Percutaneous fluoroscopically guided jejunostomy placement

To describe our experience with fluoroscopically guided direct jejunostomy placement in patients with enterocutaneous fistula, or neoplastic or postsurgical changes of the stomach or duodenum that preclude traditional gastrostomy placement.

Nineteen patients underwent percutaneous direct jejunostomy tube placement with fluoroscopic guidance from August 2004 through March 2006. There were 15 men and four women whose ages ranged from 28 to 82 years (mean, 54 years). Seven patients had surgical changes to the stomach that precluded traditional gastrostomy access, one patient had a duodenal tumor, two had unresectable gastric tumors, and nine had small bowel pathology that required distal access.

Jejunal access was initially successful in 18 of 19 (95%) procedures. Follow-up ranged from 10 days to 509 days. Two catheters were removed as they were no longer needed. Seven patients' initial tubes were still functioning at the end of their follow-up. One tube was removed secondary to pain and irritation at the insertion site. Three tubes were occluded. One patients' tube was inadvertently pulled out. In two patients, feeding was not tolerated secondary to fistula distal to the jejunostomy. Two patients died with their initial tubes. Primary patency was 285 days (95% CI 162-407). One death occurred 10 days postprocedure for a 30-day mortality of 1 of 19 (5%).

Percutaneous direct jejunostomy placement is a relatively safe and effective means of gaining enteral access in patients who have enterocutaneous fistula or who have either postsurgical or neoplastic changes of the stomach that preclude traditional gastrostomy placement.