Jejunostomy Placement Research Articles

Routine intraoperative jejunostomy placement and minimally invasive oesophagectomy: an unnecessary step?†

Adequate nutrition is challenging after oesophagectomy. A jejunostomy is commonly placed during oesophagectomy for nutritional support. However, some patients develop jejunostomy-related complications and the benefit over oral nutrition alone is unclear. This study aims to assess jejunostomy-related complications and the impact of intraoperative jejunostomy placement on weight loss and perioperative outcomes in patients with oesophageal cancer treated with minimally invasive Ivor Lewis oesophagectomy (MIE). From a prospectively maintained database, patients were identified who underwent MIE with gastric reconstruction. Between 2007 and 2016, a jejunostomy was routinely placed during MIE. After 2016, a jejunostomy was not utilized. Postoperative feeding was performed according to a standardized protocol and similar for both groups. The primary outcomes were jejunostomy-related complications, relative weight loss at 3 and 6 months postoperative and perioperative outcomes, including anastomotic leak, pneumonia and length of stay, respectively. A total of 188 patients were included, of whom 135 patients (72%) received a jejunostomy. Ten patients (7.4%) developed jejunostomy-related complications, of whom 30% developed more than 1 complication. There was no significant difference in weight loss between groups at 3 months (P = 0.73) and 6 months postoperatively (P = 0.68) and in perioperative outcomes (P-value >0.999, P = 0.591 and P = 0.513, respectively). The use of a routine intraoperative jejunostomy appears to be an unnecessary step in patients undergoing MIE. Intraoperative jejunostomy placement is associated with complications without improving weight loss or perioperative outcomes. Its use should be tailored to individual patient characteristics. Early oral nutrition allows patients to maintain an adequate nutritional status.

03:45 PM Abstract No. 311 Low-profile microcatheter/microballoon-assisted direct percutaneous fluoroscopic-guided primary jejunostomy placement

Direct percutaneous jejunostomy (DPJ) is a historically difficult procedure, indicated for patients where percutaneous gastrostomy does not provide adequate nutritional support and distal feeding is needed, such as in gastric cancers, abnormal gastric anatomy, or previous gastric surgeries. Jejunostomy placement is cumbersome and at times aborted due to the mobile nature of these small bowel loops, making anchoring difficult with conventional approaches. We report a novel procedure for primary direct percutaneous jejunostomy under fluoroscopic guidance, utilizing a low profile technique which makes placement safe and efficacious. Retrospective review of patients who underwent primary fluoroscopic jejunostomy placement at our institution was performed. In our approach, a standard micropuncture needle was advanced into jejunum under fluoroscopic or ultrasound guidance. A 2-3mm short shaft 0.014 in pedal access micro-balloon catheter was advanced into jejunum over the wire, and used as an initial anchor, so that at least two Pexy anchors could subsequently be placed into this segment of bowel. After serial dilation of the initial anchor access, a 14-16F jejunostomy tube was advanced into desired position. A total of 15 low profile approach primary jejunostomy tube placements were identified, with mean patient age 64.3 ± 17.7 years with 10/15 male (67%). 15/15 (100%) of jejunostomy tubes were successfully placed in the desired efferent segment of jejenum without major complications. (1/15) was replaced shortly after placement due to self-removal by the patient. 3/15 performed under general anesthesia (20%), with an overall average fluoroscopic time of 23.0 ± 16.0 min. Primary percutaneous jejunostomy tube placement is fraught with difficulty and avoidance due to mobility of the jejunal bowel segments, resulting in inability to routinely place these vital feeding tubes. A low profile approach as described has demonstrated a safe and effective technique that can in increase offering of this procedure.

Transnasal stent-assisted targeting technique for percutaneous jejunostomy placement in patients with hiatal hernias.

