initial surgical exploration. Occasionally, the need arises for prolonged use of the catheter, and problems occur with occlusion of the catheter. A simple technique is described for converting the needle-catheter jejunostomy into a standard-feeding jejunostomy.

Catheters, Indwelling↗
PubMed1989

Jejunostomy button as a new method for long term jejunostomy feedings.

The button jejunostomy provides long term access for jejunal feedings incorporating the benefits of the gastrostomy button device. Although this procedure requires a celiotomy, we believe the relative simplicity of the procedure and its advantages over other types of jejunostomies warrant its use in patients with clinically significant gastroesophageal reflux who require long term enteral nutrition.

Adult↗
PubMed1996

Surgically placed gastro-jejunostomy tubes have fewer complications compared to feeding jejunostomy tubes.

OBJECTIVE: During laparotomy, jejunostomy tubes (J tubes) are often placed to provide access for enteral nutrition in the immediate postoperative period. However, the placement of such tubes may be associated with potentially devastating intra-abdominal complications possibly related to the tenuous security of a tube through the small bowel wall. An alternative method for enteral nutrition access is to surgically place a "PEG-J" tube (i.e., surgical G/J tube) thus providing for jejunal feedings via a gastrotomy without a jejunotomy. The purpose of this study is to assess whether surgically placed G/J tubes reduce the postoperative complications in comparison to feeding J tubes. METHODS: Over the past 18 months, 92 J tubes and 56 G/J tubes were placed during laparotomy at a single institution and the method chosen by surgeons' preference. The frequency of complications associated with each tube was determined by review of the postoperative medical records. RESULTS: There was no enteric leakage in those patient given G/J tubes (p < 0.05). Furthermore 10% of the patients receiving J tubes required operative repair of a J tube complication while no patient with an access complication following G/J tube placement required surgical repair (p < 0.05). CONCLUSIONS: These results demonstrate that operative positioning of a jejunal feeding tube through a gastrostomy tube (surgical G/J tube) provides a safer route for enteral nutrition than does direct tube placement via the jejunal wall, by significantly reducing both the incidence of enteric leakage and the requirement for operative repair.

Adult↗
PubMedDate not supplied

Laparoscopic jejuno-jejunostomy for afferent loop stasis following truncal vagotomy with posterior gastro-jejunostomy for pyloric stenosis.

A 47-year-old man presented with epigastric pain relieved by bilious vomiting since one month. He had undergone truncal vagotomy with posterior gastrojejunostomy for benign gastric outlet obstruction 2 years ago. Endoscopy showed distension and stasis in the afferent loop, bile gastritis and esophagitis. Laparoscopic Braun jejunojejunostomy relieved his symptoms.

Gastrectomy↗
PubMed2003

Endoscopic placement of direct percutaneous jejunostomy tubes in patients with complications after esophagectomy.

BACKGROUND: Complications after esophagectomy may prevent oral intake, lead to dependence on total parenteral nutrition, and lengthen hospital stay. Direct percutaneous endoscopic placement of a jejunostomy tube allows enteral feeding in the presence of postoperative complications and eliminates the need for total parenteral nutrition. METHODS: A total parenteral nutrition database was used to identify patients who received total parenteral nutrition because of complications after esophagectomy. Records of all patients subsequently referred for percutaneous endoscopic jejunostomy placement were reviewed. RESULTS: Twenty-five patients with postesophagectomy complications were referred for percutaneous endoscopic jejunostomy placement. A percutaneous endoscopic jejunostomy was successfully placed in 21 patients (84%), all of whom were weaned off total parenteral nutrition. Six patients (29%) in whom percutaneous endoscopic jejunostomy placement was successful died during hospitalization at a mean of 20 days (range 5-40 days) after the procedure for reasons unrelated to percutaneous endoscopic jejunostomy tube insertion. The remaining 15 patients were discharged while receiving nutrition by means of the percutaneous endoscopic jejunostomy. Ten of them had subsequent removal of the percutaneous endoscopic jejunostomy at a mean of 131 days (range 20-281 days). There were no major percutaneous endoscopic jejunostomy-related complications. Minor complications occurred in 4 patients (19%). CONCLUSION: Percutaneous endoscopic jejunostomy placement may be considered in patients with complications after esophagectomy. In these patients, percutaneous endoscopic jejunostomy placement avoids the need for total parenteral nutrition.

Aged↗
PubMed1998

Direct percutaneous jejunostomy: techniques and applications--ten years experience.

