Surgical Jejunostomy Research Articles

Risk factors contributing to morbidity associated with feeding tubes placed for esophageal cancer patients undergoing esophagectomy: a single-center retrospective study.

Perioperative nutritional optimization of patients undergoing esophagectomy for cancer is important as this population is prone to malnutrition associated with poor outcomes. Nutritional supplementation has been achieved via enteral nutrition through percutaneous feeding tubes such as gastrostomy (G-tubes) and surgical jejunostomy tubes (J-tubes). While they are often routinely placed for patients undergoing esophagectomy, these are associated with adverse events including infections, dislodgement, increased healthcare visits, among others. The morbidity associated with feeding tubes has not been well characterized. We aim to determine factors associated with adverse outcomes after feeding tube placement to guide appropriate use of feeding tubes in esophageal carcinoma patients. Patients who underwent esophagectomy for carcinoma and had at least one feeding tube placed from November, 2017 to October, 2021 at a single institution were retrospectively reviewed. Subgroup analyses were performed testing for relevant characteristics. Univariate and multivariate logistic regression analyses were conducted evaluating outcomes of interest. The primary outcome was the overall rate of tube-related complications. A total of 144 patients were included with 212 feeding tubes placed (75 G-tubes; 137 J-tubes). The rate of any adverse event related to feeding tubes was 39%. Of these, 11% were wound infections, 16% required procedural intervention, 11% visited the emergency department (ED), and 2.5% required admission due to feeding tube-related complications. Factors independently associated with adverse events included smoking history [odds ratio (OR), 2.80; 95% confidence interval (CI): 1.34-6.23], being female (OR, 2.98; 95% CI: 1.36-6.72), induction treatment (OR, 2.65; 95% CI: 1.14-6.55), and J-tubes (OR, 2.07; 95% CI: 1.09-4.03). Laparoscopically placed J-tubes were associated with increased unplanned admissions compared to those placed via laparotomy (9.4% vs. 0%, P=0.01). Though not statistically significant, there was a trend toward more complications in those who were high risk for malnutrition [body mass index (BMI) <18 kg/m2, weight loss >10%] and comorbid (Charlson Comorbidity Index 5-6). There is significant morbidity related to feeding tubes. The risk profile of these tubes for individual patients should be carefully weighed against the nutritional benefits prior to placement. Patients should be carefully counselled on the possible adverse events and care requirements.

Safety and efficacy of direct percutaneous endoscopic jejunostomy tube placement compared with surgical jejunostomy: a tertiary care analysis

Background and AimsJejunostomy tube placements provides enteral access for feeding in eligible patients who cannot meet the nutritional needs by mouth. They can be surgically placed laparoscopically (lap-J) or using conventional open laparotomy (open-J) approach. Recently, direct percutaneous endoscopic jejunostomy (DPEJ) has emerged as an alternative because of its low cost and shorter recovery times. We sought to retrospectively compared the procedural success rates and complications of these methods. MethodsPatients were identified by a querying of our health system patient database and the departmental database of patients who underwent DPEJ. The patients were divided into three cohorts based on the procedure: DPEJ, lap-J, and open-J. Patient age and BMI, procedure success rate, and complications rate were compared among the three groups. Results201 patients met inclusion criteria (65 DPEJ, 111 lap-J and 25 open-J). Procedural success rates were similar between the 3 groups (DPEJ 96.9%, Lap-J 99.1%, Open-J 100%, p=0.702). Rates of infection and bleeding were also similar between the 3 groups. There were no cases of GI perforation. Tube dysfunction for any reason that required complete removal and/or replacement within 90 days occurred more often in the surgical groups than in the DPEJ group (DPEJ 0%, lap-J 35.1%, open-J 40.0%, p<0.001). This was driven largely by increased rates of tube clogging and tube dislodgement in the surgical groups. ConclusionDPEJ is a safe and effective alternative to surgical jejunostomy in eligible patients and may be associated with decreased complication rates at 90-days.

Management Experiences of Post-Gastrectomy Severe Alkaline Reflux Esophagitis.