To report the transnasal stent-assisted targeting technique for percutaneous jejunostomy placement in patients with hiatal hernias. Four patients, including three (75%) females and one (25%) male, with mean age of 77.5years (range 73-78years), and with a hiatal hernia and intrathoracic stomach precluding gastrostomy placement and loop snare placement into the mid-jejunum underwent the transnasal stent-assisted targeting technique for percutaneous jejunostomy placement. In all patients, a duodenal stent was inserted into the jejunum in a transnasal fashion. The stent was partially unsheathed in an anterior loop of jejunum and percutaneously targeted using an 18-gauge needle through which a guidewire was advanced, trapped within the stent, and removed through the nose. The tract was serially dilated and a jejunostomy was placed. Technical success, procedure time, fluoroscopy time, radiation exposure, complications, time to enteral feeding, and follow-up were recorded. Technical success was 100% (4/4) with all four patients requiring only one needle pass before successful jejunal cannulation. Mean procedure time was 108min. Mean fluoroscopy time was 44min. Mean dose area product was 3969.3 μGym2. No minor or major complications occurred. All four patients received enteral feeding oneday after the procedure. Mean follow-up was 366days. The transnasal stent-assisted targeting technique is a novel method for primary jejunostomy placement in patients with hiatal hernias.

A Strange Connection: Spontaneous Esophageal-Pleural Fistula

Esophageal-pleural fistula (EPF) is a rare clinical entity with a high degree of morbidity and mortality. The unfamiliarity of this condition, along with non-specific clinical presentations and elusive imaging findings makes it a diagnostic challenge. Our goal in presenting this case is to increase the awareness of spontaneous EPF among clinicians. A 64-year-old man who presented with a mechanical fall was found to have a right-sided hydropneumothorax on his chest radiography. A chest tube was placed, after which the patient complained of pain at the site of the tube. He denied any other symptoms and remained afebrile, but was tachycardic and tachypneic. A computed tomographic image of the chest showed small right apical and anterior basal pneumothorax with right-sided chest tube traversing right upper lobe and a small pleural effusion. His chest tube drained approximately 4.5 liters of purulent-appearing fluid overnight and due to concern for empyema, patient was started on broad spectrum antibiotics. Fluid analysis was significant for a pH of 5.56, fluid protein of 0.9 grams/deciliter, glucose of 1088 milligram/deciliter, white blood cell count of 1750 cells/microliter and lactate dehydrogenase >1300 Units/liter. The patient's hospital stay was complicated by melena with a hemoglobin drop from 8.1 to 4.5 grams/deciliter. Urgent endoscopy revealed LA grade D esophagitis and a fistulous tract leading to the right pleural space. Within the tract, retained pills and the patient's chest tube were seen. An esophageal stent was placed. Follow-up barium esophagram showed contrast leakage into the pleural space. The patient was discharged after J-tube placement. Repeat esophagram 14 days later demonstrated improvement in contrast extravasation into the pleural space. Traditionally, cases of EPF have been associated with malignancy, infection or instrumentation, with only a handful of cases occurring spontaneously. Chest imaging is the primary modality in the diagnosis of EPF. Other diagnostic clues include a high output pleural effusion and elevated glucose in the pleural fluid, as seen in our patient. Food particles can also be identified in the pleural space. Management of EPF varies according to the site, size and severity of perforation. Conservative therapy includes drainage of the fluid with gastrostomy or jejunostomy placement for nutrition. Stenting or surgical intervention may be performed, depending on clinical judgment and expertise.1750_A Figure 1. Upper endoscopic view showing LA grade D esophagitis with normal GE junction (left) and opening of fistulous tract approximately 36 cm from entry site (right).1750_B Figure 2. Chest tube and retained pill within fistulous tract leading to right pleural space.1750_C Figure 3. Barium esophagram (left) demonstrating contrast extravasation (blue arrows) from distal esophagus into long narrow fistulous tract projecting over spinal column into right pleural space. Repeat study (right) 14 days later showing narrowing of fistulous tract (red) of contrast extravasation.

Routine jejunostomy tube feeding following esophagectomy.

