Efficacy of jejunogram after jejunostomy insertion

The era of managed care has spawned a national debate over the allocation o f health care resources. We hypothesized that routine postjejunostomy jejun ogram rarely provides additional clinical information or changes patient ma nagement and, therefore, is unwarranted. We retrospectively reviewed the ch arts of 128 consecutive patients undergoing feeding jejunostomy tube insert ion between January 1995 and December 1996. All patients had postinsertion jejunograms. Eighty-five (66%) of the jejunograms were performed after oper ative insertion of the jejunostomy, and 43 (33%) were performed after percu taneous reinsertion of a previously placed jejunostomy. Data extracted from the charts include age, sex, indication for jejunogram, length of time pri or jejunostomy was in place at time of reinsertion, and results of jejunogr am There were no patients (0%) with misplaced jejunostomy or extravasation of dye, as noted on jejunogram. There were no management changes implemente d as a result of jejunogram readings (P < <0.05). The use of routine jejuno gram after operative insertion or reinsertion of a prior jejunostomy that h as become dislodged or occluded does not alter patient management, incurs u nnecessary costs, and, therefore, is unwarranted.