From the Guidelines
A percutaneous jejunostomy tube extending 3 cm externally from the skin surface is generally acceptable and within normal parameters. The external portion of feeding tubes typically ranges from 2-5 cm to allow for proper tube function while minimizing complications, as stated in the ESPEN guideline on home enteral nutrition 1. This external length provides enough tube to work with during care and feeding, while not being so long that it causes excessive pulling, tangling, or accidental dislodgement. The appropriate external length helps maintain proper tube position within the jejunum while allowing for normal body movement and reducing skin irritation. Some key points to consider when evaluating the appropriateness of the tube length include:
- The distance between the internal and external fixation devices should not be too loose or too restrictive, to prevent complications such as buried bumper syndrome (BBS) 1
- The tube should be advanced into the stomach for a minimum of about 2-3 cm, but ideally up to 5-10 cm, to ensure proper placement and minimize the risk of complications 1
- Regular assessment of the tube position, securing the tube properly, and following institutional protocols for tube care are important to prevent complications such as dislodgement, migration, or skin breakdown around the insertion site. However, if the tube has recently migrated and is now extending 3 cm when it previously was shorter, this could indicate tube displacement and should be evaluated by a healthcare provider.
From the Research
Percutaneous Jejunostomy Extension
- The extension of a percutaneous jejunostomy by 3cm externally is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies discuss various techniques and complications associated with jejunostomy, including percutaneous endoscopic jejunostomy (PEJ) and direct percutaneous endoscopic jejunostomy (DPEJ) 3, 4, 5, 6.
- The safety and efficacy of DPEJ have been demonstrated in several studies, with high technical success rates and low complication rates 4, 5, 6.
- The studies also highlight the importance of careful patient selection and respect for preprocedural, periprocedural, and postprocedural precautions to ensure a favorable outcome 6.
Complications and Considerations
- The complications associated with jejunostomy, including mechanical, infectious, gastrointestinal, and metabolic complications, are discussed in the studies 2, 4, 6.
- The rate of technical complications and adverse events varies among different techniques, with DPEJ showing promising results 4, 5, 6.
- Factors such as obesity, age, diabetes mellitus, and ongoing inflammatory status may be considered risk factors for DPEJ-associated mortality 6.
Technique and Outcomes
- The studies describe various techniques for jejunostomy, including the "pull" technique using a pediatric colonoscope, and the use of balloon-assisted enteroscopy with fluoroscopy 3, 5, 6.
- The outcomes of DPEJ are generally favorable, with high rates of technical success and low rates of complications 4, 5, 6.