Andre Ulflacker MD, Presenter: Nothing to Disclose

Yujie Qiao, Abstract Co-Author: Nothing to Disclose

Genevieve G. Easley BS, Abstract Co-Author: Nothing to Disclose

James Patrie MS, Abstract Co-Author: Nothing to Disclose

Drew L. Lambert MD, Abstract Co-Author: Nothing to Disclose

Eduard E. De Lange MD, Abstract Co-Author: Nothing to Disclose

To evaluate outcomes of fluoroscopic placement of a jejunal extension (J-arm) in patients with an already existing gastrostomy (G) tube.

Retrospective review of 391 J-arm placements over a 3-year period was performed in 174 patients requiring nutrition post ligament of Treitz [M/F 94/80, age range 1-89 y (mean 55.9 y)]. IRB approval and HIPAA compliance were maintained. Indications for jejunal nutrition were aspiration risk (35%), pancreatitis (17%), gastroparesis (13%), gastric outlet obstruction/mass/leak (12%) and other (23%). Technical success, procedure-related complications, tube malfunction rate and tube patency were assessed. G-tube location, J-arm course and fluoroscopy time were correlated for success/failure. Full and partial technical success were defined as J-arm tip placement at or beyond the ligament of Treitz, and between the pylorus and ligament, respectively. Failure was inability to advance the tip out of the stomach. Procedure-related complications were periprocedural adverse events related to tube placement occurring within 7 days. Tube malfunction was defined as coiling/kinking/clogging and inadvertent removal requiring replacement.

Tube placement was successful in 303/391 (78%). Complications occurred in 3 (0.8%) [1 perforation (0.27%), 1 hematoma (0.27%), 1 hypotension (0.27%)]. Malfunction occurred in 197 (50%). Overall patency was 51 days (95%CI:[42,58 days]) following placement. There was no association between successful J-arm placement and G-tube position in the stomach (p=0.677) or indication for jejunal nutrition (p=0.349); between J-arm trajectory in the stomach and incidence of tube malfunction (p=0.365); and between risk of coiling/kinking in the stomach and G-tube position (p=0.173) or J-arm length (p=0.987). Fluoroscopy time placement was negatively associated with procedure success (p<0.001) and not associated with G-tube position (p=0.661). Significantly more tube malfunctions occurred in tubes replaced after 90 days than in tubes replaced before the vendor-recommended 90 days (p<0.001).

Fluoroscopy guided J-arm placement was safe, with low procedural complication rate. Fluoroscopy time was the only predictor of technical success. Tubes replaced after 90 days had higher rates of tube malfunction.

Fluoroscopic guided J-arm placement is safe for patients requiring jejunal nutrition. Tubes should be replaced within 90 days.

Ulflacker, A, Qiao, Y, Easley, G, Patrie, J, Lambert, D, De Lange, E, Fluoroscopically-guided Jejunal Extension Tube Placement through an Existing Gastrostomy Tube in Patients Requiring Nutrition beyond the Ligament of Treitz: Analysis of 391 Procedures Performed over 3 Years.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13013918.html