Can Percutaneous Endoscopic Jejunostomy Prevent Gastroesophageal Reflux in Patients With Preexisting Esophagitis?

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Abstract
Ndoscopic jejunostomy tube feeding. METHODS: Eight cerebrovascular accident patients with percutaneous endoscopic jejunostomy tube placement caused by reflux esophagitis with hematemesis, food regurgitation or vomiting, and/or recurrent aspiration pneumonia were tested for gastroesophageal reflux using 24-h esophageal pH monitoring during continuous jejunal liquid meal or saline infusion with concomitant gastric decompression. Twenty-four hour pH monitoring was also performed during intragastric feeding on a different day. RESULTS: During the liquid meal feeding period, percutaneous endoscopic jejunostomy feeding reduced esophageal acid exposure 46% [12.9% (4.9–28.2%) versus 24.0% (19.0–40.6%), p= 0.01], compared to intragastric feeding. However, in the period of the jejunal tube infusion, esophageal acid exposure was significantly lower during saline infusion than during meal infusion [3.2 (0.0%–10.8%) versus 12.9% (4.9–28.2%), p= 0.008]. CONCLUSION: Percutaneous endoscopic jejunostomy feeding reduced but did not eliminate gastroesophageal reflux, compared to intragastric feeding in patients with severe gastroesophageal reflux. However, gastroesophageal reflux during percutaneous jejunal feeding was associated with meal infusion. This might, in part, explain the failure of percutaneous endoscopic jejunostomy tube placement to prevent pulmonary aspiration. Reprint requests and correspondence: Han-Chung Lien, MD, 160, Sec. 3 Chung-Kang Road, Taichung, Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan 407 Received June. 29, 2000; accepted August. 2, 2000 © The American College of Gastroenterology 2000. All Rights Reserved....

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