Malnutrition is an important problem following esophagectomy. A surgically placed jejunostomy secures an enteral feeding route, facilitating discharge with home-tube feeding and long-term nutritional support. However, specific complications occur, and data are lacking that support its use over other enteral feeding routes. Therefore routine jejunostomy tube feeding and discharge with home-tube feeding was evaluated, with emphasis on weight loss, length of stay and re-admissions. Consecutive patients undergoing esophagectomy for cancer, with gastric tube reconstruction and jejunostomy creation, were analyzed. Two different regimens were compared. Before January 07, 2011 patients were discharged when oral intake was sufficient, without tube feeding. After that discharge with home-tube feeding was routinely performed. Logistic regression analysis corrected for confounders. Some 236 patients were included. The median duration of tube feeding was 35 days. Reoperation for a jejunostomy-related complication was needed in 2%. The median body mass index (BMI) remained stable during tube feeding. The BMI decreased significantly after stopping tube feeding: from 25.6 (1st-3rd quartile 23.0-28.6) kg/m2 to 24.4 (22.0-27.1) kg/m2 at 30 days later [median weight loss: 3.0 (1.0-5.3) kg; 3.9% (1.5-6.3%)]. Weight loss was not affected by the duration of tube feeding duration. Routine home-tube feeding did not affect weight loss, admission time or the readmission rate. Weight loss following esophagectomy occurs once that tube feeding is stopped, independently from the time interval after esophagectomy. Moreover routine discharge with home-tube feeding does not reduce length of stay or readmissions. These findings question the value of routine jejunostomy placement and emphasize the need for further research.

Postoperative complications and weight loss following jejunostomy tube feeding after total gastrectomy for advanced adenocarcinomas.

ObjectivePatients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this self-controlled study was to examine the effect of jejunostomy tube feeding (JTF) and other factors on postoperative weight and the incidence of jejunostomy-related complications in patients undergoing total gastrectomy for cancer.MethodsAll consecutive patients who underwent total gastrectomy for gastric cancer with jejunostomy placement were included from a prospective single-center database (2003–2014). Jejunostomy-related complications and postoperative weight changes were evaluated up to 12 months after surgery. Multivariable linear regression analysis was performed to identify factors associated with weight loss 12 months after gastrectomy.ResultsOf 113 patients operated in the study period, 65 received JTF after total gastrectomy for a median duration of 18 d [interquartile range (IQR), 10–55 d]. Jejunostomy-related complications occurred in 11 (17%) patients, including skin leakage (n=3) and peritoneal leakage (n=2), luxation (n=3), occlusion (n=2), infection (n=1) and torsion (n=1). In 2 (3%) patients, a reoperation was needed due to jejunostomy-related complications. The mean preoperative weight of patients was 71.8 kg (100%), and remained stable during JTF (73.9 kg, 103%, P=0.331). After JTF was stopped, the mean weight of patients decreased to 64.9 kg (90%) at 12 months after surgery (P<0.001). A high preoperative body mass index (BMI) (≥25 kg/m2) was associated with high postoperative weight loss compared to patients with a low BMI (<25 kg/m2) (16.3% vs. 8.6%, P=0.016). ConclusionsJTF can prevent weight loss in the early postoperative phase. However, this is at the prize of possible complications. As weight loss in the long term is not prevented, routine JTF should be re-evaluated and balanced against the selected use in preoperatively malnourished patients. Special attention should be paid to patients with a high preoperative BMI, who are at risk of more postoperative weight loss.

PTH-237 Differing risk of small bowel necrosis in patients undergoing oesophagectomy and total gastrfectomy with feeding jejunostomy placement: Abstract PTH-237 Table 1