Alkaline reflux esophagitis is a recognized complication of procedures that compromise the lower esophageal sphincter (LES), including gastrectomy. Incidence of reflux is dependent on the reconstructive procedure, with Roux-en-Y (RY) esophagojejunostomy commonly accepted as the optimal method. The authors report their experience of 5 patients who underwent remedial intervention for severe alkaline reflux esophagitis following gastric cancer surgery, over a 6-year period (2014-2020). Primary diagnoses encompassed 4 gastric adenocarcinomas and 1 gastric neuroendocrine tumor. Four patients previously underwent total gastrectomy and 1 subtotal gastrectomy with RY reconstruction. Onset of postoperative reflux symptoms ranged from 2weeks to 3years. Failing medical management, all patients underwent jejunojejunal anastomosis and Roux limb length revision with surgical jejunostomy. At follow-up, 4 out of 5 patients had some degree of symptom resolution and one with unresolved symptoms. The authors report our experience of managing this complication following gastrectomy with jejunojejunal anastomosis and Roux limb length revision.

Balloon-assisted Jejunostomy Placement

Jejunal feeding is indicated in patients with functional or physical abnormalities that prevent gastrostomy tube placement or feeding. J-tubes are most often placed using one of four techniques: Open surgical, laparoscopic, needle catheter, or direct percutaneous placement, depending on the patient needs and expertise of the surgeon. Minimally invasive techniques are considered standard of care, and thus, J-tube placement most often occurs through laparoscopic methods. While percutaneous insertion using balloon dilation rather than serial dilation has shown greater success rates, lower complication rates, and alleviates patient discomfort in G-tube placement, this procedure has not been utilized for J-tube placement. Here, we report a balloon-assisted jejunostomy placement technique utilized to replace a previous surgical jejunostomy tube that the cutaneous tract had healed over.

56 Gastroesophageal reflux disease in children with neurological impairment: a population-based retrospective cohort study

Abstract Background Children with neurological impairment (NI) are at increased risk of gastroesophageal reflux disease (GERD) and may be more susceptible to complications such as esophagitis and aspiration. Diagnosis is challenging due to communication impairments and frequent comorbidities, such as dysphagia, that present similarly to GERD. There is a risk of both under and over diagnosis with detrimental effects. Prior research has suggested the prevalence of GERD is as high as 75%. However, these studies examined subpopulations such as children presenting with symptoms or living in institutions, often many decades ago. Objectives Our aim was to determine the incidence and prevalence of GERD diagnosis and treatment in children with NI at a population level. Design/Methods This is a retrospective cohort study using provincial administrative data. Children with NI were identified by International Classification of Diseases (ICD-10) codes in the Discharge Abstract Database (DAD) between 2006 and 2018. GERD was defined as: (1) 1+ codes in DAD or National Ambulatory Care Reporting System; (2) 2+ specialist claims; (3) 1+ ASM prescription. Age, gender, complex chronic conditions (CCC) and technology assistance (TA) were covariates. ASM prescriptions and anti-reflux procedures were collected. Descriptive statistics included means with standard deviations and counts with proportions. Univariable and multivariable Poisson regressions calculated incidence rates and rate ratios for the presence of GERD and prescription of ASM. Results Among 10,309 children with NI, 2,772 (26.9%) met the GERD definition. The unadjusted incidence rate was 52.1 per 1000 person-years. Increasing numbers of CCCs were associated with a higher risk of GERD. Children with four or more CCCs had an incidence almost three times that of children with no CCCs. A gastrostomy tube incurred a five times higher rate of GERD. Overall, 2486 (23.7%) of the children were treated with ASMs of which 1535 (61.7%) met no other GERD criteria. The incidence rate was 16.9 prescriptions per year. Neonatal, respiratory and congenital CCCs were associated with higher rates of ASM prescribing. The prevalence of gastrojejunostomy tubes was 1.1% (n=121), surgical jejunostomy tubes was 0.7% (n=79) and fundoplication was 3.3% (n=351). Conclusion The incidence of GERD in children with NI is dramatically higher than in the general pediatric population, as is the use of ASM. Both disparities are heightened in children with gastrostomy tubes, perhaps due to increased severity of NI or relevant comorbidities. Regardless, GERD is clearly a significant clinical issue in this population that warrants additional study to determine optimal diagnosis and treatment practices.

