Gastrojejunostomy Tube Placement and Management

Definition and Structure

A GJ tube creates access to the jejunum through the stomach, typically with two ports, allowing for simultaneous jejunal feeding and gastric decompression, as recommended by the American Gastroenterological Association 1, 2
The tube is inserted through the abdominal wall into the stomach with an extension that passes through the pylorus into the jejunum, a procedure outlined by the American College of Gastroenterology 3

GJ tubes can be placed using several techniques, including endoscopically guided placement, radiologically guided placement, and conversion of an existing gastrostomy to a gastrojejunostomy, as described by the European Society of Gastrointestinal Endoscopy 4, 5, 6
The procedure typically involves initial gastrostomy placement, advancement of a jejunal extension tube, and confirmation of proper positioning using imaging guidance, according to the American Society for Gastrointestinal Endoscopy 5, 6

GJ tubes are indicated for simultaneous feeding and decompression, allowing for jejunal feeding while decompressing the stomach, as recommended by the American Gastroenterological Association 2
They are also used for patients with GI obstruction or fistula, allowing for gastric decompression while maintaining enteral nutrition, as outlined by the Society of Critical Care Medicine 1, 2
Small bowel feeding via the jejunal port can improve outcomes compared to parenteral nutrition in patients with pancreatitis, according to the American College of Gastroenterology 1

GJ tubes can improve clinical outcomes with decreased length of hospital stay and reduced infectious complications compared to parenteral nutrition, as reported by the American Gastroenterological Association 1

Mechanical issues such as tube kinking or coiling in the stomach can occur, as described by the European Society of Gastrointestinal Endoscopy 6
Gastrointestinal symptoms including diarrhea, abdominal distension, and dumping syndrome can also occur, according to the American College of Gastroenterology 4
Continuous rather than bolus feeding through the jejunal port is required due to loss of the stomach reservoir, as recommended by the American Society for Parenteral and Enteral Nutrition 4