Introduction Placement of feeding jejunostomy at the time of oesophagectomy or total gastrectomy has become standard of care at most UK centres. Review of the literature reveals isolated reports of small bowel necrosis, although the frequency of this problem is unclear. Further, it is unclear whether the risk of small bowel problems is similar for patients after gastrectomy as those after oesophagectomy. The aim of this study was to ascertain the frequency of small bowel problems in a cohort of patients undergoing oesophagogastric surgery. Method Retrospective review of patients undergoing oesophagogastric resection for cancer during the years 2009–2014. Results The study population comprised 325 patients undergoing oesophagogastric resection with jejunostomy placement (255 oesophagectomy, 70 total gastrectomy). Five patients undergoing total gastrectomy developed small bowel necrosis (5/70, 7%), while this was not observed in any patient undergoing oesophagectomy (0/255, 0%). The table details the time of this complication and the associated factors. All five patients developed small bowel necrosis after initial discharge from intensive care unit to the surgical ward. All patients required laparotomy with small bowel resection with double barrel stoma formation, parenteral nutrition and subsequent reconstruction (6–8 weeks later). Only one patient had a leukocytosis on the day of diagnosis. No laboratory abnormalities were identified in the preceding 24 hr in the other four patients. One patient dies from multi-organ failure, the remaining four were discharged home. Conclusion Small bowel necrosis and perforation is a serious and life threatening complication of feeding jejunostomy. In our cohort, it was observed exclusively in patients who had undergone total gastrectomy. There were very few antecedent signs of a problem. All patients required laparotomy and small bowel resection. Disclosure of interest None Declared.

Primary Gastric Melanoma: Wait, I Thought the Stomach Did Not Have Any Melanocytes!

Introduction: We report a case of a patient who presented with abdominal pain and decreased ability to tolerate food, and was found to have melanoma in the gastric mucosa. We highlight the difficulty of diagnosing primary gastric melanoma with certainty, given its rarity and theoretical implausibility, as normal gastric epithelium lacks melanocytes. We also briefly review several pathophysiologic and embryologic hypotheses for this phenomenon. A 50-year-old Hispanic male presented to our clinic with epigastric pain and decreased ability to tolerate food. An EGD revealed a large, irregular ulcerated gastric mass extending 1.5 to 2 cm from the gastroesophageal junction to the antrum. The mass was biopsied, and immunohistochemical stains showed the tumor cells were positive for melan-A, HMB45 and vimentin, confirming melanoma. A thorough search for another possible primary lesion, consisting of a complete skin examination and positron emission tomography (PET), did not identify a clear primary site of melanoma. The PET scan revealed uptake involving the gastric walls and lymph nodes in the perigastric, retroperitoneal and left supraclavicular regions. BRAF analysis was positive for a V600 mutation. The patient subsequently underwent palliative jejunostomy placement and was evaluated by medical oncology. Primary gastric melanoma is extremely rare (with only a handful of cases reported in the literature), likely due to the lack of melanocytes in normal gastric epithelium. Therefore, when melanoma is encountered in the stomach, it is crucial to search for a primary melanocytic lesion that may have metastasized to the stomach. While gastrointestinal involvement by melanoma has been found in up to 60% of autopsies of patients who have died with primary cutaneous melanoma, melanoma located primarily in the gastric mucosa is an uncommon occurrence. Several pathophysiologic mechanisms have been suggested. Ectopic migration of melanocyte precursors or differentiation of the APUD cells to melanocytes have been suggested as possible mechanisms. Spontaneous regression of primary melanoma has also been recognized, and it is possible that our patient’s gastric melanoma may have represented a metastasis from primary lesion that had spontaneously regressed. The median overall survival for primary melanoma of the GI tract is 17 months; for primary melanoma of the stomach, 5 months. There is little consensus on therapy for patients with primary GI melanoma, but treatment with complete excision may provide long-term disease-free survival. Vemurafenib, a BRAF kinase inhibitor, has been shown to improve both overall and progression-free survival in patients with metastatic melanoma with the BRAF V600E mutation

Sa1467 Outcomes of Double Balloon Endoscopy-Assisted Direct Percutaneous Endoscopic Jejunostomy Placement

Conventional direct percutaneous endoscopic jejunostomy (DPEJ) tube placement using pediatric or adult colonoscopes fails in approximately one third of cases, primarily due to lack of abdominal transillumination or limited instrument insertion into the jejunum. In a small pilot study, double balloon endoscopy (DBE)-assisted DPEJ placement was successful in all patients in whom attempted conventional DPEJ failed.