Gastro-oesophageal reflux disease in children with neurological impairment: a retrospective cohort study

ObjectivesTo determine the incidence and prevalence of gastro-oesophageal reflux disease (GERD) diagnosis and treatment in children with neurological impairment (NI) along with relationship to key variables.DesignThis is a population-based retrospective...

P-EGS19 Complete oesophageal transection during thyroidectomy; Successful management of anastomotic leak using endoluminal vacuum therapy (EVT) following failed primary repair

Abstract Background Perforation of the cervical oesophagus is an extremely rare but recognised complication of thyroidectomy. As with all oesophageal perforations management depends on timing of diagnosis in relation to the timing of injury, the size of the oesophageal wall defect, extent of extraluminal contamination, and how unwell the patient is with respect to sepsis. We report a case of complete transection of the cervical oesophagus during total thyroidectomy and its subsequent management. Methods A previously well 32-year-old female had a complete cervical oesophageal transection during total thyroidectomy and neck dissection for papillary carcinoma of thyroid. This was recognised by her ENT surgeon who repaired the oesophagus primarily. Subsequently, she developed sepsis with cellulitis of her anterior chest wall. Cross-sectional imaging demonstrated a leak at the site of the cervical oesophageal repair. Gastroscopy confirmed a 50% dehiscence of the oesophageal anastomosis. Control and management of her oesophageal leak was achieved with EVT delivered using an ad-hoc endoluminal vacuum device (EVD) constructed from open cell foam sutured around the distal end of a nasogastric tube. Results The patient was managed in the intensive care unit (ICU) with appropriate organ support and antimicrobial cover. A surgical jejunostomy was placed to facilitate enteral feeding. EVT was delivered using the ad-hoc EVD which was placed endoscopically and situated intraluminally across the anastomotic leak site. Continuous negative pressure (125 mmHg) was applied. Six EVD changes were required to heal the leak. Her total length of stay was 41 days, of which 38 days were in ICU. There were no periprocedural complications related to using the EVD or EVT, although the patient subsequently developed an oesophageal stricture which required endoscopic dilatation. Conclusions Accidental complete transection of the cervical oesophagus is extremely rare. This case highlights the importance of a multidisciplinary team approach for managing such cases. EVT is an emerging treatment option for upper gastrointestinal (UGI) leaks and is reported to be safe and effective for leaks from a wide range of causes throughout the UGI tract. Successful resolution of the oesophageal leak in this unusual case demonstrates the utility of EVT in difficult clinical situations which may otherwise pose a formidable management challenge using traditional treatment strategies.

P-O02 Management Experiences of Post-gastrectomy Severe Alkaline Reflux Oesophagitis

Abstract Background Alkaline reflux oeosphagitis is a recognized complication of procedures that compromise the lower oesophageal sphincter (LES), including gastrectomy. Incidence of reflux is dependent on the reconstructive procedure with Roux-en-Y esophagojejunostomy commonly accepted as the optimal method. The authors report their experience of 6 patients who underwent remedial intervention for severe alkaline reflux esophagitis following gastric surgery. Methods A retrospective review of 6 patients who had underwent a previous gastric procedure and developed symptoms of gastroesophageal reflux disease, over a 6-year period (2014-2020). Reflux symptoms were diagnosed by clinical history, radiology, endoscopy and esophageal manometry prior to proceeding to surgical reflux control. Post-operative outcomes following anti-reflux surgery were assessed by means of serial outpatient assessments and endoscopy. Results Six patients were included in this report, 4 males and 2 females with an average age of 73 years (range 58-91). Primary diagnoses encompassed; 4 gastric adenocarcinomas, 1 gastric neuroendocrine tumour and 1 patient with debilitating gastric antral vascular ectasia (GAVE) syndrome. Four patients underwent total gastrectomy and 2 subtotal gastrectomy with Roux-en-Y reconstruction. Onset of post-operative reflux symptoms ranged from 2-weeks to 3-years. Failing medical management, all patients underwent jejunojejunal anastomosis and Roux limb length revision with surgical jejunostomy. At follow up 5 patients had some degree of symptom resolution; 3 complete resolution, 2 initial resolution and 1 with unresolved symptoms. Conclusions Severe alkaline reflux oesophagitis is a recognized complication of gastric procedures compromising the LES. The authors report our experience of managing this complication following gastrectomy with jejunojejunal anastomosis and Roux limb length revision, with a majority of patients having improvement in if not complete resolution of reflux symptoms.

