Recent experience with percutaneous endoscopic gastrostomy/jejunostomy (PEG/J) for enteral nutrition

Background: Enteral feeding is the preferred means of nutritional support i n patients unable to eat orally. Jejunal placed feeding tubes are often con sidered optimal for this purpose. Successful administration of such tube fe edings depends on the method of placement and the size of the tube. Herein we review our experience with endoscopically placed jejunal feeding tubes. Methods: Thirteen percutaneous endoscopic gastrostomy/jejunostomy (PEG/J) t ubes were placed in 13 patients at the Emery University hospital by one sur geon. Indications for jejunal placement included aspiration in five patient s and suspicion of increased reflux susceptibility in eight patients. Inser tion of an 8.5-Fr nasobiliary tube was attempted in nine patients using the technique described by Coates and Mac-Fadyen. A 12-Fr tube was placed in f our patients using a technique that took advantage of previously placed PEG tubes. Results: Initial placement was successful in all but one patient. Nine tube -related complications occurred in seven patients. These included six tube occlusions, one tube site infection, one peristomal leak, and one tube perf oration that required replacement. Five of six tube occlusions (83%) occurr ed in the smaller 8.5-Fr. tubes. There was one non-tube-related death. Conclusions: PEG/J insertion can be performed successfully and safely in mo st patients. Long-term tube patency is, however, dependent on the use of tu bes with a large diameter; thus, modalities that enable placement of larger -sized tubes are preferable. Further technical developments are needed to f acilitate the endoscopic insertion of larger jejunostomy tubes.