Jejunostomy Tube Change

Background and indications

Jejunostomy tube change is a maintenance procedure to replace an obstructed, displaced, or end-of-life jejunostomy tube. Jejunostomy is a feeding tube positioned directly in the jejunum (small bowel), used when gastrostomy is contraindicated (severe gastroparesis, prior gastrectomy, major gastroesophageal reflux with aspiration risk).

The tube can be a gastrojejunostomy (GJ — tube traversing stomach then duodenum to jejunum via gastrostomy) or a direct jejunostomy.

Pre-procedure assessment

Clinical evaluation (tube dysfunction, insufficient nutritional output, pain) is usually sufficient. Abdominal X-ray may verify existing tube position.

Procedure

Under local anesthesia and fluoroscopic guidance: the old tube is removed over a guidewire (guidewire kept in place in jejunum). A new tube is advanced over the guidewire through the existing tract to the jejunum. Position is verified by contrast injection. For GJ tubes, a directional catheter may be needed to cross the pylorus and duodenum. The procedure takes 15-30 minutes.

Results and scientific evidence

Technical success rate is 95-99%. Change is generally needed every 3-6 months. Change frequency is higher than for simple gastrostomies due to more frequent jejunal tube obstruction (smaller caliber).

Risks and complications

Tract loss (< 1% if over-wire change), malposition (5-10%, repositionable), pain (10-20%), perforation (exceptional). The procedure is considered very low-risk.

Recovery

Same-day discharge. Immediate enteral feeding resumption.

Practical information

The procedure is performed as an outpatient. It is performed by an interventional radiologist.