PURPOSE: To present 10 years experience with direct fluoroscopically guided percutaneous jejunostomy. MATERIALS AND METHODS: Percutaneous jejunostomy was performed in 62 patients, most of whom had undergone major abdominal surgery. A new or replacement jejunostomy was created for alimentation in 20 and 21 patients, respectively. Jejunostomy was performed for interventional procedures of the bile ducts or intestine in 13 patients and for retrograde gastroesophageal drainage in eight. The distended jejunum was accessed with a 21-gauge needle, immobilized with a gastric anchor, and catheterized with a 10-14-F locking loop drain. RESULTS: The technical success rate was 19 of 20 (95%) for new feeding jejunostomy and 17 of 21 (81%) for replacement feeding jejunostomy. Jejunostomy facilitated drainage, dilation, stone extraction, and recanalization in the bile ducts or intestine in all 13 patients. Retrograde jejunoesophagogastrostomy suction effectively replaced painful nasogastric suction in all eight patients. Two patients who underwent replacement jejunostomy required laparotomy for possible leakage; there was no important procedure-related morbidity and no procedure-related mortality. CONCLUSION: The technical success and complication rates of feeding percutaneous jejunostomy compare favorably with those of surgery or endoscopy. Percutaneous jejunostomy is a useful and underused approach to managing bowel and biliary obstruction.

Adult↗
PubMed1994

Tube jejunostomy as an adjunct to esophagectomy.

BACKGROUND: The safety and efficacy of various methods of accessing the intestinal tract, including needle catheter jejunostomy, have been well described. This review represents an evaluation of the Witzel tube jejunostomy as an adjunct to esophagectomy. METHODS: The records of 523 patients who underwent esophagectomy for benign or malignant disease from 1976 to 1991 were reviewed. Each patient underwent placement of a tube jejunostomy at the time of esophagectomy and esophageal reconstruction. Utilization of the jejunostomy tube and the complications related to its placement were examined. RESULTS: The feeding jejunostomy was used in all patients in the initial postoperative period, for more than 3 weeks in 11%, and for more than 2 months in 6.9%. Major complications related to the jejunostomy tube occurred in 11 patients (2.1%). There were no fatal complications. CONCLUSIONS: Tube jejunostomy is a useful adjunct to esophagectomy for providing enteral nutrition during the postoperative period. The Witzel jejunostomy as described herein is comparable in terms of safety, function, and complication rate to the needle catheter jejunostomy and has certain technical advantages. Routine use of tube jejunostomy is recommended in patients undergoing esophagectomy.

Adolescent↗
PubMed1987

Feeding jejunostomy (versus gastrostomy) passes the test of time.

The authors previously reported a higher incidence of early postoperative complications after feeding gastrostomy compared to jejunostomy, prompting the recommendation of jejunostomy for chronic enteral feeding. Long-term follow-up has since been obtained on these 31 patients and an additional 25 patients undergoing surgical feeding procedures. The 26 feeding gastrostomies were 16 Stamm, eight permanent mucosal-lined, and two Witzel. The 30 feeding jejunostomies consisted of 19 Roux-en-Y, nine Stamm, and two Witzel. Patients with gastrostomy have had a mean follow-up of 100 days. Adverse events have occurred in 15/26 (58%), including 9 patients with pulmonary aspiration (35%), two of which were fatal. Twenty-three additional patients have died of underlying diseases. All 11 patients with tube jejunostomy died of underlying diseases within 4 months of surgery. The complication rate was 36%, including pulmonary aspiration in both patients with Witzel jejunostomy. The 19 patients with Roux-en-Y jejunostomy have had mean follow-up of 169 days. Complications have occurred in 9 patients (47%); 16/19 patients (mean age 55 years) have died of underlying disease. The mean age of the patients still alive is 35 years. Feeding jejunostomy has a lower incidence of complications, especially pulmonary aspiration, than gastrostomy. Stamm jejunostomy should be used for enteral feeding in older patients and in patients with short life expectancy. In younger patients requiring lifelong enteral feeding, Roux-en-Y jejunostomy should be used.

Enteral Nutrition↗
PubMed2005

[Direct percutaneous radiologic jejunostomy (PR) and duodenostomy: a retrospective analysis].

PURPOSE: To present our experience with direct percutaneous radiologic duodenostomy and jejunostomy (PRJ) for alimentation. MATERIALS AND METHODS: A retrospective study identified 24 patients who had undergone percutaneous jejunostomy or duodenostomy guided by CT and fluoroscopy over a period of 9 years. Whenever possible, the jejunum was inflated with a 5 French diagnostic catheter and jejunopexy was performed using Cope anchors (T-fasteners). A 12 to14 French locking pigtail drain was inserted for alimentation. In 8 patients, percutaneous direct jejunostomy was performed using only fluoroscopy. In 9 patients, both CT and fluoroscopy were used to guide the jejunostomy. In all 7 patients who underwent duodenostomy, a combination of CT and fluoroscopy was used. The reports were reviewed for complications and the technical success rate. The technical success rate was determined. RESULTS: Percutaneous radiologic jejunostomy was attempted in 17 patients and failed in 5 patients. PRJ was successful in all 8 procedures guided by fluoroscopy and in 4 of 9 procedures guided by CT and fluoroscopy. Direct percutaneous duodenostomy guided by CT and fluoroscopy was successful in all 7 cases. There were no procedure-related laparotomies and no mortality related to the jejunostomy. Minor complications were infection of the abdominal wall (n = 1), lingering pain requiring a new jejunostomy (n = 1) and aspiration because of persistent reflux (n = 1). CONCLUSION: PRJ is a safe procedure even in critically ill patients. It is technically difficult and may fail if the jejunum cannot be distended. Percutaneous radiologic duodenostomy and jejunostomy are recommended for prolonged alimentation of malnourished patients following esophageal or gastric surgery.

