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01-05-2018

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

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

Published in: Surgical Endoscopy | Issue 5/2018

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.

McClave SA, Martindale RG, Rice TW, Heyland DK (2014) Feeding the critically ill patient. Crit Care Med 42(12):2600–2610CrossRefPubMed

McClave SA, Heyland DK (2009) The physiologic response and associated clinical benefits from provision of early enteral nutrition. Nutr Clin Pract 24(3):305–315CrossRefPubMed

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

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 PubMed

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 Spring

Wolfsen HC, Kozarek RA, Ball TJ, Patterson DJ, Botoman VA (1990) Tube dysfunction following percutaneous endoscopic gastrostomy and jejunostomy. Gastrointest Endsoc 36(3):261–263CrossRef

Gauderer MWL, Ponsky JL, Izant RJ (1980) Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 15(6):872–875CrossRefPubMed

Ponsky JL, Gauderer MWL (1981) Percutaneous endoscopic gastrostomy: a nonoperative technique for feeding gastrostomy. Gastrointest Endosc 27(1):9–11CrossRefPubMed

Ponsky JL, Aszodi A (1984) Percutaneous endoscopic jejunostomy. Am J Gastroenterol 79(2):113–116PubMed

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.

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):36–42CrossRefPubMed

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):239.243CrossRef

13.

DiSaria JA, Foutch PG, Sanowski RA (1990) Poor results with percutaneous endoscopic gastrojejunostomy. Gastrointest Endosc 36(3):257–260CrossRef

14.

Bochicchio GV, Guzzo JL, Scaelea TM (2006) Percutaneous endoscopic gastrostomy in the super-morbidly obese patient. JSLS 10(4):409–413PubMedPubMedCentral

15.

Ho HS, Ngo H (1999) Gastrostomy for enteral access. A comparison among placement by laparotomy, laparoscopy, and endoscopy. Surg Endosc 13(10):991–994CrossRefPubMed

16.

Stellato TA, Gauderer MW, Ponsky JL (1984) Percutaneous endoscopic gastrostomy following previous abdominal surgery. Ann Surg 200(1):46–50CrossRefPubMedPubMedCentral

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):537–542CrossRefPubMed

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):890–894CrossRefPubMed

19.

Simon T, Fink AS (2000) Recent experience with percutaneous endoscopic gastrostomy/jejunostomy (PEG/J) for enteral nutrition. Surg Endosc 14(5):436–438CrossRefPubMed

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):21–27CrossRef

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):159–211CrossRefPubMed

Title: Comparison of laparoscopic jejunostomy tube to percutaneous endoscopic gastrostomy tube with jejunal extension: long-term durability and nutritional outcomes
Authors: Ivy N. Haskins
Andrew T. Strong
Mary Baginsky
Gautam Sharma
Matthew Karafa
Jeffrey L. Ponsky
John H. Rodriguez
Matthew D. Kroh
Publication date: 01-05-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 5/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5954-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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