What is the Janeway technique used for in patients requiring long-term enteral nutrition?

The Janeway Technique for Long-Term Enteral Nutrition

The Janeway technique is an outdated surgical gastrostomy procedure that has been largely replaced by percutaneous endoscopic gastrostomy (PEG) for patients requiring long-term enteral nutrition, as PEG has been shown to have superior outcomes with lower complication rates. 1

Historical Context and Current Status

• The Janeway technique is a traditional surgical gastrostomy procedure that was used before the development of modern percutaneous techniques 1
• It belongs to a group of conventional surgical gastrostomies (along with Witzel and Stamm techniques) that have been largely superseded by less invasive approaches 1
• Clinical studies have clearly demonstrated the superiority of percutaneously placed gastrostomies compared to these former surgical procedures in terms of patient outcomes 1

Modern Alternatives for Long-Term Enteral Nutrition

Preferred Options (In Order of Preference)

• Percutaneous Endoscopic Gastrostomy (PEG) is now the first-line procedure for patients requiring enteral nutrition for periods exceeding 2-3 weeks 1

  • PEG offers higher subjective and social acceptance
  • Less stigmatizing than other options
  • Reduced rates of esophageal reflux and aspiration pneumonia
  • Superior nutritional efficacy compared to nasogastric tubes 1

• Percutaneous Endoscopic Jejunostomy (PEJ) for patients with persistent aspiration after PEG placement 2

  • Direct PEJ has lower tube dysfunction and reintervention rates compared to jejunal extension tubes through existing PEG 2

• Laparoscopic Modifications of Traditional Techniques when endoscopic access is limited 3, 4

  • Laparoscopic Janeway gastrostomy (LJG) has been developed as a minimally invasive alternative with fewer complications than traditional surgical approaches 4, 5
  • Percutaneous laparoscopic assisted gastrostomy (PLAG) shows lower complication rates than conventional surgical techniques 3

Indications for Enteral Nutrition Access

• Long-term enteral nutrition (>2-3 weeks) in patients with:
  • Neurological disorders affecting swallowing 1
  • Head and neck cancers 1
  • Malabsorptive syndromes 1
  • Severe intestinal motility disorders 1
  • Patients who cannot meet nutritional requirements orally 1

Decision Algorithm for Selecting Appropriate Access

1. For short-term feeding (<6 weeks):

   • Nasogastric or nasojejunal tubes are appropriate 1

2. For long-term feeding (>6 weeks):

   • PEG is the preferred option 1
   • If risk of aspiration exists, consider direct PEJ 2, 6
   • If endoscopic access is limited (e.g., impassable tumors), consider laparoscopic approaches 3, 4

3. For patients requiring post-surgical jejunal feeding:

   • Needle catheter jejunostomy (NCJ) placed during surgery 1

Complications and Considerations

• Traditional surgical gastrostomies like the Janeway technique have higher morbidity rates, particularly gastric leakage around the tube 3
• PEG has lower complication rates compared to surgical gastrostomies 1
• Laparoscopic versions of traditional techniques show improved outcomes over open surgical approaches 4, 5, 7
• Monitoring for tube dysfunction, dislodgement, and infection is essential with all enteral access devices 1

Special Considerations for Long-Term Management

• Regular reassessment of nutritional status during hospital stay and after discharge is recommended 1
• Continuation of nutritional support after discharge should be considered for patients who cannot meet their energy requirements orally 1
• For home enteral nutrition (HEN), PEG or PEJ is the preferred access device for feeding periods exceeding 6 weeks 1

Practical Management Tips

• Feeding through jejunal tubes typically requires continuous rather than bolus feeding for better tolerance 2
• Tolerance of tube feeding should be monitored closely in patients with impaired intestinal function 1
• It may take 5-7 days to reach target intake volumes, which is not considered harmful 1