Evidence - Catheter jejunostomy

  1. Literature summary

    Postoperative nutrition

    Major intestinal surgery should be closely followed by early enteral nutrition.[1, 2] The German S3 guideline on the diagnosis and treatment of squamous cell carcinomas and adenocarcinomas of the esophagus states:[3]

    "Due to the metabolic risk following esophageal resection, enteral nutrition should be initiated within 24 hours. Parenteral supplementation may be recommended if less than 60-75% of the energy requirement is supplied by enteral means (expert consensus).“

    Nutrition support is indicated for patients with established malnutrition and those without malnutrition, but who will probably be unable for more than 7 days post surgery to tolerate oral nutrition. It is also indicated for patients unable to consume more than 60–75% of the recommended energy requirement orally for more than 10 days. Nutrition support, preferably enteral, should be initiated immediately in these patients.[1, 3]

    Several meta-analyses have established the benefits of early postoperative enteral nutrition.[1, 4] As early oral nutrition is not possible after esophageal resection, it is recommended that a transnasal feeding tube with the tip in the jejunum or a catheter jejunostomy (CJ) be placed intraoperatively.[5] 

    An observational study demonstrated significant benefits for the provision of safe and long-term enteral nutrition via CJ after esophageal resection, particularly in the case of anastomotic suture line failure.[4] Another study on early enteral nutrition after esophageal resection did not reveal any difference in catheter-related risks between a nasoduodenal tube and CJ.[5] Since nasoduodenal and nasojejunal tubes dislocate significantly more often, the CJ is superior for long-term nutrition.[6]  With standardized technique and appropriate expertise, open and laparoscopic CJ placement has a low complication rate of 1.5–3.3 %.[7, 8]

    Under strict monitoring of intestinal tolerance, a low flow rate of 10 - 20 ml per hour is recommended at the start of tube feeding; it may well take 5–7 days for the patient to reach the calorie target.[9] If the flow rate is increased too quickly, this may result in torsion of the small bowel loop with intestinal necrosis. If less than 60 - 75 % of the energy intake is possible by enteral means, additional parenteral supplementation should be administered.[1]

    Technical aspects of catheter jejunostomy

    The principle of CJ is submucosal tunneling in the jejeunal wall with peritoneal fixation.[10] According to Vestweber, the following aspects are key to preventing leakage:[11]

    • Fixation and sealing of the catheter at the intestinal puncture site with purse string suture,
    • Complete fixation of the jejunal loop to the abdominal wall with peritonealization of the catheter,
    • Avoiding torsion of the small bowel loop by superior and inferior fixation to the abdominal wall.


  2. Ongoing trials on this topic

  3. Possible literature on this topic

    1. Weimann A, Breitenstein S, Breuer JP et al (2014) S3LeitliniederDeutschen Gesellschaft für Ernährungsmedizin e.V. (DGEM) in Zusammenarbeit mit der Gesellschaft für klinische Ernährung der Schweiz (GESKES), der Österreichischen Arbeitsgemeinschaft für klinische Ernährung (AKE), der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), der Deutschen Gesellschaft für Anästhesie, Intensiv- und Notfallmedizin (DGAI) und der Deutschen Gesellschaft für Chirurgie (DGCH). Chirurgie 85:320–326

    2. Weimann A, Braga M, Harsanyi L et al ESPEN (European Society for Parenteral and Enteral Nutrition) (2006) ESPEN guidelines on enteral nutrition: Surgery including organ transplantation.ClinNutr25:224–244

    3. Porschen R, Buck A, Fischbach W et al (2015) S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus (Langversion 1.0 – September 2015, AWMF-Registernummer: 021/023OL). Z Gastroenterol 53:1288–1347

    4. Osland E, Yunus RM, Khan S, Memon MA (2011) Early versus traditional postoperative feeding in patients undergoing resectional gastrointestinal surgery: A meta-analysis. JPEN J Parenter Enteral Nutr35:473–487

    5. Gupta V (2009) Benefits versus risks: A prospective audit. Feeding jejunostomy during esophagectomy. WorldJSurg33:1432–1438

    6. Markides GA, Alkhaffaf B, Vickers J (2011) Nutritional access routes following oesophagectomy – a systematic review. EurJClinNutr 65:565–573

    7. Falkner D, Plato R, Weimann A (2014) Die Wertigkeit der Feinnadelkatheterjejunostomie in der postoperativen enteralen Ernährung nach Ösophagusresektion. Ger Med Sci.

    8. Weijs TJ, Berkelmans GHK, Nieuwenhuijzen GAP, Ruurda JP, v Hillegersberg R, Soeters PB, Luyer MDP (2015) Routes for early enteral nutrition after esophagectomy. A systematic review. Clin Nutr 34:1–6

    9. Carli F, Scheede-Bergdahl C (2015) Prehabilitation to enhance perioperative care. Anesthesiol Clin 33:17–33

    10. Delany HM, Carnevale N, Garvey JW et al (1977) Postoperative nutritional support using needle  catheter feeding jejunostomy. Ann Surg 186:165–170

    11. Vestweber KH, Eypasch E, Paul A et al (1989) Fine-needle catheter jejunostomy. Z Gastroenterol 27  (Suppl 2):69–72


Ait Hammou Taleb MH, Mahmutovic M, Michot N, Malgras A, Nguyen-Thi PL, Quilliot D. Effectiveness of

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