Introduction Home enteral tube feeding (HETF) has grown in the past 2 decades and there is now also a growing demand for post-pyloric HETF (PP-HETF) for selected cases.1,2 The optimum route for delivering this is not established, with several options available including surgical jejunostomy (SJ), direct percutaneous endoscopic jejunostomy (DPEJ), and PEG with jejunal extension (PEG-J). We have reviewed our experience to help identify comparative outcomes.
Methods Choice of feeding device was clinician-led according to indication, surgical and endoscopic risk. A 2 year review was done from Jan 2014 onwards. Patients were included if they were (1) already undergoing PP-HETF as of January 2014 or (2) had an interventional procedure to start PP-HETF at any time thereafter during the study period. Cases were identified from the community dietetic and electronic endoscopy databases. Case files were reviewed to identify outcome measures which were categorised as: Success of planned procedures; longevity of feeding device, premature removal (removal because of sepsis, migration, blockage or accidental), procedural complications or mortality
Results 26 patients were identified (M:F 14:12, median age 55, range 22–83). Indications for PP-HETF were learning difficulties with Gastro-oesophgeal(GO) reflux (8), neurodegenerative or cerebrovascular disease with GO reflux (5), upper GI cancers(9) & others (4).
Feeding interventions done successfully prior to or during the study period were SJ (10), DPEJ (14), PEG-J (14).Procedural success rates during study period were; SJ; 10/10 (100%), DPEJ;7/11 (64%), PEG-J; 12/13 (92%).Longevity of feeding devices at review census point (in months, median & range) was: SJ, 11 (3–23); DPEJ,18 (3–48); PEG-J, 6 (0.25–23).
Tube premature removal rates (and reasons) were: SJ; 3/10 (30%; all fell out), DPEJ; 3/14(21%; 1 accidental, 2 infected), PEG-J; 6/14 (43%; 4 accidental, 2 blocked). There were no procedural complications recorded but one patient (DPEJ) died <7 days from respiratory failure.
Conclusion In this case series which includes similar numbers of the common PP-HETF options, SJ had the highest, and DPEJ the lowest, procedure success rate.DPEJ had the highest longevity. Choice of feeding device for PP-HETF will depend on co-morbidity and surgical/ endoscopic risk but when DPEJ can be placed this may be the preferred option for long-term feeding.
References 1 Ojo O. Managing patients on enteral feeding tubes in the community. Br J Community Nurs 2010;15:S6–S13.
2 Ojo O. The challenges of home enteral tube feeding: a global perspective. Nutrients 2015;7(4):2524–2538. doi:10.3390/nu7042524.
Disclosure of Interest None Declared
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