What is the difference between a Jejunal (J) tube and a Percutaneous Endoscopic Jejunostomy (PEJ) tube?

Difference Between J Tube and PEJ Tube

A Percutaneous Endoscopic Jejunostomy (PEJ) is a direct primary access to the jejunum created endoscopically through the abdominal wall, while a J tube typically refers to a jejunal extension tube placed through an existing gastrostomy (PEG-J) or other indirect jejunal access methods. 1

Anatomical Placement and Access Methods

PEJ (Percutaneous Endoscopic Jejunostomy)

• Direct primary access to the jejunum through the abdominal wall
• Created as an initial procedure with endoscopic guidance
• Uses larger diameter tubes (typically 20F)
• Placed directly into the jejunum beyond the ligament of Treitz
• Creates a dedicated stoma directly into the small intestine

J Tube (Jejunal Tube)

• Often refers to several different types of jejunal access:
  • Jejunal extension through existing PEG (PEG-J)
  • Nasojejunal (NJ) tube
  • Orojejunal (OJ) tube
  • JET-PEG (jejunal tube through PEG)
• Typically smaller diameter tubes (9F-12F when used as extensions)
• May be temporary (nasal/oral route) or more permanent (through gastrostomy)

Clinical Performance and Outcomes

Tube Function and Durability

• Direct PEJ advantages:
  • Significantly longer tube patency
  • Lower rate of tube dysfunction (36% vs 19% requiring intervention)
  • Reduced need for reinterventions compared to PEG-J 2
  • More stable jejunal access for long-term feeding

Complications

• Direct PEJ complications:

  • Higher risk of peristomal leakage due to larger tube caliber
  • Placement is technically more challenging
  • Perioperative complication rate around 12.5% 3
  • Rare complications include small intestinal intussusception 4

• PEG-J complications:

  • Higher rate of tube migration
  • More frequent tube clogging due to smaller diameter
  • More frequent need for replacement
  • Tube dysfunction requiring replacement more common 5

Indications for Use

PEJ Indications

• Long-term jejunal feeding (>4 weeks)
• Patients with surgically altered foregut anatomy
• Severe gastroesophageal reflux with aspiration risk
• Gastroparesis or gastric outlet obstruction
• After bariatric surgery requiring enteral access

J Tube (PEG-J) Indications

• Patients who already have a PEG in place
• When direct PEJ placement is technically difficult
• When temporary jejunal access is needed
• Gastroduodenal motility problems
• Pyloric stenosis

Placement Techniques

PEJ Placement

• Requires specialized endoscopic skills
• Can be performed in endoscopy suite or operating room
• Often requires deeper sedation or anesthesia
• More technically challenging than PEG placement

PEG-J Placement

• Requires an existing gastrostomy
• Jejunal extension tube is threaded through the PEG tube
• Can be placed at bedside or with endoscopic guidance
• Generally simpler procedure than direct PEJ

Clinical Decision Making

When deciding between direct PEJ and PEG-J, consider:

1. Duration of feeding need (longer needs favor direct PEJ)
2. Risk of tube dysfunction (higher with PEG-J)
3. Technical feasibility of placement
4. Patient's anatomy (prior surgeries may necessitate direct PEJ)
5. Risk of aspiration (both can reduce aspiration risk)

Important Considerations

• For patients requiring long-term jejunal feeding, direct PEJ is preferred over PEG-J due to lower reintervention rates and better tube patency 1, 2
• In patients with altered anatomy from bariatric or foregut surgery, direct PEJ offers a less invasive alternative to surgical jejunostomy 3
• Tube dysfunction and need for replacement are significantly higher with PEG-J compared to direct PEJ 2
• Both methods aim to reduce aspiration risk by bypassing the stomach, though evidence for aspiration reduction is conflicting 1