Jejunostomy - CIRSE

During a percutaneous image-guided jejunostomy, an interventional radiologist will place a tube directly through the abdominal wall and into part of your small ... PatientsIRproceduresJejunostomyJejunostomyWhatispercutaneousimage-guidedjejunostomy?Ifyouhavebeenunabletoeatforoversevendays,youmayneedtoreceivenutrientsintravenously(calledparenteralfeeding)orviaatubeintothestomachorsmallbowel(calledenteralfeeding).Thereareanumberofwaysthatenteralfeedingcanbecarriedout,suchasplacingatubethroughthenoseandintothestomach.Thisiscalledanasogastricornasoentericfeedingtube,andisthepreferredoptionifyouranticipatedneedislessthan30days.However,nasoenterictubesarenotsuitableforuselongerthan30days,astheycancauseconsiderablediscomfortandcomplicationssuchasinflamedsinuses.Ifyourneedisanticipatedtobeforlongerthan30days,abetteroptionforyouisdirectenteralaccess.Thisinvolvesplacingatubedirectlyintoyourstomachorbowel.Thisusedtorequiresurgery,butminimallyinvasivetechniquesarenowavailableasanalternative,suchaspercutaneousimage-guidedjejunostomy.Duringapercutaneousimage-guidedjejunostomy,aninterventionalradiologistwillplaceatubedirectlythroughtheabdominalwallandintopartofyoursmallintestinecalledthejejunum,providingawayfornutrientstoenteryourbody.Howdoestheprocedurework?Theprocedureiscarriedoutusing fluoroscopic guidance.Theinterventionalradiologistwillfirstinflateyourstomachusinganasogastrictube.Thiswillaidthefluoroscopy,therequiredpunctureandenlargementofthetract.Inrarecases,nasogastricaccessmaynotbepossible,sothestomachisinflatedusinganeedleintroducedintothestomach,underimageguidance.Tominimisetheriskofpuncturingthecolon,theinterventionalradiologistmayadministeracontrastliquidintoyourcolonthedaybeforethejejunostomyprocedure,tohelpvisualisethecolon.Duringthejejunostomyprocedure,theinterventionalradiologistwillpuncturetheskinwherethetubewillbeinserted,andthendirecttheneedleunderimageguidancetothesmallintestine.Theneedlemaybeattachedtoananchor,whichtheinterventionalradiologistwilldirectintothejejunumusingaguidewire.Toensurethereisenoughspaceforthetube,thetractwillbeexpandedusingdilatorsortinyballoons,whichtheinterventionalradiologistwillinsertusingaseparateguidewire.Theinterventionalradiologistwilltheninsertajejunostomytubeovertheguidewire,usingfluoroscopytoconfirmitsposition.Onceithasbeenconfirmedthatthetubeiscorrectlyplaced,theinterventionalradiologistwillremovetheguidewiresandsecurethetubetotheskinusinganchors.Whyperformit?Thereareanumberofreasonswhyajejunostomytubemaybebeneficialforyou.Thetubesmaybeusedininfantsandchildrenwhohaveissueswithswallowingduetosurgery.Theymayalsobeusedinpatientswhoareunabletoswallowasaresultofcentralnervoussystemdisorders,patientswhorequirefeedingsupplementationorspecialdietsortoadministerfrequentdosesofmultiplemedications.Patientswhoarechronicallyillorneurologicallyimpairedmayrequireatubeindefinitely.Jejunostomyisanalternativeforpatientswhomaynotbeabletohaveafeedingtubeintheirstomach.Whataretherisks?Itisverycommonforairorgastobepresentintheabdominalcavityaswellasbruising.However,theseusuallyhavenoadverseclinicaleffect.Minorcomplicationsthatyoumayexperienceincludeincorrecttubeplacementortubemovement,granulationtissueformation(skinthatisredandsoreasitheals)andminorbleedingfromthesite.Somepatientsdevelopaconditioncalledintussusception,whenpartoftheintestinefoldsontoanothersectionoftheintestine,causingbowelobstruction.Anotherpossiblecomplicationislocalinfection.Otherprocedure-relatedcomplicationsincludedamagetotheabdominalorgastricwallscausedbydecreasedbloodsupplyandleakagefromthecatheter.Majorcomplicationsarerare,butincludeperforationofthesmallintestineandinflammationofthelungsorairwayscausedbyinhalingfoodorothersubstances.Bibliography1.OlsonDL,KrubsackAJ,StewartET“Percutaneousenteralalimentation:gastrostomyversusgastrojejunostomy,”Radiology1993.2.FriedmanJN,AhmedS,ConnollyB,ChaitP,MahantS,“Complicationsassociatedwithimage-guidedgastrostomyandgastrojejunostomytubesinchildren,”Pediatrics.2004Aug;114(2):458-61.Cookieshelpusprovideourcontentandservices.Mostofthemweneedtoensurethefunctionalityofourwebsite,othersareusedtoanalyseyourbrowsingbehaviour("technicallynon-necessarycookies"),wherebypersonaldataisalsoprocessed,formoreinformationseeourPrivacyStatement.Below,weaskforyourconsenttotheuseoftechnicallynon-necessarycookiessothatwecanprovideyouwiththebestpossibleserviceonourwebsite.InaccordancewithArt49(1)aGDPR,yourconsentalsoincludesthetransferofyourpersonaldatatorecipientsininsecurethirdcountries,suchastheUSinparticular,whichisfurtherdescribedinourPrivacyStatement.Youcanrefusethestorageofcookiesthatarenottechnicallynecessaryinadvanceunder"[managecookiepreferences]"orrevokeyourconsenttostorageatanytimeinyourbrowsersettings.Byclickingonthe"[confirmall]"button,youconsenttothestorageofalltechnicallynon-necessarycookies.ConfirmallManagecookiepreferencesRejectAllManageconsentClosePrivacyOverviewThiswebsiteusescookiestoimproveyourexperiencewhileyounavigatethroughthewebsite.Outofthese,thecookiesthatarecategorizedasnecessaryarestoredonyourbrowserastheyareessentialfortheworkingofbasicfunctionalitiesofthewebsite.Wealsousethird-partycookiesthathelpusanalyzeandunderstandhowyouusethi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