Enough is enough: Radiation doses in children with gastrojejunal tubes

IntroductionMany children with gastric feeding intolerance require postpyloric tube feeding via a gastrojejunal (GJ) tube. Placement or positioning of these tubes is typically a procedure with a low dose of radiation. Although the risk of developing cancer from radiation exposure owing to computed tomography scans is well-documented in children, the risk of cumulative radiation exposure owing to frequent GJ tube replacement often goes unnoticed in the clinical decision-making process. We sought to define the frequency and cost of GJ tube replacement, quantify the radiation doses associated with the initial placement and replacements, and assess the number of conversions to surgical jejunostomies. MethodsAll pediatric patients who underwent GJ tube placement or replacement by Interventional Radiology (IR), surgery, and gastroenterology between 2010 and 2018 at a single center were reviewed. We evaluated the total cost of the initial placement and replacement of each GJ tube, the total number of replacements, and the cumulative radiation dose (mGy). ResultsWe identified 203 patients who underwent GJ tube placement and/or replacement, of which 150 had radiation data available. Patients underwent a median of five GJ tube replacement procedures, and there was a wide range in the number of replacements per patient, from zero to 88. Patients were exposed to a median cumulative dose of 6.0 mGy (IQR: 2.2, 22.6). Nine percent of patients with available radiation data were exposed to more than 50 mGy, solely from GJ tube replacements. The median cost per replacement was $1170. The sum of the cost of the replacements for dislodged GJs translated to more than $1.4 million during the study period. ConclusionsOverall, the average dose per GJ replacement was 3.50 mGy among all patients with available data. Nine percent of patients (14/150) were exposed to greater than 50 mGy cumulative radiation solely from GJ replacements. Patients who receive more than 50 mGy of cumulative radiation dose, who undergo seven GJ tube replacements in one year, or two consecutive GJ tube replacement procedures with radiation doses exceeding 10 mGy (per replacement) should be considered for a surgical jejunostomy. Level of evidenceIV Type of studyTreatment study.

Acute Gastric Dilatation in a 13 Year Old Child. A Case Report

Summary Acute gastric dilatation is a rare and life threatening disease. The usual symptoms of acute gastric dilatation can vary and be nonspecific, including acute abdominal pain, abdominal distension, nausea and vomiting. Many aetiologies of acute gastric dilatation are described. This article presents a case of a 13 year old girl who presented in our clinic with acute gastric dilatation after an orthopaedic operation. Clinical signs and a diagnostic pathway are presented in the report. In the early treatment of acute gastric dilatation, nasogastric tube insertion was used for gastric decompression. As a surgical approach jejunostomy insertion was used to ensure enteral feeding. Our case study shows that the optimal treatment for this pathology is mainly conservative.

