Ivy N Haskins, MD1, Andrew T Strong, MD1, Gautam Sharma, MD1, Matthew Karafa, PhD2, John H Rodriguez, MD, FACS1, Matthew D Kroh, MD, FACS1. 1Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic Foundation, 2Department of Quantitative Health Sciences, Cleveland Clinic Foundation
Introduction: Enteral access through the jejunum is indicated when patients cannot tolerate oral intake or gastric feeding. While multiple approaches to jejunal access exist, few studies have compared the efficacy of these routes of obtaining jejunal enteral access. The purpose of this study was to investigate the long-term durability, re-interventions rates, and nutritional outcomes between percutaneous endoscopic gastrostomy tubes with jejunal extension tube (PEG-JET) to laparoscopic jejunostomy tubes (j-tube).
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 (> 6 months) tube complications and nutritional parameters 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. PEG-JET patients were significantly older (p = 0.007), were more likely to be male (p = 0.003), and had a lower preoperative albumin level (p < 0.001). There was no statistically significant difference between the two groups in terms of patient comorbidities. The most common indications for PEG-JET placement were gastroparesis (n=35, 39.8%), aspiration (n=27, 30.7%), and dementia (n=8, 9.1%). The most common indications for laparoscopic j-tube were gastroparesis (n=159, 62.4%) and esophageal cancer (n=26, 10.2%). 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 were significantly more likely to require 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 (> 6 months), patients who underwent PEG-JET placement were significantly more likely to experience tube occlusion (p < 0.001) and require 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, both in terms of re-intervention rates and nutritional outcomes. Consideration should be given to laparoscopic jejunostomy tube placement in all surgical patients who cannot tolerate oral intake or gastric enteral feeding.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79575
Program Number: S120
Presentation Session: MIS – Cool Stuff
Presentation Type: Podium