Percutaneous enteral alimentation: gastrostomy versus gastrojejunostomy

Scintigraphy was used to detect gastroesophageal reflux, determine whether percutaneous gastrostomy (PG) tubes cause reflux, and help in the choice between PG tubes versus percutaneous gastrojejunostomy (PGJ) tubes. During a 2-year period, 46 patients were evaluated with scintigraphy immediately before and 1 week after PG tube placement. Findings in the pre- and postplacement reflux studies were the same in 39 patients (85%). Proof of reflux on either study was considered an indication for conversion to the PGJ tube; at least one study was positive for reflux in 21 patients (46%). All patients were followed up for tube complications, pneumonia, and cause of death. During follow-up, six of 24 patients correctly maintained with PG tubes (25%) and 18 patients with PGJ tubes (39%) developed pneumonia, the cause of death in four of 24 patients with PG tubes (17%) and five of 18 patients with PGJ tubes (28%). The PG tube does not induce reflux, and scintigraphy is useful in selection of patients who can be safely maintained with the PG tube without an increase in the morbidity or mortality associated with reflux and aspiration.