Can percutaneous endoscopic jejunostomy prevent gastroesophageal reflux inpatients with preexisting esophagitis?

OBJECTIVE: Percutaneous endoscopic jejunostomy has been used for preventing pulmonary aspiration arising from gastric contents by concomitant jejunal feeding and gastric decompression in susceptible patients. Our objective wa s to evaluate gastroesophageal reflux in patients with percutaneous endosco pic jejunostomy tube feeding. METHODS: Eight cerebrovascular accident patients with percutaneous endoscop ic jejunostomy tube placement caused by reflux esophagitis with hematemesis , food regurgitation or vomiting, and/or recurrent aspiration pneumonia wer e tested for gastroesophageal reflux using 24-h esophageal pH monitoring du ring continuous jejunal liquid meal or saline infusion with concomitant gas tric decompression. Twenty-four hour pH monitoring was also performed durin g intragastric feeding on a different day. RESULTS: During the liquid meal feeding period, percutaneous endoscopic jej unostomy feeding reduced esophageal acid exposure 46% [12.9% (4.9-28.2%) ve rsus 24.0% (19.0-40.6%), p = 0.01], compared to intragastric feeding. Howev er, in the period of the jejunal tube infusion, esophageal acid exposure wa s significantly lower during saline infusion than during meal infusion [3.2 (0.0%-10.8%) versus 12.9% (4.9-28.2%), p = 0.008]. CONCLUSION: Percutaneous endoscopic jejunostomy feeding reduced but did not eliminate gastroesophageal reflux, compared to intragastric feeding in pat ients with severe gastroesophageal reflux. However, gastroesophageal reflux during percutaneous jejunal feeding was associated with meal infusion. Thi s might, in part, explain the failure of percutaneous endoscopic jejunostom y tube placement to prevent pulmonary aspiration. (C) 2000 by Am. Cell. of Gastroenterology.