Safety of Prophylactic Gastrostomy Tube Placement and Gastrostomy Tube Usage in Patients Treated by Radio(chemo)therapy for Head and Neck Cancer

A gastrostomy feeding tube is one method for long-term feeding support in patients undergoing radio(chemo)therapy for head and neck cancer (HNC). The aim of this study was to analyze the safety of prophylactic gastrostomy tube placement and usage in HNSCC patients. HNC patients undergoing percutaneous endoscopic gastrostomy (PEG) or radiological percutaneous gastrostomy (RPG) tube placement prior to radio(chemo)therapy from 2010-2014 were retrospectively reviewed regarding procedural and long-term gastrostomy tube-related complications, usage of PEG/RPG, weight profile, pretreatment and posttreatment body mass index. A total of 212 patients underwent prophylactic feeding tube placement (71% RPG, 27% PEG and 2% surgical jejunostomy). A total of 173 patients utilized their gastrostomy tubes for either total or supplemental nutrition support. Despite this, 157 patients (74%) lost weight during therapy (mean weight loss=8 kg). The rate of severe tube-related complications (peritonitis/incorrect placement) was low and similar in both groups (PEG 2.7% vs. RPG 3.4%). Although a very high proportion of patients used their PEG/RPG during radio(chemo)therapy there was a high mean weight loss. Serious complications of tube placement were rare.

Fluoroscopic-guided nasogastric tube placement in patients with advanced head and neck cancers

Enteral feeding, mainly by using a nasogastric tube (NGT), is generally favored over parenteral supplementation in head and neck cancer (HNC) patients with dysphagia. However, the placement of a NGT, either blindly or by endoscopy, is technically challenging in these patients due to the obstructive mass and the altered regional anatomy. The aim of this retrospective study was to estimate the clinical feasibility and safety of fluoroscopic-guided NGT placement in patients with advanced HNC. Between January 2010 and June 2018, a total of 572 fluoroscopic-guided NGT placements were performed on 231 patients. Technical success was defined as successful insertion of the NGT into the stomach with proper positioning, which was verified by air injection into the NGT. Complications, including aspiration pneumonia, and the ones requiring intensive care, or procedure-related death, were recorded. Technical success was obtained in 558 (97.6%) procedures, and the other 14 (2.4%) procedures failed because of patient intolerance (n=1) and high-grade obstruction (n=13). Of the high-grade obstruction patients, eight (61.5%) were shifted to percutaneous radiological gastrostomy, two (15.4%) to surgical feeding jejunostomy, one (7.6%) to endoscopic balloon dilatation, and two (15.4%) to orogastric tube insertion. The average procedure time and fluoroscopy time were 11.7±7.4min and 3.1±3.1min, respectively. There were no major complications. Our results show that fluoroscopic-guided NGT placement is a highly safe and effective procedure for patients with advanced HNC requiring enteral feeding.

Routine placement of surgical jejunostomy feeding tubes (JFT) in patients who have undergone oesophagectomy: a patient experience questionnaire

Nutrition-related complications such as reduced oral intake and malnutrition are common following oesophagectomy. Sustained periods of inadequate nutrition can result from surgical side effects and/or dietary modifications linked with anatomical changes.

Surgical jejunostomy and radiological gastro-jejunostomy\xa0tube feeding in children: risks, benefits and nutritional outcomes

PurposeRadiologically inserted gastrojejunal tubes (RGJ) and surgical jejunostomy (SJ) are established modes of jejunal feeding. The aim of the study is to review nutritional outcomes, complications and the practical consideration to enable patients and carers to make informed choice.MethodsRetrospective review of patient notes with a RGJ or SJ in 2010, with detailed follow-up and review of the literature.ResultsBoth RGJ and SJ are reliable modes to provide stable enteral nutrition. Both have complications and their own associated limitations.ConclusionsThe choice has to be tailored to the individual patient, the social care available, the inherent medical disease and risk/benefit of repeated anaesthetic and radiation exposure. RGJ and SJ are important tools for nutritional management that achieve and maintain growth in a complex group of children. The risk and benefits should be reviewed for each individual patient.

Endoscopic and Surgical Gastrostomy and Jejunostomy Tube Placement

AbstractEnteral access is a common request for consulting surgeons and interventionists. Prior to the 1980s, such a consultation often necessitated open surgical intervention whereas today, enteral access is often performed via several minimally invasive methods. Tools and techniques for minimally invasive enteral access have changed drastically due to advancements in the fields of endoscopy, laparoscopy, and interventional radiology. Percutaneous endoscopic gastrostomy tube placement is one such advancement. Since its first development, its basic principles have been applied to other minimally invasive techniques, which have resulted in an expansion of techniques for establishment of enteral access. In this article, we outline various endoscopic and surgical techniques for gastric and jejunal access.

