PWE-127 Gastrointestinal dysmotility – the conundrum of feeding: a new technique

Abstract

Introduction Gastrointestinal (GI) dysmotility disorders can be debilitating and their management challenging. Patients often require feeding tubes to support nutrition, which can be complicated by discomfort and/or displacement. Laparoscopically Assisted-Enteroscopically Positioned Jejunostomy Tube (LA-EPJT) insertion is a novel technique not previously described in GI literature. It involves enteroscopic insertion of a jejunostomy tube under direct laparoscopic vision and general anaesthesia. This study reviews the experience of LA-EPJT insertion for GI dysmotility disorders at a district hospital. Methods Endoscopy records were used to identify all patients who had undergone LA-EPJT insertion. Patient notes were reviewed to identify indications, previous tube requirements and outcomes. Results 7 LA-EPJTs were placed between 2014 and 2017 (6 females; age 19–77; median 35; mean 43). Table 1 shows patient symptoms and indications for LA-EPJT insertion. No tubes migrated or were dislodged after insertion. 1/7 patients (14.3%) had early bleeding and tube-site infection. Perforation rates were 0%. 5/7 (71.4%) had initial pain with feeding after LA-EPJT insertion although this universally subsided, 1/7 (14.3%) had ongoing vomiting. 5/7 (71.4%) tubes remain in situ. 1 was replaced with a PEG-J to allow venting of intestinal contents, and 1 was removed and TPN commenced (psychological factors precluded continued tube-feeding). Conclusions This study suggests that LA-EPJTs are useful nutritional adjuncts for patients with GI dysmotility disorders. They are a more permanent solution, with little risk of migration. They appear to better control symptoms such as pain and vomiting than traditional tubes, and are simple to change. The procedure benefits from direct laparoscopic vision of the jejunum and therefore carries low perforation rates. Further studies are needed to assess long-term complications and efficacy of LA-EPJTs for symptom control and nutrition. However, this data is promising and GI centres could consider adoption of this novel technique for patients with GI dysmotility disorders. Previous non-pharmacological treatments and nutritional support utilised by patients are shown in table 2.