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The Button Jejunostomy for Long-Term Jejunal Feeding: Results of a Prospective Randomized Trial

Division of Gastrointestinal Surgery and The Nutrition Support Service, Hospital of the University of Pennsylvania, Philadelphia

Jon B. Morris, MD

Division of Gastrointestinal Surgery and The Nutrition Support Service, Hospital of the University of Pennsylvania, Philadelphia

Cathleen A Metz, MSN

Division of Gastrointestinal Surgery and The Nutrition Support Service, Hospital of the University of Pennsylvania, Philadelphia

James L. Mullen, MD

Division of Gastrointestinal Surgery and The Nutrition Support Service, Hospital of the University of Pennsylvania, Philadelphia

Low profile, self-retaining feeding conduits ("buttons") inserted percutaneously through a mature gastrostomy stoma are ideal for prepyloric feeding. We tested the efficacy of a surgically inserted button (Button, C.R. Bard, Inc) in the jejunum for long-term postpyloric feeding. Forty-two aspiration risk patients were prospectively randomized to receive a standard No. 14 French red rubber catheter (n = 21, mean age 68 ± 17 years) or the button (n = 21, mean age 68 ± 18 years). Common indications for jejunal feeding were aphagia due to obtundation (41%) and esophageal dysmotility (41%). All feeding devices were inserted 20 cm distal to the ligament of Treitz via a serosal tunnel (catheter) or double pursestring (button) technique. No patient required reoperation, and cardiopulmonary failure was the most frequent cause of death, occurring in 11 patients (26%). Goal feedings were obtained in 91% of the catheter patients and 100% of the button patients by postoperative day 4.7 ± 1.9 and 4.2 ± 2.2, respectively. At a follow-up of 43 ± 13 days, 12 (92.3%) of 13 catheter patients and 9 (81.8%) of 11 button patients were receiving goal feedings. Three patients in the catheter group and four patients in the button group had resumed an oral diet. Device-related complications (dislodgment, occlusion, peritubular leak, or bowel obstruction) and total number of patients with complications were significantly lower in the button group (one [5%] vs eight [38%] for device-related complications and one [5%] vs six [29%] for incidence of complications for the button and catheter groups, respectively). The jejunostomy button appears to be an attractive alternative for selected patients requiring long-term postpyloric feeding. (Journal of Parenteral and Enteral Nutrition 17:428-431, 1993)

Journal of Parenteral and Enteral Nutrition, Vol. 17, No. 5, 428-431 (1993)
DOI: 10.1177/0148607193017005428


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