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Randomized Study of Radiologic vs Endoscopic Placement of Gastrojejunostomies in Patients at Risk of Aspiration Pneumonia
Author(s) -
Lewis Stephen,
Jackson Simon,
Latchford Andrew
Publication year - 2014
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1177/0884533614529999
Subject(s) - medicine , reflux , aspiration pneumonia , enteral administration , pneumonia , feeding tube , surgery , intubation , tube (container) , parenteral nutrition , disease , mechanical engineering , engineering
Objective : In patients at risk of aspiration pneumonia due to gastroesophageal reflux who require gastrojejunostomy feeding tubes, the tubes are placed either radiologically (RIGJ) or endoscopically (PEGJ). There is little published evidence of the superiority of one technique over the other. Methods : Patients referred for long‐term jejunal feeding were randomly allocated to have a 14F RIGJ or 15F with 9F jejunal extension PEGJ inserted. A technetium‐99m ( 99m Tc) colloid study was done to determine the presence of gastroesophageal reflux and jejunogastric reflux after feeding tube placement. We recorded enteral feed and tube‐related complications, in addition to tube‐related morbidity and mortality to 90 days following placement. Results : Baseline characteristics were similar between groups, with gastroesophageal reflux demonstrated in 52%. Following enteral tube placement, gastroesophageal reflux was not observed by 99m Tc studies or any difference in clinical outcome to 90 days after placement. No jejunal tubes were displaced in any of the 31 RIGJ tubes, while 9 tubes were displaced in the 34 PEGJ patients ( P = .008). Reversible jejunal tube blockages occurred: 19 RIGJ (5 patients) and 61 PEGJ (11 patients) ( P = .003, χ 2 = 9.1). Conclusion : There was little difference between the 2 tubes for clinical outcomes. RIGJ tubes were less prone than PEGJ tubes to reversible blockage and displacement. It is likely that the better outcome for RIGJ tubes relates to their larger tube diameter and stiffness.