Jejunostomy Tubes: through Gastrostomy or Nasal

The benefits of enteral feeding in critically ill animals have been clearly established and include preservation of the mucosal integrity of the gut, reduction in rates of sepsis and augmentation of the host immune defense mechanisms. A multitude of tube types and techniques for tube insertion have been reported but fundamentally speaking, the decision for the type of enteral feeding required comes down to four options: Gastric, transpyloric, gastric combined with transpyloric and intestinal. Precise clinical algorithms for ideal tube selection in any given patient are not established and therefore it is essential that the clinician carefully anticipate both the short and long-term nutritional needs of the patient prior to tube placement. Variables to consider include the following: Anticipated duration of feeding, patient tolerance of the tube, physiologic disturbances of primary disease, surgical vs. non-surgical placement, owner capabilities, cost and likelihood of gastroparesis. Gastric feeding via gastrostomy (G) tubes and intestinal feeding via jejunostomy (J) tubes have long been the mainstay for providing enteral nutrition to animals. Minimally invasive techniques for both G and J tube placement have been described, however, J tube placement generally requires some form of an open abdominal procedure. Complication rates associated with J tube feeding have been reported and range from 15.6% to 43.3%. Although the most common complications are mild and generally related to inflammation around the tube stoma or migration of the tube within the bowel, fatal complications associated with premature dislodgement resulting is septic peritonitis have been reported. On the contrary, a distinct benefit of enterostomy tube feeding alone is that a large percentage of critically ill animals develop gastroparesis, which would preclude early feeding through a G tube. In critically ill people receiving gastric feedings, a significantly higher rate of aspiration events (46%) has been reported compared to people receiving post-gastric feeding (6%). In order to maximize the benefit of each feeding tube type while simultaneously reducing the complications, a combined gastrojejunostomy (GJ) tube was developed. A GJ tube is one in which a smaller bore tube (J tube) is fed through the lumen of a routinely placed G tube and is subsequently advanced into the small intestine. The cap on the end of the J tube is manufactured such that it will anchor into the end of the G tube, as well as, allow for simultaneous access to both the lumen of the G and J tube (Figure 1).