Effects of Mechanical Complications on Radiation Exposure During Fluoroscopically Guided Gastrojejunostomy Exchange in the Pediatric Population.

The purpose of the article is to evaluate the effects of mechanical complications, such as clogging or coiling, of gastrojejunostomy tubes on radiation exposure during exchange in the pediatric population. In this HIPAA-compliant and IRB-approved study, we retrospectively reviewed procedural records for patients undergoing gastrojejunostomy (GJ) tube exchange during a 4-month period in 2014. Success of the procedure, specifications of the tube, age, and sex of the patient as well as radiation exposure during the procedure were included. Radiation exposure was measured in fluoroscopy time and cumulative air kerma. Complications encountered during exchange were also recorded, if available. Patients presenting for gastrostomy to GJ conversions or combined procedures were excluded from the study. Ordinary and mixed effect linear regression models were used to test associations between GJ tube parameters, presence of mechanical complications, and fluoroscopy time and radiation dose. 146 patients undergoing 285 GJ exchanges met inclusion criteria over the 4-month study period (M:F 82:64). All exchanges were successful with 85 demonstrating a form of mechanical complication (44 coiled, 41 clogged). Of the reported GJ tube specifications, only tube length was significantly associated with mechanical complications (p<0.001). The presence of mechanical complication was significantly associated with increased radiation exposure and fluoroscopy time (p<0.0001). Mechanical complications of gastrojejunostomy tubes, such as clogging or coiling, are associated with increased radiation exposure during exchange. Strategies to decrease these complications, including re-siting the gastrostomy tract or placement of a surgical jejunostomy in the event of repeated coiling of a tube should be strongly considered.

Endoscopic ultrasound-guided pancreatic duct stenting with a new plastic stent for nondilated pancreatic duct in pancreatic fistula after pancreaticoduodenectomy

A 76-years-old man who underwent pylorus-preserving pancreaticoduodenectomy for lower cholangiocarcinoma developed peritonitis with intra-abdominal abscess from anastomotic leakage. We have done a reoperation for surgical drainage and jejunostomy for intestinal decompression. After operation, pancreatic leakage from anastomosis of pancreatico-jejunum was detected using contrast medium from jejunostomy. We tried percutaneous drainage for abscess several times but could not treat pancreatic leakage completely over 6 months hospitalization. The pancreatic duct stenting from the intestine by balloon endoscopy was impossible because of adhesion. We tried antegrade stenting using endoscopic ultrasound-guided pancreatic drainage (EUS-PD). In EUS findings, we could identify main pancreatic duct with a diameter of 1.3 mm. It is too thin to insert the needle for EUS-PD. Therefore, we punctured it with a 22-gauge needle and succeeded pancreatography. Then, we inserted 0.018 inch guidewire, and it reached into the duct of pancreatic head. After expanding the puncture site by ultra-tapered dilator and standard dilation catheter step-wisely, the guidewire was exchanged to 0.025 inch hard-type guidewire. We placed a new 7 Fr plastic stent smoothly across the pancreatic duct (Through Pass Type IT, Gadelius Medical, Tokyo, Japan); the distal part was in the intestine, and the proximal part (pigtail) was in the gastric lumen. Pancreatic leakage was improved and patient was discharged. EUS-PD with newly developed tube stent may be considered as an effective therapy in selected patients with a pancreatic leakage after pancreatectomy.

Replaceable Jejunal Feeding Tubes in Severely Ill Children.

