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Comparison of laparoscopic jejunostomy tube to percutaneous endoscopic gastrostomy tube with jejunal extension: long-term durability and nutritional outcomes.
Surg Endosc. 2018 05; 32(5):2496-2504.SE

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.

Authors+Show Affiliations

Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.Department of Clinical Nutrition, The George Washington University Hospital, Washington, DC, USA.Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA. Cleveland Clinic Lerner College of Medicine, Case Western Reserve, Cleveland, OH, USA.Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA. krohm@clevelandclinicabudhabi.ae. Cleveland Clinic Lerner College of Medicine, Case Western Reserve, Cleveland, OH, USA. krohm@clevelandclinicabudhabi.ae. Digestive Disease Institute, Clevelad Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. krohm@clevelandclinicabudhabi.ae.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29218657

Citation

Haskins, Ivy N., et al. "Comparison of Laparoscopic Jejunostomy Tube to Percutaneous Endoscopic Gastrostomy Tube With Jejunal Extension: Long-term Durability and Nutritional Outcomes." Surgical Endoscopy, vol. 32, no. 5, 2018, pp. 2496-2504.
Haskins IN, Strong AT, Baginsky M, et al. Comparison of laparoscopic jejunostomy tube to percutaneous endoscopic gastrostomy tube with jejunal extension: long-term durability and nutritional outcomes. Surg Endosc. 2018;32(5):2496-2504.
Haskins, I. N., Strong, A. T., Baginsky, M., Sharma, G., Karafa, M., Ponsky, J. L., Rodriguez, J. H., & Kroh, M. D. (2018). Comparison of laparoscopic jejunostomy tube to percutaneous endoscopic gastrostomy tube with jejunal extension: long-term durability and nutritional outcomes. Surgical Endoscopy, 32(5), 2496-2504. https://doi.org/10.1007/s00464-017-5954-6
Haskins IN, et al. Comparison of Laparoscopic Jejunostomy Tube to Percutaneous Endoscopic Gastrostomy Tube With Jejunal Extension: Long-term Durability and Nutritional Outcomes. Surg Endosc. 2018;32(5):2496-2504. PubMed PMID: 29218657.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of laparoscopic jejunostomy tube to percutaneous endoscopic gastrostomy tube with jejunal extension: long-term durability and nutritional outcomes. AU - Haskins,Ivy N, AU - Strong,Andrew T, AU - Baginsky,Mary, AU - Sharma,Gautam, AU - Karafa,Matthew, AU - Ponsky,Jeffrey L, AU - Rodriguez,John H, AU - Kroh,Matthew D, Y1 - 2017/12/07/ PY - 2017/02/05/received PY - 2017/10/21/accepted PY - 2017/12/9/pubmed PY - 2019/10/18/medline PY - 2017/12/9/entrez KW - Enteral nutrition KW - Jejunostomy tube KW - Jejunum KW - Nutrition KW - Percutaneous endoscopic gastrostomy tube with jejunal extension SP - 2496 EP - 2504 JF - Surgical endoscopy JO - Surg Endosc VL - 32 IS - 5 N2 - 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. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/29218657/Comparison_of_laparoscopic_jejunostomy_tube_to_percutaneous_endoscopic_gastrostomy_tube_with_jejunal_extension:_long_term_durability_and_nutritional_outcomes_ L2 - https://dx.doi.org/10.1007/s00464-017-5954-6 DB - PRIME DP - Unbound Medicine ER -