Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.
Department of Clinical Nutrition, The George Washington University Hospital, Washington, DC, USA.
Surg Endosc. 2018 May;32(5):2496-2504. doi: 10.1007/s00464-017-5954-6. Epub 2017 Dec 7.
Enteral access through the jejunum is indicated when patients cannot tolerate oral intake or gastric feeding. While multiple approaches for feeding jejunal access exist, few studies have compared the efficacy of these techniques. The purpose of this study was to investigate the long-term durability, re-intervention rates, and nutritional outcomes following percutaneous endoscopic gastrostomy tubes with jejunal extension tubes (PEG-JET) versus laparoscopic jejunostomy tubes (j-tubes).
Retrospective chart review was performed on all patients who underwent PEG-JET or laparoscopic jejunostomy tube placement from January 2005 through December 2015 at our institution. Thirty-day and long-term outcomes were compared between the two groups.
A total of 105 patients underwent PEG-JET and 307 patients underwent laparoscopic j-tube placement during the defined study period. In terms of 30-day outcomes, patients who underwent PEG-JET placement were significantly more likely to experience a tube dislodgement event (p = 0.005) and undergo a re-intervention (p < 0.001). Patients who had a laparoscopic j-tube placed were significantly more likely to meet their enteral feeding goals (p = 0.002) and less likely to require nutritional supplementation with total parenteral nutrition (TPN) (p < 0.001). With regard to long-term outcomes, patients who underwent PEG-JET placement were significantly more likely to experience tube occlusion (p < 0.001) and require an endoscopic or surgical tube re-intervention (p < 0.001). Patients who underwent laparoscopic j-tube placement were significantly more likely to experience a tube site leak (p = 0.015) but were less likely to require nutritional supplementation with TPN (p = 0.001).
Laparoscopic jejunostomy tubes provide more durable long-term enteral access compared to PEG-JET. Consideration should be given to laparoscopic jejunostomy tube placement in eligible patients who cannot tolerate oral intake or gastric enteral feeding.
当患者不能耐受口服摄入或胃饲时，需要通过空肠进行肠内喂养。虽然有多种方法可以进行空肠喂养，但很少有研究比较这些技术的疗效。本研究旨在探讨经皮内镜胃造口管加空肠延长管（PEG-JET）与腹腔镜空肠造口管（j-tube）的长期耐用性、再干预率和营养结局。
对 2005 年 1 月至 2015 年 12 月在我院行 PEG-JET 或腹腔镜空肠造口管置管术的所有患者进行回顾性图表分析。比较两组患者的 30 天和长期结果。
在规定的研究期间，共 105 例患者行 PEG-JET 置管术，307 例患者行腹腔镜 j-tube 置管术。在 30 天结果方面，行 PEG-JET 置管术的患者发生管移位事件的可能性明显更高（p=0.005），需要再次干预的可能性也明显更高（p<0.001）。行腹腔镜 j-tube 置管术的患者更有可能达到肠内喂养目标（p=0.002），需要接受全肠外营养（TPN）补充的可能性较低（p<0.001）。在长期结果方面，行 PEG-JET 置管术的患者发生管腔阻塞的可能性明显更高（p<0.001），需要进行内镜或手术干预的可能性也明显更高（p<0.001）。行腹腔镜 j-tube 置管术的患者发生管位漏的可能性明显更高（p=0.015），但需要接受 TPN 补充的可能性较低（p=0.001）。
与 PEG-JET 相比，腹腔镜空肠造口管提供更持久的长期肠内通路。对于不能耐受口服摄入或胃内肠内喂养的患者，应考虑行腹腔镜空肠造口管置管术。