Long-term enteral nutrition in chronically ill, malnourished children represents a clinical challenge if adequate feeding via nasogastric or gastrostomy tubes fails. We evaluated the usefulness and complications of a new type of surgical jejunostomy that allows for easier positioning and replacement of the jejunal feeding tube in children. We surgically inserted replaceable jejunal feeding tubes (RJFT) connected to a guide thread which exited through a separate tiny opening of the abdominal wall. In a retrospective case series, we assessed the effectiveness and complications of this technique in severely ill children suffering from malnutrition and complex disorders. Three surgical complications occurred, and these were addressed by reoperation. Four children died from their severe chronic disorders within the study period. The RJFT permitted continuous enteral feeding and facilitated easy replacement of the tube. After the postoperative period, jejunal feeding by RJFT resulted in adequate weight gain. This feeding access represents an option for children in whom sufficient enteral nutrition by nasogastric tubes or gastrostomy proved impossible. Further studies are required to investigate the safety and effectiveness of this surgical technique in a larger case series.

PTU-103 How Best to Deliver Enteral Access for Post-Pyloric Home Enteral Tube Feeding? A 2-Year Review

Introduction Home enteral tube feeding (HETF) has grown in the past 2 decades and there is now also a growing demand for post-pyloric HETF (PP-HETF) for selected cases. 1,2 The optimum route for delivering this is not established, with several options available including surgical jejunostomy (SJ), direct percutaneous endoscopic jejunostomy (DPEJ), and PEG with jejunal extension (PEG-J). We have reviewed our experience to help identify comparative outcomes. Methods Choice of feeding device was clinician-led according to indication, surgical and endoscopic risk. A 2 year review was done from Jan 2014 onwards. Patients were included if they were (1) already undergoing PP-HETF as of January 2014 or (2) had an interventional procedure to start PP-HETF at any time thereafter during the study period. Cases were identified from the community dietetic and electronic endoscopy databases. Case files were reviewed to identify outcome measures which were categorised as: Success of planned procedures; longevity of feeding device, premature removal (removal because of sepsis, migration, blockage or accidental), procedural complications or mortality Results 26 patients were identified (M:F 14:12, median age 55, range 22–83). Indications for PP-HETF were learning difficulties with Gastro-oesophgeal(GO) reflux (8), neurodegenerative or cerebrovascular disease with GO reflux (5), upper GI cancers(9) & others (4). Feeding interventions done successfully prior to or during the study period were SJ (10), DPEJ (14), PEG-J (14).Procedural success rates during study period were; SJ; 10/10 (100%), DPEJ;7/11 (64%), PEG-J; 12/13 (92%).Longevity of feeding devices at review census point (in months, median & range) was: SJ, 11 (3–23); DPEJ,18 (3–48); PEG-J, 6 (0.25–23). Tube premature removal rates (and reasons) were: SJ; 3/10 (30%; all fell out), DPEJ; 3/14(21%; 1 accidental, 2 infected), PEG-J; 6/14 (43%; 4 accidental, 2 blocked). There were no procedural complications recorded but one patient (DPEJ) died Conclusion In this case series which includes similar numbers of the common PP-HETF options, SJ had the highest, and DPEJ the lowest, procedure success rate.DPEJ had the highest longevity. Choice of feeding device for PP-HETF will depend on co-morbidity and surgical/ endoscopic risk but when DPEJ can be placed this may be the preferred option for long-term feeding. References 1 Ojo O. Managing patients on enteral feeding tubes in the community. Br J Community Nurs 2010; 15 :S6–S13. 2 Ojo O. The challenges of home enteral tube feeding: a global perspective. Nutrients 2015; 7 (4):2524–2538. doi:10.3390/nu7042524. Disclosure of Interest None Declared

Rejejunostomy under local anesthesia for patients with esophageal carcinoma.

A jejunostomy is performed simultaneously with an esophagectomy for nutritional support. For various reasons, there is the potential for a second-time jejunostomy. We report a new and simple percutaneous technique for jejunostomy replacement under local anesthesia. A new tube is placed into the jejunum andiatrogenically fixed to the previous jejunostomy incision. All five patients in our study accepted the second-time jejunostomy successfully. The mean operating time was 15.8±4.0 min, with limited blood loss. This approach for second-time jejunostomy under local anesthesia in previous surgical jejunostomy patients is technically feasible, with a high technical success rate.