A two institution experience with 226 endoscopically placed jejunal feeding tubes in critically ill surgical patients.
BACKGROUND
Early jejunal feeding after surgery or trauma reduces infectious complications. Although not ideal gastric and postpyloric feedings are often used, however, because of difficulty in placing feeding tubes distal to the ligament of Treitz (LOT). Our hypothesis was that feeding tube placement distal to the LOT can be accomplished using a bedside transendoscopic technique.


METHODS
Transendoscopic jejunal (TEJ) tube placement and TEJ tubes inserted simultaneously through percutaneous gastrostomy (PEG) tubes (PEG/TEJ) were attempted to be placed distal to the LOT.


RESULTS
In all, 226 feeding tubes (185 TEJ, 41 PEG/TEJ) were placed in 179 trauma and 47 nontrauma patients over 3 years (August 20, 1998 to July 15, 2001). Tube location was jejunal in 93.8% of trauma patients, 76.6% of nontrauma patients, and 90.3% of all patients. (Confidence intervals were 89.3% to 96.5%, 62.8% to 86.4%, and 85.7% to 93.5%). Days of total parenteral nutrition were reduced 71.3% in trauma patients, 22.8% in nontrauma patients, and 45% overall at one institution.


CONCLUSIONS
Bedside TEJ and PEG/TEJ placement is safe and successful in placing feeding tubes distal to the LOT in more than 90% of critically ill surgical patients.
Nicholas
Jeffrey M
JM
Department of Surgery, Emory University/Grady Memorial Hospital/Rollins School of Public Health, Atlanta, GA, USA. jeffrey_nicholas@emoryhealthcare.org
Cornelius
Mark W
MW
Tchorz
Kathryn M
KM
Tremblay
Lorraine N
LN
Spiegelman
E Ronald
ER
Easley
Kirk A
KA
Small
William
W
Feliciano
David V
DV
Powell
Melissa A
MA
Poklepovic
Jerry
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D004385:Duodenostomy; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D011182:Postoperative Care; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000628:therapy