What is the difference between a Jejunostomy (J) tube and a Gastrostomy (G) tube?

Differences Between Jejunostomy (J) Tubes and Gastrostomy (G) Tubes

The primary difference between J tubes and G tubes is their anatomical placement: G tubes are inserted directly into the stomach through the abdominal wall, while J tubes are placed into the jejunum (part of the small intestine), bypassing the stomach entirely. 1

Anatomical Placement

G Tubes (Gastrostomy Tubes)

• Inserted directly into the stomach through the abdominal wall
• Creates an artificial access to the stomach for feeding and/or decompression
• Common placement methods include:
  • Percutaneous Endoscopic Gastrostomy (PEG)
  • Percutaneous Laparoscopic Gastrostomy (PLG)
  • Percutaneous Sonographically Guided Gastrostomy (PSG)
  • Percutaneous Fluoroscopically Guided Gastrostomy (PFG) 1

J Tubes (Jejunostomy Tubes)

• Inserted directly into the jejunum (small intestine) through the abdominal wall
• Creates artificial access to the small intestine for feeding and/or decompression
• Common placement methods include:
  • Percutaneous Endoscopic Jejunostomy (PEJ)
  • Percutaneous Laparoscopic Jejunostomy (PLJ)
  • Percutaneous Sonographically Guided Jejunostomy (PSJ)
  • Percutaneous Fluoroscopically Guided Jejunostomy (PFJ) 1

Clinical Indications

G Tube Indications

• Most common form of long-term enteral access
• Used when patients can tolerate gastric feeding
• Appropriate for patients with:
  • Neurological disorders affecting swallowing (stroke, multiple sclerosis, etc.)
  • Head and neck cancers
  • Mechanical obstruction to swallowing
  • Cognitive impairment 1

J Tube Indications

• Used when gastric feeding is unsafe or impossible
• Specifically indicated for patients with:
  • History of aspiration or high risk of aspiration
  • Gastroesophageal reflux disease (GERD)
  • Gastroparesis or delayed gastric emptying
  • Gastric outlet obstruction
  • Upper GI obstruction
  • Pancreatitis (jejunal feeding has shown improved outcomes) 1, 2

Technical Considerations

G Tubes

• Allow for more feeding options (bolus, continuous, or intermittent)
• Can accommodate higher feeding rates and more viscous formulas
• Generally easier to place and maintain
• Can be used for gastric decompression 1

J Tubes

• Require continuous feeding (no bolus feeding)
• More technically challenging to place due to small bowel mobility
• Higher rate of tube-related complications
• May require more frequent tube replacements
• More difficult to replace if dislodged 1, 3

Hybrid Options

Gastrojejunostomy (G-J) Tubes

• Dual-lumen tubes with ports in both the stomach and jejunum
• Allow for simultaneous jejunal feeding and gastric decompression
• Used when both gastric decompression and post-pyloric feeding are needed
• Often used when antireflux surgery fails or is inappropriate 4

Complication Profiles

G Tube Complications

• Peristomal infection (5.4-30%)
• Leakage around tube (1-2%)
• Buried bumper syndrome (0.3-2.4%)
• Gastric ulceration (0.3-1.2%)
• Aspiration risk (0.3-1.0%) 1

J Tube Complications

• Higher mechanical complication rates (tube migration, dislocation, clogging)
• Smaller diameter tubes more prone to clogging
• Potentially lower risk of aspiration pneumonia (though studies show mixed results)
• Technical complications range from 1.5-21% depending on technique 5, 3

Practical Considerations

• G tubes generally allow for easier home care management
• J tubes require more precise formula administration and continuous feeding
• G tubes can be converted to low-profile "button" devices after tract maturation
• J tubes are more challenging to replace if dislodged and often require imaging guidance
• Both require regular maintenance to prevent clogging 1, 6

Decision Algorithm for G vs J Tube Selection

1. Assess aspiration risk:

   • High risk → Consider J tube
   • Low risk → Consider G tube

2. Evaluate gastric emptying:

   • Delayed → J tube preferred
   • Normal → G tube acceptable

3. Consider feeding duration:

   • Short-term (2-3 weeks) → Consider nasogastric/nasojejunal
   • Long-term → Consider permanent G or J tube 1

4. Assess technical feasibility:

   • Accessible stomach → G tube feasible
   • Upper GI obstruction → J tube necessary

5. Consider patient comfort and care requirements:

   • Need for bolus feeding → G tube
   • Need for simultaneous decompression and feeding → G-J tube

Remember that while J tubes theoretically reduce aspiration risk, clinical studies have not consistently demonstrated significant differences in aspiration pneumonia rates between G tubes and J tubes 5.