Complications and Management of Feeding Jejunostomy

Overview of Complication Rates

Feeding jejunostomy carries a substantial complication rate of approximately 20-22.5%, with major complications occurring in 4-4.7% of cases, and procedure-related mortality ranging from 0-1.4% 1, 2
The overall adverse event rate is significant, with the largest analysis of 307 jejunostomy attempts showing a 68% success rate and 22.5% experiencing adverse events 1, 2

Bowel perforation occurs in approximately 2-3% of cases and may require emergency laparotomy 1, 2
Jejunal volvulus is a unique complication of direct jejunostomy, occurring in approximately 1% of cases, often requiring surgical intervention 1, 2, 3
Severe bleeding occurs in approximately 1% of cases 1, 2
Abdominal wall abscess is reported in endoscopy-guided procedures 1, 2
Aspiration pneumonia particularly occurs in neurological patients unable to protect airways, with incidence up to 20% 4, 5, 6
Sepsis/peritonitis can result from peristomal infection or intraperitoneal contamination 1, 2

Tube dislodgement occurs in 4-8.2% of cases, more frequent in neurological patients due to higher medication use 4, 5
Tube obstruction/clogging occurs in 8.2-10.9% of cases, especially with small-caliber tubes and inadequate flushing 4, 5, 6
Tube migration can occur with inadequate fixation 1, 2
Peristomal infection occurs in 1-4.1% of cases 1, 2
Persistent pain at jejunal access site is reported in 6-11% of minor complications 1, 2
Pressure-induced jejunal mucosal ulcerations result from chronic tube pressure 1, 2
Persistent enterocutaneous fistulas can occur after tube removal, particularly with direct jejunostomy 1, 2, 3

Hyperglycemia occurs in up to 29% of patients 4, 5, 6
Hypophosphatemia and hypomagnesemia are risk factors for refeeding syndrome 4, 5, 6
Electrolyte imbalances require close monitoring, especially in malnourished patients 4, 5, 6, 10
Refeeding syndrome is potentially fatal if not monitored, particularly when initiating nutrition in malnourished patients 4, 5, 6

The American Gastroenterological Association recommends that jejunostomy should only be considered when dysphagia is expected to persist beyond 4-6 weeks and the patient has adequate gastrointestinal function 8
Aspiration prevention: elevate head of bed 30° or more during and for 30 minutes after feeding 7, 5, 6
Mechanical complications: neurological patients have significantly more complications than cancer patients, primarily mechanical issues related to higher medication use 4, 5
Tube selection: use percutaneous tubes instead of nasal tubes for long-term needs (≥4-6 weeks) to reduce mechanical complications (Grade B recommendation) 4, 5, 6
Monitoring: regular assessment for aspiration risk, as incidence can reach 20% in patients unable to protect airways 4, 5, 6

Preventing tube obstruction: flush with water before and after every feed or medication 7
Managing aspiration risk: elevate head of bed 30° or more during and for 30 minutes after feeding 7, 5, 6
Managing gastrointestinal intolerance: reduce infusion rate, consider prokinetic agents 7
Managing metabolic complications: monitor plasma electrolytes and phosphorus strictly, especially when initiating nutrition in malnourished patients 4, 5, 6, 10

Adequate training of patient/caregiver in pump use, infection control, and stoma care before discharge (Grade B recommendation) 4, 7, 5
Continuity of care: HEN team should provide adequate follow-up to decrease complications and rehospitalizations 4, 5
Written protocols: hospitals should follow standardized discharge protocols 7
Contact information: patient/carer should have list of expert contacts 7
Community coordination: full liaison with district nurses, community dietitians, and GPs 7