Durability of surgically versus endoscopically placed jejunostomy tubes in non-oncology patients - A single centre experience over 10 years.

BACKGROUND

Jejunal access is indicated in patients with impaired oral intake or gastroparesis who require enteral nutrition or medication delivery. There are various approaches to establishing jejunal access; including radiological, endoscopic and surgical methods. This study aims to evaluate the complication and re-intervention rates between endoscopic and surgical placement of jejunal tubes (JT).

METHOD: We retrospectively collected data on patients undergoing surgical or endoscopic placement of JT at a single centre over a ten-year period (2011-2021). We analysed the following information: age, gender, underlying pathology necessitating the JT placement, significant co-morbidities as well as the following outcome data: rates of tube occlusion, dislodgement and need for re-admission and re-intervention.

RESULTS

There were 165 patients included in the cohort. Of these, 96/165 underwent endoscopic placement either using Direct Percutaneous Endoscopic Jejunostomy (DPEJ) (14/96) or through Percutaneous Endoscopic Gastrostomy with Jejunal Extension (PEG-J) (82/96), and the remaining 69/165 underwent surgical placement either via a surgical flange (SF) tube (45/69) or the surgical Witzel (SW) technique (18/69). Idiopathic gastroparesis as an indication for JT placement (including Ehlers-Danlos Syndrome patients) affected 63.8 % of the surgical and 42.7 % of the endoscopic cohorts. At mean follow up of almost 17 months, the overall need for re-intervention, JT dislodgment and JT occlusion were 32.4 %, 8.8 % and 14.7 % in the surgical cohort, versus 62.8 %, 25.5 % and 27.7 % in the endoscopic cohort (p values of 0.0002, 0.0075 and 0.057, respectively). Individual re-intervention rates were 38.9 % for SW, 31.1 % for SF, 61 % for PEG-J and 64.3 % for DPEJ.

CONCLUSION

Surgical siting of JT demonstrates significantly reduced dislodgement rates, and requirement for re-intervention in the long-term as compared to endoscopic JT placement.