Name of the Procedure:

Small intestinal endoscopy, enteroscopy beyond the second portion of the duodenum, not including ileum; with placement of percutaneous jejunostomy tube.

Summary

This procedure involves using a flexible tube with a light and camera (an endoscope) to examine and pass beyond the initial sections of the small intestine. Simultaneously, a feeding tube (jejunostomy tube) is placed through the abdominal wall into the jejunum part of the small intestine.

Purpose

The purpose of this procedure is to diagnose and treat conditions affecting the middle part of the small intestine and to provide a means of nutritional support by placing a feeding tube directly into the jejunum.

Indications

• Chronic malnutrition or inability to maintain adequate oral intake.
• Blockages or severe motility disorders in the upper digestive tract.
• Recurrent aspiration pneumonia due to swallowing difficulties.
• Certain cancers or treatments affecting the upper digestive system.

Preparation

• Patients may need to fast for 8-12 hours before the procedure.
• Certain medications, particularly blood thinners, might need adjustment.
• Diagnostic imaging or other tests may be required to plan the procedure.

Procedure Description

1. The patient is sedated or under general anesthesia.
2. An endoscope is inserted through the mouth and guided through the stomach into the small intestine.
3. The physician examines the intestinal lining and may take biopsies if needed.
4. A small incision is made in the abdominal wall, and a jejunostomy tube is placed into the jejunum.
5. The tube is secured and connected to a feeding system.
6. The incision is closed and bandaged.

Tools and equipment:

• Endoscope
• Jejunostomy tube
• Sedative or anesthetic agents
• Incision and suturing tools

Duration

The procedure typically takes 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or a specialized outpatient surgical center.

Personnel

• Gastroenterologist or endoscopic surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses
• Technicians

Risks and Complications

• Infection at the incision site
• Bleeding or injury to the gastrointestinal tract
• Displacement or blockage of the jejunostomy tube
• Peritonitis (inflammation of the abdominal lining)
• Adverse reactions to sedation or anesthesia

Benefits

• Improved nutritional intake directly into the jejunum
• Reduced risk of aspiration pneumonia
• Potential to identify and treat underlying gastrointestinal issues

Recovery

• Patients may need to stay in the hospital for monitoring.
• Instructions on tube care, feeding methods, and signs of complications will be provided.
• Full recovery typically takes a few weeks, but tube feeding adjustments could be immediate.

Alternatives

• Nasogastric or nasojejunal feeding tubes (temporary solutions)
• Total parenteral nutrition (nutrition delivered through a vein)
• No intervention, relying on dietary adjustments (not suitable for severe cases)

Pros and cons of alternatives:

• Nasogastric/Nasojejunal tubes can be uncomfortable and prone to displacement.
• Total parenteral nutrition requires central venous access and carries risks of infection.
• Dietary adjustments may not address severe or anatomical issues.

Patient Experience

During the procedure, patients will typically be under sedation or anesthesia, so they won't feel any discomfort. Post-procedure, there may be mild pain or discomfort at the incision site. Pain management will be provided, and specific instructions for tube care and feeding will help ensure comfort during recovery.