Choice between

Gastrostomy and
Jejunostomy
Ri 蘇彥榮
AGA guideline: Enteral
nutrition
Indications for Tube
Feeding
n Patients who cannot or will not eat
n Patients who have a functional gut
n Safe method of access is possible.
n Mechanical obstruction is the only
absolute contraindication to
enteral feeding.
Methods of Feeding
Complications of Tube
Feeding
n Infection
n Aspiration
n Diarrhea
n Alterations in drug absorption and
metabolism
n Metabolic disturbances
Gastrostomy (1)
n Percutaneous endoscopic
gastrostomy (PEG)
n First choice of gastric access
n Surgical gastrostomy
n Comparable to PEG, but is more
expensive and requires more
recovery time
n Radiological gastrostomy
Gastrostomy (2)
n For gastric access using conscious
sedation, PEG is usually preferred.
n Surgical gastrostomy is
comparable but is more expensive
and requires more recovery time.
Percutaneous endoscopic
gastrostomy (PEG)
Jejunostomy
n Percutaneous endoscopic
jejunostomy (PEJ)
n Extension through an existing
gastrostomy tube (PEG-J)
n Surgical jejunostomy
n Radiological jejunostomy
Percutaneous endoscopic
jejunostomy (PEJ)
PEG-J
 When Should a
Gastrostomy Be Used?
n Requires prolonged tube feeding (>30
days)
n Adequate function and structure of
stomach and low esophageal
sphincter
n No history of :
n Recurrent aspiration of gastric contents
n Esophageal dysmotility or regurgition
When Should Jejunostomy
Tubes Be Used?
n Pulmonary aspiration
n Severe GER and reflux esophagitis
n Gastroparesis
n Insufficient stomach from previous
resection
n Post surgery/multiple trauma
n Access in a patient with
Adavntages of
Gastrostomy
n More physiological
n Ease of placement
n Convenience
n Bolus feeding
n Greater flexibility in choosing formula
Disadavntages of
Gastrostomy
n Delayed gastric emptying
n Continueous feeding
n Prokinetic drug
n Gastroesophageal reflex and
aspiration
n Elevation of head
n Reduce feeding rate and volume
n More hydrolyzed or lower osmolarity
formula
Adavntages of
Jejunostomy
n Minimize aspiration risk
n Benefits in acute pancretitis
n Role in critically ill patients
n In the critically ill adult patient, we
recommend the routine use of
small bowel feedings in units
where obtaining small bowel
access is feasible.

n Canadian Clinical Practice Guidelines for Nutrition Support in

Mechanically Ventilated, Critically Ill Adult Patients.
JOURNAL OF PARENTERAL AND ENTERAL NUTRITION, 2003, Vol. 27,
No. 5
n Early use of post-pyloric feeding
instead of gastric feeding in
critically ill adult patients with no
evidence of impaired gastric
emptying was not associated with
significant clinical benefits.
n A comparison of early gastric and post-pyloric feeding in
critically ill patients: a meta-analysis. Intensive Care Med (2006)
32:639–649
Disadavntages of
Jejunostomy
n Difficulty with placement and ease
of displacement
n Feeding tolerance
n Dumping syndrome
n Slow feeding rate
n Change in formula
 Long-term use of
gastrostomy and jejunostomy

n If gastrostomy are no longer

tolerated
n Surgical jejunostomy
n PEG-J
n If jejunostomy are no longer
tolerated
n TPN
Summary
n Most patients can be started on
low volume contineous intragastric
feeding.
n Beginning with jejunal feeding may
be considered in patients with
severe GER and esophagitis, post
surgery/multiple trauma, and
gastric dysmotility.