Severe laceration in a percutaneous endoscopic jejunostomy placement resolved with over-the-scope clips

Severe laceration in a percutaneous endoscopic jejunostomy placement resolved with over-the-scope clips

Gastrostomy feeding versus oral feeding alone for children with cerebral palsy.

Children with cerebral palsy can be significantly disabled in terms of their ability to suck, chew and swallow. This can lead to significant impairment in feeding and, eventually, to undernutrition. It can also result in aspiration of food into the lungs. Length of feeding time may be considerably increased and, instead of being an enjoyable experience, mealtimes may be distressing for both child and carer. For children unable to maintain a normal nutritional state feeding by mouth, gastrostomy or jejunostomy tubes are increasingly being used to provide the digestive system with nutrients. A gastrostomy tube is a feeding tube inserted surgically through the abdominal wall directly into the stomach. A jejunostomy feeding tube is inserted into the jejunum, part of the small intestine, either directly or via a previous gastrostomy. Although gastrostomy or jejunostomy placement may greatly facilitate the feeding of children with cerebral palsy, many carers find it very emotionally difficult to accept this intervention. Moreover, the intervention is costly and there is the possibility of complications. The effectiveness and safety of the treatment requires further assessment. This review is an update of one previously published in 2004. To assess the effects of nutritional supplementation given via gastrostomy or jejunostomy to children with feeding difficulties due to cerebral palsy. For this update, we searched the following databases in July 2012: CENTRAL, MEDLINE , Embase, CINAHL, Science Citation Index, Conference Proceedings Citation Index, LILACS and Zetoc. We searched for trials in ICTRP and Clinicaltrials.gov, and for theses in WorldCat and Proquest Index to Theses. We also contacted other researchers and experts in this field. We looked for randomised controlled trials that compared delivery of nutrition via a gastrostomy or jejunostomy tube compared with oral feeding alone for children up to the age of 16 years. Screening of search results was undertaken independently by two review authors. No data extraction was possible as there were no included studies. No trials were identified that met the inclusion criteria for this review. Considerable uncertainty about the effects of gastrostomy for children with cerebral palsy remains. A well designed and conducted randomised controlled trial should be undertaken to resolve the current uncertainties about medical management for children with cerebral palsy and physical difficulties in eating.

Jejunostomy Enteral Feeding in Children

The aim of this study was to report on the clinical outcome and safety of jejunostomy tube feeding used in our clinical setting for more than 14 years. A retrospective study of all children who underwent a surgical catheter jejunostomy placement between July 1996 and March 2010 was conducted. Data were collected regarding the outcome and complications. Thirty-three children (14 girls) were included. The median age at the time of primary surgery was 1.43 years (range, 0.15-17.7 years), and the median time of follow-up was 2.34 years (range, 0.27-12.6 years). Seventeen children were severely neurologically impaired (NI). Surgical insertion of a jejunostomy tube was performed due to 1 or more of the following indications: gastroesophageal reflux disease (GERD), failure to thrive, recurrent pneumonia, esophageal disease, or oral feeding difficulties. The effect of the indications showed a reduction in GERD and pneumonia. Feeding difficulties also decreased. Weaning was possible in 12 of 16 children without NI but in only 2 of 17 with NI. Major complications requiring surgical reoperation affected 8 children. No mortality was related to the jejunostomy feeding catheter. In selected cases, surgically placed jejunostomy tubes for feeding in children is an effective and safe method to overcome GERD, feeding difficulties, or recurrent pneumonia without major surgery.

Safety and efficacy of radiological percutaneous jejunostomy for decompression of malignant small bowel obstruction