Critical Illness↗
PubMed2002

Comparison of direct percutaneous endoscopic jejunostomy and PEG with jejunal extension.

BACKGROUND: Jejunostomy tubes can be placed endoscopically by means of percutaneous gastrostomy with jejunal extension (PEG-J) or by direct percutaneous jejunostomy. These 2 techniques were retrospectively compared in patients requiring long-term jejunal feeding. METHOD: An endoscopy database was used to identify all patients who underwent endoscopic jejunal feeding tube placement from January 1996 to May 2001. Patients with a history of upper GI surgery were excluded. There were 56 patients with a direct percutaneous jejunostomy and 49 with a percutaneous gastrostomy with jejunal extension. Patients in the direct percutaneous jejunostomy group received a 20F direct jejunostomy tube; a 20F PEG tube with a 9F jejunal extension was used in the percutaneous gastrostomy with jejunal extension group. Medical records for the period of 6 months after establishment of jejunal access were reviewed. Complications and need for further endoscopic intervention within this time frame were recorded. The duration of feeding tube patency (number of days from established jejunal access to first endoscopic reintervention) was compared for both groups. RESULTS: Feeding tube patency was significantly longer in patients who had a direct percutaneous jejunostomy compared with those with a percutaneous gastrostomy with jejunal extension. Within the 6-month period, 5 patients with a direct percutaneous jejunostomy required endoscopic reintervention for tube dysfunction compared with 19 patients who had a percutaneous gastrostomy with jejunal extension (p < 0.0001). CONCLUSIONS: For patients who require long-term jejunal feeding, a direct percutaneous jejunostomy with a 20F tube provides more stable jejunal access compared with a percutaneous gastrostomy with jejunal extension with a 9F extension and has a lower associated rate of endoscopic reintervention.

Adult↗
PubMed2007

Randomized clinical trial comparing feeding jejunostomy with nasoduodenal tube placement in patients undergoing oesophagectomy.

BACKGROUND: Feeding jejunostomy is frequently performed in patients undergoing oesophageal surgery, but can lead to serious complications. This prospective randomized trial compared the efficacy and complications of feeding jejunostomy with those of nasoduodenal tube feeding in oesophageal surgery. METHODS: Over an 18-month period, 150 consecutive patients undergoing oesophageal resection were randomized to participate in the trial. Enteral access was by jejunostomy in 79 patients and by nasoduodenal tube in 71. Enteral feeding was started on the first day after surgery. RESULTS: Full enteral feeding took 3 days to be established in both groups. Minor catheter-related complications occurred in 28 patients (35 per cent) in the jejunostomy group, and in 21 (30 per cent) in the nasoduodenal group (P = 0.488). One patient had jejunostomy leakage that required reoperation. Enteral nutrition was given for a median of 11 days in the jejunostomy group and for 10 days in the nasoduodenal group. Nine patients who had a jejunostomy and five with a nasoduodenal tube did not tolerate full enteral feeding (P = 0.411). CONCLUSION: Nasoduodenal tube feeding is safe and efficient after oesophageal resection.

Adult↗
PubMed2006

Post-oesophagectomy early enteral nutrition via a needle catheter jejunostomy: 8-year experience at a specialist unit.

