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

Background: Enteral feeding is the preferred means of nutritional support in patients unable to eat orally. Jejunal placed feeding tubes are often considered optimal for this purpose. Successful administration of such tube feedings 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) tubes were placed in 13 patients at the Emery University hospital by one surgeon. Indications for jejunal placement included aspiration in five patients and suspicion of increased reflux susceptibility in eight patients. Insertion 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 four 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 perforation that required replacement. Five of six tube occlusions (83%) occurred 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 most patients. Long-term tube patency is, however, dependent on the use of tubes with a large diameter; thus, modalities that enable placement of larger-sized tubes are preferable. Further technical developments are needed to facilitate the endoscopic insertion of larger jejunostomy tubes.