This study aimed to evaluate the safety and efficacy of percutaneous radiological jejunostomy (PRJ) and stent placement in patients with malignant small bowel obstructions (MSBO). A total of 21 patients (mean age 60 years) with single (n = 4) or multiple (n = 17) MSBO underwent PRJ following jejunopexy. The medical records and imaging studies were retrospectively reviewed to evaluate the technical/clinical success and complications. Clinical success was determined by symptomatic relief and radiologic bowel decompression. PRJ using a 12- or 14-F drainage catheter was technically successful in all patients. Eleven patients required placement of an 18-F nasogastric tube across one (n = 3), two (n = 6) and three (n = 2) obstructions to achieve clinical success. Subsequently, self-expandable stents were placed through the PRJ tracts to recanalise MSBO in four patients. Clinical success was achieved in 18 patients (85.7 %). The median food intake capacity score improved from 4.0 to 2.0 (P = 0.001). There were one major (peritonitis, 4.8 %) and six minor complications (28.6 %) PRJ using a nasogastric tube across the obstructions is an effective palliative treatment for MSBO. The PRJ tract can be used as an approach route for stent placement to recanalise MSBO. However, dedicated devices should be developed to reduce frequent procedure-related complications. • Bowel decompression provides palliative treatment in malignant small bowel obstruction • Percutaneous radiological jejunostomy (PRJ) is a safe and effective palliative treatment. • Long tube placement across obstructions facilitates adequate drainage of multiple bowel obstructions. • PRJ tract can be used for stent placement to approach MSBO recanalisation.

Treatment Challenges for Inflammatory Demyelinating Polyneuropathy in the Setting of Acute Retroviral Syndrome: Case Report and Review of the Literature

This is a case of a 20-year-old male with acute retroviral syndrome and concurrent acute inflammatory demyelinating polyneuropathy (IDP) progressing to chronic IDP. Whereas the patient followed a relapsing and remitting course prior to the initiation of antiretroviral therapy (ART), he demonstrated gradual and sustained clinical improvement in the ten months of follow-up after ART was combined with chronic corticosteroids and intermittent plasmapheresis. This case presents and addresses multiple challenges for the treatment of IDP in the setting of acute HIV infection to include: timing of initiation and selection of appropriate ART, the potential risk for immune reconstitution inflammatory syndrome, ART initiation in the setting of severe gastroparesis with jejunostomy placement, and the effect of plasmapheresis on the levels of antiretroviral therapy.

Percutaneous Jejunostomy: Repeat Access at the Healed Site of Prior Surgical Jejunostomy with US and Fluoroscopic Guidance

PurposeTo evaluate the safety and efficacy of ultrasound (US)- and fluoroscopy-guided jejunostomy tube placement in patients with a history of surgical jejunostomy. Materials and MethodsBetween June 2003 and June 2012, percutaneous US-guided jejunostomy placement was attempted 28 times in 26 patients with a history of surgical jejunostomy (14 men and 12 women). Retrospective chart review was performed to determine procedural success, complications, and interval between original jejunostomy and new tube placement. Clinical outcomes were evaluated with a mean follow-up period of 110 days (range, 3–631 d; median, 68 d). ResultsSuccessful tube placement was achieved in 26 of 28 attempts (92%). The mean time between removal of the original surgical jejunostomy and percutaneous placement of the new tube was 278 days (range, 3 d to 8 y; median, 88 d). A single minor complication involved a tube site infection 4 days after the procedure. There were no major complications. Mean procedure time was 49 minutes (range, 15–125 min; median, 45 min). ConclusionsPercutaneous jejunostomy access can be reliably and safely reestablished with US and fluoroscopic guidance in patients with a history of surgical jejunostomy.

Trocar Guided Laparoscopic Feeding Jejunostomy

Several techniques of laparoscopic feeding jejunostomy have been described. Most of them require costly commercial kits. Here we present a novel, simple, low-cost method for laparoscopic jejunostomy tube placement. This technique involves 4 ports. A left lateral "guide" trocar is used as a landmark for tube placement. A jejunal loop is selected and 4 vicryl sutures are placed in a diamond shape on the antimesenteric side of the intestine and left untied. These 4 stitches are extracted using a transabdominal suture grasper inserted through 4 small incisions around the left lateral guide trocar. After an enterotomy is made in the center of these 4 stitches using cautery device, the left lateral trocar is removed and a 12 Fr Foley catheter is inserted in the trocar site and introduced into the bowel. The 4 stitches are pulled toward the abdominal wall and gently tied without additional suturing. Eight patients who underwent this procedure between 2007 and 2009 were reviewed. The procedure was successful in all patients. The median operative time was 70.5 minutes. There were no postoperative complications with respect to infection, bleeding, or bowel obstruction, and no perioperative mortality. Our trocar-guided approach for laparoscopic feeding jejunostomy placement is a simple, cost-effective, safe, and effective method.

