Percutaneous Jejunostomy Replacement in Patients Who Have Undergone Esophagectomy

Purpose: The authors expand their experience with a technique for the percutaneous replacement of a feeding jejunostomy tube in patients who have undergone esophagectomy, in which markers placed during the initial surgical jejunostomy are used. Patients and Methods: During esophagectomy in eight patients, a loop of jejunum was intubated with a surgical jejunostomy tube. This loop was then fixed to the anterior abdominal wall and marked with metal clips. In eight patients who required late nutritional support, the surgically placed metal clips on the fixed jejunal loop were used as fluoroscopic guides to mark the site for percutaneous access into the jejunum. Once access was obtained and verified with use of the Seldinger technique, a feeding jejunostomy tube was placed percutaneously after tract dilation. Results: Percutaneous replacement of a feeding jejunostomy tube was successful in all eight patients; in one patient, two placement attempts on successive days were required. No immediate complications occurred. Only one replacement jejunostomy tube has required replacement due to leakage around the tube (mean follow-up, 3.1 months). Conclusion: Percutaneous replacement of a feeding jejunostomy tube with use of surgically placed clips as guides for access is a safe and effective method for providing late nutritional support in the postesophagectomy patient.