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Nutrition clinique

Jejunostomy

Direct feeding tube placed in the small intestine for patients who cannot tolerate gastric feeding.

Definition

Surgical creation of an opening in the jejunum (small intestine) for direct feeding, bypassing the stomach. Used when gastric feeding is contraindicated or poorly tolerated.

How it works

Jejunostomy provides direct nutrient delivery to the proximal small intestine, which is useful in patients with severe gastric dysfunction, recurrent aspiration from gastric feeding, or partial gastrectomy. The placement is typically surgical but can sometimes be endoscopic. Feeding through the jejunum requires specially formulated, often elemental or semi-elemental feeds because the small intestine cannot digest complex food as efficiently as the stomach. This route has higher rates of complications such as dumping syndrome, diarrhea, and tube obstruction, requiring careful monitoring.

Role

Delivers nutrition directly to the small intestine in patients with gastric dysfunction or aspiration risk, supporting metabolic needs while reducing pulmonary complications.

Examples

  • Severe pancreatitis
  • Post-gastrectomy patients
  • Chronic aspiration despite gastrostomy
  • Gastric outlet obstruction

Recommendations

Use pre-digested, low-fat feeds specifically designed for jejunal feeding. Increase flow rate gradually to minimize dumping syndrome. Monitor for diarrhea and electrolyte imbalances. Start continuous feeding rather than bolus to improve tolerance.

Key takeaway

Jejunostomy is essential for patients who cannot tolerate gastric feeding, though it requires specialized feed formulations and careful monitoring.

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