The button jejunostomy for long-term jejunal feeding: results of a prospective randomized trial.
Low profile, self-retaining feeding conduits ("buttons") inserted percutaneously through a mature gastrostomy stoma are ideal for prepyloric feeding. We tested the efficacy of a surgically inserted button (Button, C.R. Bard, Inc) in the jejunum for long-term postpyloric feeding. Forty-two aspiration risk patients were prospectively randomized to receive a standard No. 14 French red rubber catheter (n = 21, mean age 68 +/- 17 years) or the button (n = 21, mean age 68 +/- 18 years). Common indications for jejunal feeding were aphagia due to obtundation (41%) and esophageal dysmotility (41%). All feeding devices were inserted 20 cm distal to the ligament of Treitz via a serosal tunnel (catheter) or double pursestring (button) technique. No patient required reoperation, and cardiopulmonary failure was the most frequent cause of death, occurring in 11 patients (26%). Goal feedings were obtained in 91% of the catheter patients and 100% of the button patients by postoperative day 4.7 +/- 1.9 and 4.2 +/- 2.2, respectively. At a follow-up of 43 +/- 13 days, 12 (92.3%) of 13 catheter patients and 9 (81.8%) of 11 button patients were receiving goal feedings. Three patients in the catheter group and four patients in the button group had resumed an oral diet. Device-related complications (dislodgment, occlusion, peritubular leak, or bowel obstruction) and total number of patients with complications were significantly lower in the button group (one [5%] vs eight [38%] for device-related complications and one [5%] vs six [29%] for incidence of complications for the button and catheter groups, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Gorman
R C
RC
Division of Gastrointestinal Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104-4283.
Morris
J B
JB
Metz
C A
CA
Mullen
J L
JL
D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies