Comparison of laparoscopic jejunostomy tube to percutaneous endoscopic gastrostomy tube with jejunal extension: long-term durability and nutritional outcomes
Enteral access through the jejunum is indicated when patients cannot tolerate oral intake or gastric feeding. While multiple approaches for feeding jejunal access exist, few studies have compared the efficacy of these techniques. The purpose of this study was to investigate the long-term durability, re-intervention rates, and nutritional outcomes following percutaneous endoscopic gastrostomy tubes with jejunal extension tubes (PEG-JET) versus laparoscopic jejunostomy tubes (j-tubes).
Retrospective chart review was performed on all patients who underwent PEG-JET or laparoscopic jejunostomy tube placement from January 2005 through December 2015 at our institution. Thirty-day and long-term outcomes were compared between the two groups.
A total of 105 patients underwent PEG-JET and 307 patients underwent laparoscopic j-tube placement during the defined study period. In terms of 30-day outcomes, patients who underwent PEG-JET placement were significantly more likely to experience a tube dislodgement event (p = 0.005) and undergo a re-intervention (p < 0.001). Patients who had a laparoscopic j-tube placed were significantly more likely to meet their enteral feeding goals (p = 0.002) and less likely to require nutritional supplementation with total parenteral nutrition (TPN) (p < 0.001). With regard to long-term outcomes, patients who underwent PEG-JET placement were significantly more likely to experience tube occlusion (p < 0.001) and require an endoscopic or surgical tube re-intervention (p < 0.001). Patients who underwent laparoscopic j-tube placement were significantly more likely to experience a tube site leak (p = 0.015) but were less likely to require nutritional supplementation with TPN (p = 0.001).
Laparoscopic jejunostomy tubes provide more durable long-term enteral access compared to PEG-JET. Consideration should be given to laparoscopic jejunostomy tube placement in eligible patients who cannot tolerate oral intake or gastric enteral feeding.
KeywordsEnteral nutrition Jejunostomy tube Jejunum Nutrition Percutaneous endoscopic gastrostomy tube with jejunal extension
Ivy N. Haskins: study concept, data acquisition, data analysis, data interpretation, and manuscript writing. Andrew T. Strong: data acquisition, data analysis, data interpretation, and manuscript writing. Mary Baginsky: data interpretation and manuscript writing. Gautam Sharma: data acquisition and manuscript writing. Matthew Karafa: data analysis, data interpretation, and final manuscript review. Jeffrey L. Ponsky: data interpretation and final manuscript review. John H. Rodriguez: study concept, data interpretation, and final manuscript review. Matthew D. Kroh: study concept, data interpretation, and final manuscript review.
Compliance with ethical standards
Ivy N. Haskins has no conflict of interest relevant to this publication but has an active Resident Research Grant from the Americas Hernia Society. John H. Rodriguez has no conflict of interest relevant to this publication and has received research funding from Intuitive Surgical. Matthew D. Kroh has no conflict of interest relevant to this publication and is a consultant for Levita™ Magnetics and has received research funding from Cook Biotech, Medtronic, and Pacira Pharmacueticals. Andrew T. Strong, Mary Baginsky, Gautam Sharma, Matthew Karafa, and Jeffrey L. Ponksy have no conflict of interest or financial ties to disclose.
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