BACKGROUND AND AIMS: The purpose of this study was to prospectively evaluate post-operative jejunostomy feeding in terms of nutritional, biochemical, gastrointestinal and mechanical complications in patients undergoing upper gastrointestinal surgery for oesophageal malignancy. METHODS: The study included 205 consecutive patients who underwent oesophagectomy for malignancy. All patients had a needle catheter jejunostomy (NCJ) inserted at the conclusion of laparotomy. Patients were followed prospectively to record nutritional intake, type of feed administered, rate progression, tolerance, weight changes and complications either mechanical, biochemical or gastrointestinal. RESULTS: Ninety-two per cent of patients were successfully fed exclusively by NCJ post-oesophagectomy, and 94% of patients were tolerating a maintenance regimen of 2000 ml feed over 20 h by day 2 post-operatively. Patients spent a median of 15 days on jejunostomy feeding post-surgery (range 2-112 days); however, 26% required prolonged jejunostomy feeding (>20 days). Minor gastrointestinal complications were effectively managed by slowing the rate of infusion, or administering medication. Three (1.4%) serious complications of jejunostomy feeding occurred, all requiring re-laparotomy, one resulting in death. NCJ feeding was extremely effective in preventing severe post-operative weight loss in the majority of oesophagectomy patients post-op. However, oral intake was generally poor at discharge with only 65% of requirements being met orally. Sixteen patients (8%) patients required home jejunostomy feeding. By the first post-operative month, a further 6% (12) patients were recommenced on jejunostomy feeding. CONCLUSION: NCJ feeding is an effective method of providing nutritional support post-oesophagectomy, and allows home support for the subset that fail to thrive. Serious complications, most usually intestinal ischaemia or intractable diarrhoea, are rare.

Adult↗
PubMedDate not supplied

Percutaneous jejunostomy replacement in patients who have undergone esophagectomy.

PURPOSE: The authors expand their experience with a technique for the percutaneous replacement of a feeding jejunostomy tube in patients who have undergone esophagectomy, in which markers placed during the initial surgical jejunostomy are used. PATIENTS AND METHODS: During esophagectomy in eight patients, a loop of jejunum was intubated with a surgical jejunostomy tube. This loop was then fixed to the anterior abdominal wall and marked with metal clips. In eight patients who required late nutritional support, the surgically placed metal clips on the fixed jejunal loop were used as fluoroscopic guides to mark the site for percutaneous access into the jejunum. Once access was obtained and verified with use of the Seldinger technique, a feeding jejunostomy tube was placed percutaneously after tract dilation. RESULTS: Percutaneous replacement of a feeding jejunostomy tube was successful in all eight patients; in one patient, two placement attempts on successive days were required. No immediate complications occurred. Only one replacement jejunostomy tube has required replacement due to leakage around the tube (mean follow-up, 3.1 months). CONCLUSION: Percutaneous replacement of a feeding jejunostomy tube with use of surgically placed clips as guides for access is a safe and effective method for providing late nutritional support in the postesophagectomy patient.

Abdominal Muscles↗
PubMed2000

Roux-en-Y venting jejunostomy in pancreatic transplantation: a novel approach to monitor rejection and prevent anastomotic leak.

INTRODUCTION: Pancreatic transplantation (PTx) with portal venous delivery of insulin and enteric drainage of the exocrine secretion is more physiologic than bladder-systemic (BS) drainage. With portal-enteric (PE) PTx, the diagnosis of acute rejection (AR) requires a percutaneous biopsy. The roux-en-y (RNY) venting jejunostomy in patients with PEPTx offers a novel approach to monitor rejection and prevent anastomatic leaks. METHODS: From January 1996 to December 1998, we performed 17 simultaneous kidney/pancreas transplants (SKPTx). The initial 4 patients underwent BS drainage and the subsequent 13 patients underwent RNY venting jejunostomy with PE drainage. All patients were treated with quadruple therapy. There were 9 males, 14 patients were Caucasian with a mean age of 32 yr (range 30-54 yr), and a mean pre-transplantation duration of diabetes of 25 yr. Six patients underwent endoscopic donor duodenal biopsy through the jejunostomy to rule out clinically suspected AR. Gastrograffin was inserted into the jejunostomy to examine the integrity of anastamosis when indicated. In 9 out of 13 patients, the venting jejunostomy was taken down 9-12 months post-transplantation after allograft function was stable. RESULTS: Actual patient, kidney, and pancreas graft survival rates were 100, 100 and 94%, respectively, after a mean follow-up of 16 months. Renal allografts functioned immediately in 89% of patients. The mean length of hospital stay was 19 d. Four (23%) patients (2 with BS drainage and 2 with PE drainage) suffered an AR episode in the first month, and 4 (23%) patients had five AR from 3-36 months post-transplantation. Other complications were post-operative bleeding in 3 patients, wound infection in 2 patients and a proximal duodenal stump leak in 1 patient. In patients with clinical rejection, endoscopy through the venting jejunostomy showed inflamed, friable doudenal mucosa and doudenal biopsy findings were compatible with AR. CONCLUSION: These preliminary results suggest that RNY venting jejunostomy with PE drainage can be used safely to diagnose and monitor pancreas AR and to diagnose and prevent anastamotic leaks. This technique will be even more useful to visualize transplanted duodenal mucosa, collect pancreatic secretions (amylase) for analysis and perform endoscopic retrograde cholangiopancreatography if needed to obtain pancreatic biopsies.

Adult↗