Endoscopic solutions to challenging enteral feeding problems

Enteral nutrition support is often required in patients who are unable to meet their own nutritional requirements. Endoscopists play a key role in the placement of enteral feeding catheters. This review focuses on the recently published solutions to common problems encountered during endoscopic placement of enteral feeding devices. Case reports and case series describe solutions for overcoming common problems encountered during the placement of enteral feeding devices. Transnasal techniques can simplify nasojejunal tube placement, whereas deep enteroscopy techniques provide more reliable jejunostomy placement. Endoscopic ultrasound can help when transillumination is not possible or in the setting of postsurgical anatomy like Roux-en-Y. Laparoscopic-assisted procedures are useful when endoscopic techniques have failed in adults or in select high-risk pediatric patients. The American Society for Gastrointestinal Endoscopy and the American Gastroenterology Association both published comprehensive guidelines that outline the indications, contraindications, technical aspects of feeding catheter placement, and complications. Advances in endoscopic techniques, including deep enteroscopy, endoscopic ultrasound, ultra-slim transnasal endoscopes and laparoscopic-assisted procedures, have enabled endoscopists to successfully place enteral feeding tubes in patients who previously required open procedures.

PMO-086 How useful is feeding jejunostomy in upper gastro intestinal cancer surgery—a retrospective review

IntroductionA retrospective review of outcome of 100 consectutive open feeding jejunostomies performed as part upper GI cancer surgery in our Centre in the last 3 years.Methods100 consecutive patients undergoing open...

Jejunal Adaptation in a Prepubertal Boy After Total Ileal Resection and Jejunostomy Placement

Intestinal adaptation is the process that attempts to restore total gut absorption after intestinal resection. In humans, the ileum and the colon can undergo adaptation without the jejunum. However, there is little evidence for the jejunum to undergo adaptation in the absence of the ileum. Here, we report the unusual case of a prepubertal boy who underwent total ileal resection, right hemicolectomy, and jejunostomy after a motor vehicle accident. Despite ileal resection, he showed evidence of successful structural and functional jejunal adaptation.

Retrospective analyses of complications associated with transcutaneous replacement of percutaneous gastrostomy and jejunostomy feeding devices

Feeding device replacement is often required for long-term maintenance after initial percutaneous endoscopic gastrostomy or jejunostomy placement. Although there are several case reports on serious complications of gastrostomy device replacement, there are few reports of an overall analysis of the complications associated with feeding device replacement. To evaluate the frequency and variety of complications of transcutaneous replacement of feeding devices. A retrospective study. Single center: Nishimino Kosei Hospital. This study involved 363 consecutive patients undergoing a total of 1265 percutaneous gastrostomy or jejunostomy device replacements from March 2000 to September 2010. A new replacement device was inserted through the ostomy tract by using an obturator after traction removal of the previous device. Endoscopic treatments were performed in the cases of fistula disruption or hemorrhage. Complications and their outcomes. Gastrostomy and jejunostomy devices were replaced 1126 and 139 times, respectively. There were 16 complications (1.3% of total replacements) consisting of 10 cases of fistula disruption caused by misplacement of replacement devices into the peritoneal cavity, 4 cases of hemorrhage, and 1 case each of colocutaneous fistula and device breakage. Anticoagulation or antiplatelet medications were continued in all 4 hemorrhage cases but in only 27 of 347 (7.7%) complication-free cases (P < .0001). There were no replacement-related adverse events that required surgical repair. A single center, retrospective analysis. Fistula disruption and hemorrhage were the most common complications associated with device replacement. In patients on anticoagulants, caution is necessary to avoid hemorrhage after replacement. It is also important to verify that the replaced device is located in the GI tract lumen before feeding.