What is a GJ (gastrojejunostomy) tube?

What is a GJ Tube?

A gastrojejunostomy (GJ) tube is a specialized feeding tube that provides access to both the stomach and jejunum through a single device, allowing for simultaneous jejunal feeding and gastric decompression. 1

Definition and Structure

• A GJ tube creates access to the jejunum through the stomach, typically with two ports (openings) - one into the stomach and one extending into the small intestine 1
• The tube is inserted through the abdominal wall into the stomach (gastrostomy portion) with an extension that passes through the pylorus into the jejunum 1
• Unlike standard gastrostomy tubes that only access the stomach, GJ tubes provide direct access to the small intestine while maintaining gastric access 2

Placement Methods

• GJ tubes can be placed using several techniques:

  • Endoscopically guided placement (percutaneous endoscopic gastrojejunostomy or PEG-J) 1
  • Radiologically guided placement using fluoroscopy 1
  • Conversion of an existing gastrostomy to a gastrojejunostomy by adding a jejunal extension 1
  • Surgical placement (less common as primary approach) 3

• The procedure typically involves:

  • Initial gastrostomy placement or use of existing gastrostomy tract
  • Advancement of a jejunal extension tube through the gastrostomy and pylorus into the jejunum
  • Confirmation of proper positioning using imaging guidance 1

Clinical Indications

• Simultaneous feeding and decompression: The dual-port design allows for jejunal feeding while decompressing the stomach 1, 2
• Patients at risk for aspiration: Those with gastroesophageal reflux, severe gastroparesis, or history of aspiration pneumonia 2
• Foregut dysmotility: Particularly in neurologically impaired patients who cannot tolerate gastric feeding 4
• Post-surgical feeding: Used in patients recovering from major upper gastrointestinal surgery 3
• GI obstruction or fistula: Allows for gastric decompression while maintaining enteral nutrition 1
• Pancreatitis: Small bowel feeding via the jejunal port can improve outcomes compared to parenteral nutrition 1

Advantages and Benefits

• Allows for enteral nutrition when gastric feeding is contraindicated 2
• Reduces risk of aspiration compared to gastric feeding in high-risk patients 2
• Provides a reversible alternative to more permanent surgical interventions like fundoplication 4
• Can improve clinical outcomes with decreased length of hospital stay and reduced infectious complications compared to parenteral nutrition 1

Complications and Limitations

• Tube dysfunction including clogging, deterioration, or migration of the jejunal extension 2, 5
• Dislodgement of the jejunal portion (requiring replacement) 5, 4
• Infection at insertion site 2
• Peristomal leakage or skin irritation 2
• Mechanical issues such as tube kinking or coiling in the stomach 1
• Gastrointestinal symptoms including diarrhea, abdominal distension, and dumping syndrome 1, 3
• Requires continuous rather than bolus feeding through the jejunal port due to loss of the stomach reservoir 1

Maintenance Considerations

• Regular assessment of tube position and function is essential 5
• GJ tubes typically require more frequent replacement than standard gastrostomy tubes 4
• The median replacement time is approximately 175 days, though this varies considerably 4
• Specialized care teams are often needed to coordinate tube replacements and manage complications 4