Post-pyloric feeding

Table 1 Differences between gastric and jejunal feeding

	Nasogastric tube	Nasojejunal tube
Indications	Anorexia, dysphagia, odynophagia	Gastroparesis, gastric outlet obstruction, recurrent aspirations, severe pancreatitis, hyperemesis gravida, proximal enteric fistula, postoperative anastomotic gastroenteric stenosis
Insertion technique	Easy access, no need for endoscopic or radiological study or medication	Needs endoscope or prokinetic agents
Costs	Much cheaper because: 1. low cost of the tube; 2. may be inserted by a nurse	More expensive because: 1. costly equipment; 2. requires insertion by physician
Physiology	More physiological, keep normal motility and hormonal profile	Less controlled motility and hormonal control. Less pancreatic stimulation if inserted after the Trietz ligament
Feeding mode	Bolus or continuous. Pump is not mandatory	Continuous only. Pump is mandatory in most cases
Risk of aspiration	High in patients with GER and swallowing impairments	Less frequent but not absolutely prevented
Clogging rate	Rare thanks to larger diameter of tube	Frequent

Table 2 Potential complications of nasojejunal tube feeding

Common (> 10%)

Failure of placement1

Displacement

Clogging of the tube

Mild transient epistaxis

Irritation of nasal, pharyngeal or esophageal areas

Feeding-related diarrhea

Abdominal cramping

Metabolic complication, such as hyperglycemia

Uncommon (< 10%)

Otitis media

Nasal mucosal pressure sores

Esophageal ulcers

Risks of intravenous sedation and gastroscopy

Sinusitis

Misplacement (pulmonary or intracranial intubation)

Dumping-like symptoms

¹Depends on the technique of insertion.

Table 3 Potential complications of jejunostomy feeding

Common (> 10%)

Pain at the jejunostomy site

Skin infection of the jejunostomy site

Feeding-related diarrhea

Abdominal cramping

Clogging of tube

Transient pneumoperitoneum immediately after the insertion (but it has no clinical significance in most cases)

Metabolic complication, such as hyperglycemia

Displacement of jejunostomy

Leakage around the jejunostomy

Uncommon (< 10%)

Failure of placement

Misplacement

Gastric hemmorhage

Perforation of internal organs during the placement and peritonitis

Colocutaneous fistula

Persistent jejunocutaneous fistula after the removal of jejunostomy

Risks of intravenous sedation and gastroscopy or risks of anesthesia and surgery

Hemorrhage at jejunostomy site

Pressure sore due to skin disk of jejunostomy

Dumping-like symptoms