From the Guidelines
Total Parenteral Nutrition (TPN) and Jejunostomy (J) tube feeds are two different methods of providing nutritional support to patients who are unable to feed orally. The main difference between the two is that TPN involves delivering nutrients directly into the bloodstream through a vein, whereas Jejunostomy tube feeds involve delivering nutrients directly into the small intestine through a tube.
Key differences
- Route of administration: TPN is administered intravenously, while Jejunostomy tube feeds are administered directly into the small intestine [ 1 ].
- Nutrient absorption: TPN bypasses the digestive system, while Jejunostomy tube feeds allow for normal digestion and absorption of nutrients in the small intestine [ 1 ].
- Complications: TPN is associated with a higher risk of complications, such as infected peripancreatic necrosis, single organ failure, and multiple organ failure, compared to Jejunostomy tube feeds [ 1 ].
Recommendations
- Enteral nutrition is preferred: The American Gastroenterological Association recommends enteral nutrition over parenteral nutrition for patients with acute pancreatitis who are unable to feed orally [ 1 ].
- Jejunostomy tube feeds are a viable option: Jejunostomy tube feeds can be delivered safely and are associated with fewer complications compared to TPN [ 1 ].
Clinical implications
- Choose Jejunostomy tube feeds over TPN: When possible, Jejunostomy tube feeds should be chosen over TPN for patients who require nutritional support, as they are associated with fewer complications and better outcomes [ 1 ].
From the Research
Overview of Total Parenteral Nutrition (TPN) and Jejunostomy (J) Tube Feeds
- TPN is a method of providing nutrients to the body through a vein, bypassing the digestive system 2, 3, 4, 5.
- Jejunostomy (J) tube feeds, on the other hand, involve delivering nutrients directly into the jejunum, a part of the small intestine, through a tube 2, 4, 5, 6.
Key Differences
- Route of Nutrition: TPN delivers nutrients intravenously, while J tube feeds deliver nutrients directly into the intestine 2, 3, 4, 5.
- Cost: Studies have shown that J tube feeds are significantly less costly than TPN 2, 3.
- Complications: TPN is associated with a higher risk of infections and gastrointestinal symptoms, while J tube feeds may cause diarrhea, ileus, and perforation 2, 3, 5.
- Nutritional Outcomes: J tube feeds have been shown to promote more rapid resolution of toxicity and stress response, and improve nutritional outcomes compared to TPN 2, 4, 5, 6.
Comparison of Jejunostomy Tube Placement Methods
- Laparoscopic Jejunostomy Tubes: Provide more durable long-term enteral access compared to percutaneous endoscopic gastrostomy tubes with jejunal extension (PEG-JET) 6.
- Percutaneous Endoscopic Gastrostomy Tubes with Jejunal Extension (PEG-JET): May be associated with a higher risk of tube dislodgement and re-intervention compared to laparoscopic jejunostomy tubes 6.