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Efficacy of jejunogram after jejunostomy insertion.
1Department of Surgery, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden 08103, USA.
The American Surgeon
|November 7, 1999
Summary
Routine post-jejunostomy jejunograms rarely offer new clinical insights or alter patient care, suggesting this diagnostic imaging is often unnecessary. This practice incurs costs without improving patient management outcomes.
Area of Science:
- Gastroenterology
- Medical Imaging
- Health Economics
Background:
- Managed care has intensified discussions on healthcare resource allocation.
- The utility of routine post-jejunostomy jejunography in clinical practice is debated.
Purpose of the Study:
- To evaluate the clinical utility and impact on patient management of routine post-jejunostomy jejunograms.
- To determine if routine jejunography after jejunostomy tube insertion or reinsertion is warranted.
Main Methods:
- Retrospective chart review of 128 patients who underwent feeding jejunostomy tube insertion or reinsertion between January 1995 and December 1996.
- Analysis of jejunogram results, patient demographics, and clinical management changes.
- Data included indication for jejunogram, jejunostomy placement history, and imaging findings.
Main Results:
- No instances of misplaced jejunostomy tubes or dye extravasation were reported.
- Routine jejunograms did not lead to any changes in patient management (P < 0.05).
- The diagnostic yield of routine jejunography in this cohort was negligible.
Conclusions:
- Routine jejunography following operative jejunostomy insertion or percutaneous reinsertion is not clinically indicated.
- The practice does not alter patient management and represents an unnecessary cost.
- Healthcare providers should reconsider the routine use of post-jejunostomy jejunograms.