Surgical Endoscopy

, Volume 32, Issue 5, pp 2496–2504 | Cite as

Comparison of laparoscopic jejunostomy tube to percutaneous endoscopic gastrostomy tube with jejunal extension: long-term durability and nutritional outcomes

  • Ivy N. Haskins
  • Andrew T. Strong
  • Mary Baginsky
  • Gautam Sharma
  • Matthew Karafa
  • Jeffrey L. Ponsky
  • John H. Rodriguez
  • Matthew D. Kroh
Article

Abstract

Introduction

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).

Methods

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.

Results

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).

Conclusion

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.

Keywords

Enteral nutrition Jejunostomy tube Jejunum Nutrition Percutaneous endoscopic gastrostomy tube with jejunal extension 

Notes

Acknowledgements

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

Disclosures

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.

References

  1. 1.
    McClave SA, Martindale RG, Rice TW, Heyland DK (2014) Feeding the critically ill patient. Crit Care Med 42(12):2600–2610CrossRefPubMedGoogle Scholar
  2. 2.
    McClave SA, Heyland DK (2009) The physiologic response and associated clinical benefits from provision of early enteral nutrition. Nutr Clin Pract 24(3):305–315CrossRefPubMedGoogle Scholar
  3. 3.
    Haskins IN, Baginsky M, Gamsky N, Sedghi K, Yi S, Amdur RL, Gergley M, Sarani B (2015) A volume-based enteral nutrition support regimen improves caloric delivery but may not affect clinical outcomes in critically ill patients. JPEN J Parenter Enteral Nutr.  https://doi.org/10.1177/0148607115617441 Google Scholar
  4. 4.
    Haskins IN, Baginsky M, Amdur RL, Agarwal S (2016) Preoperative hypoalbuminemia is associated with worse outcomes in colon cancer patients. Clin Nutr.  https://doi.org/10.1016/j.clnu.2016.08.023 PubMedGoogle Scholar
  5. 5.
    Mueller CM, Kovacevich DS, Mcclave SA, Miller SJ, Schwartz DB (2012) The A.S.P.E.N. adult nutrition support core curriculum, 2nd edn. The American Society for Parenteral and Enteral Nutrition, Silver SpringGoogle Scholar
  6. 6.
    Wolfsen HC, Kozarek RA, Ball TJ, Patterson DJ, Botoman VA (1990) Tube dysfunction following percutaneous endoscopic gastrostomy and jejunostomy. Gastrointest Endsoc 36(3):261–263CrossRefGoogle Scholar
  7. 7.
    Gauderer MWL, Ponsky JL, Izant RJ (1980) Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 15(6):872–875CrossRefPubMedGoogle Scholar
  8. 8.
    Ponsky JL, Gauderer MWL (1981) Percutaneous endoscopic gastrostomy: a nonoperative technique for feeding gastrostomy. Gastrointest Endosc 27(1):9–11CrossRefPubMedGoogle Scholar
  9. 9.
    Ponsky JL, Aszodi A (1984) Percutaneous endoscopic jejunostomy. Am J Gastroenterol 79(2):113–116PubMedGoogle Scholar
  10. 10.
    Strong AT, Sharma GA, Davis M, Mulcahy M, Punchai S, O’Rourke CP, Brethauer SA, Rodriguez J, Ponsky JL, Kroh MD (2016) Direct percutaneous endoscopic jejunostomy (DPEJ) tube placement: a single institution experience and outcomes to 30 days and beyond.  https://doi.org/10.1007/s11605-016-3337-2
  11. 11.
    Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF (1999) Preoperative serum albumin level as a predictor of operative mortality and morbidity. Arch Surg 134(1):36–42CrossRefPubMedGoogle Scholar
  12. 12.
    DeLegge MH, Duckworth PF, McHenry L, Fox-Orestein A, Craig RM, Kirby DF (1995) Percutaneous endoscopic jejunostomy: a dual center safety and efficacy trial. JPEN J Parenter Enteral Nutr 19(3):239.243CrossRefGoogle Scholar
  13. 13.
    DiSaria JA, Foutch PG, Sanowski RA (1990) Poor results with percutaneous endoscopic gastrojejunostomy. Gastrointest Endosc 36(3):257–260CrossRefGoogle Scholar
  14. 14.
    Bochicchio GV, Guzzo JL, Scaelea TM (2006) Percutaneous endoscopic gastrostomy in the super-morbidly obese patient. JSLS 10(4):409–413PubMedPubMedCentralGoogle Scholar
  15. 15.
    Ho HS, Ngo H (1999) Gastrostomy for enteral access. A comparison among placement by laparotomy, laparoscopy, and endoscopy. Surg Endosc 13(10):991–994CrossRefPubMedGoogle Scholar
  16. 16.
    Stellato TA, Gauderer MW, Ponsky JL (1984) Percutaneous endoscopic gastrostomy following previous abdominal surgery. Ann Surg 200(1):46–50CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Aytac E, Stocchi L, DeLong J, Costedio MM, Gorgun E, Kessler H, Remzi FH (2015) Impact of previous midline laparotomy on the outcomes of laparoscopic intestinal resections: a case-matched study. Surg Endosc 29(3):537–542CrossRefPubMedGoogle Scholar
  18. 18.
    Fan AC, Baron TH, Rumalla A, Harewood GC (2002) Comparison of direct percutaneous endoscopic jejunostomy and PEG with jejunal extension. Gastrointest Endosc 56(6):890–894CrossRefPubMedGoogle Scholar
  19. 19.
    Simon T, Fink AS (2000) Recent experience with percutaneous endoscopic gastrostomy/jejunostomy (PEG/J) for enteral nutrition. Surg Endosc 14(5):436–438CrossRefPubMedGoogle Scholar
  20. 20.
    Peev MP, Yeh DD, Qurasishi SA, Osler P, Chang Y, Gillis E, Albano CE, Darak S, Velmahos GC (2015) Causes and consequences of interrupted enteral nutrition: a prospective observational study in critically ill surgical patients. JPEN J Parenter Enteral Nutr 39(1):21–27CrossRefGoogle Scholar
  21. 21.
    McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, McCarthy MS, Davanos E, Rice TW, Cresci GA, Gervasio JM, Sacks GS, Roberts PR, Compher C, Society of Critical Care Medicine, American Society for Parenteral and Enteral Nutrition (2016) Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: society of critical care medicine (SCCM) and american society for parenteral and enteral nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 40(2):159–211CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Ivy N. Haskins
    • 1
  • Andrew T. Strong
    • 1
  • Mary Baginsky
    • 2
  • Gautam Sharma
    • 1
  • Matthew Karafa
    • 3
  • Jeffrey L. Ponsky
    • 1
    • 4
  • John H. Rodriguez
    • 1
  • Matthew D. Kroh
    • 1
    • 4
    • 5
  1. 1.Section of Surgical Endoscopy, Department of General SurgeryCleveland Clinic FoundationClevelandUSA
  2. 2.Department of Clinical NutritionThe George Washington University HospitalWashingtonUSA
  3. 3.Department of Quantitative Health Sciences, Lerner Research InstituteCleveland Clinic FoundationClevelandUSA
  4. 4.Cleveland Clinic Lerner College of MedicineCase Western ReserveClevelandUSA
  5. 5.Digestive Disease Institute, Clevelad Clinic Abu DhabiAbu DhabiUnited Arab Emirates

Personalised recommendations