A Ten-Year Evaluation of Jejunostomy Tube Indications, Complications, and Clinical Outcomes for Nutritional Support at a Tertiary University Hospital

Abstract

Introduction: Malnutrition affects up to 40% of hospitalized patients, increases morbidity and mortality, and can be severe enough to warrant enteral delivery of nutrients. A jejunostomy (J) tube route is recommended in settings of a high aspiration risk, gastric dysmotility, refractory nausea and vomiting, gastric outlet obstruction, and pancreatitis. Our goal was to document the clinical indications, complications, and long-term outcomes of patients requiring nutrition via a J tube at a tertiary medical center. Methods: This was a retrospective medical chart review conducted from January 2004 to December 2014 to define the demographics, clinical settings, and diagnoses of J tube recipients, as well as duration of use, complications, and outcomes. Results: One hundred-sixty patients, mean age 50.5 (18-84), 50% female, 71% Hispanics, 26% Caucasians, 2% Asians, and 1% African Americans, received a J tube during that time period. Their baseline mean serum albumin was 2.56 g/dL (0.9-4.5 g/dL). Indications were: 1.) 72% with anatomically compromised esophagus, stomach, or duodenum due to esophageal (9%) or gastric (13%) cancer; esophageal (4%), gastric, or duodenal (14%) perforation, gastric outlet or duodenal obstruction (25%), and abdominal trauma (7%); 2.) gastroparesis and refractory nausea/vomiting (14%), with 41% being diabetic; 3.) Pancreatic pathology (14%): pancreatitis (12%), pancreatic adenocarcinoma (2%). The J tube was surgically placed in 92.5%, and endoscopically by a gastroenterologist in 7.5% of cases. The J tube size ranged from 12-24 French and infusion rates varied from 20-100 mL/hr either continuous or nocturnal. Duration of use ranged from 2 weeks to ≥1 year. J tube complications included tube leak (6%), localized skin reactions (3%), clogging (2%), and enterocutaneous fistula (1%). Twenty-four (15%) patients died related to their underlying esophageal, gastric, and pancreatic adenocarcinoma or bowel perforation. Of the 85% of patients who survived, 15% achieved their goal weight, 31% tolerated PO and J tube was eventually discontinued, 23% continued on long-term jejunostomy tube feeding, and 31% did not have documented long-term outcomes. Conclusion: In an academic tertiary care facility: 1.) Approximately 0.5% of patients admitted to the medical service required placement of a J tube for nutrition. 2.) Indications varied from an anatomically compromised esophageal or gastroduodenal junction (72%), to gastroparesis and refractory nausea/vomiting (14%), to pancreatic pathology (14%); 3.) A significant benefit was evident by adequate weight gain, and return to PO nutrition was achieved in the majority. Our study supports J tube feeding as the preferred route to safely achieve long-term nutritional support and clinical outcomes.