It is sometimes necessary to place a separate J-tube that has a stoma directly to the intestine. This is not usually an initial feeding tube placement for a child. In many cases, a J-tube is placed because anatomical issues prevent using a GJ-tube, or a GJ-tube will not stay in place. Sometimes, a J-tube may be placed if a child doesn’t have a hospital nearby that can replace a GJ-tube.
There are several methods of placing J-tubes. The simplest is a straight or direct placement, which may be done using an endoscope (called a PEJ or Percutaneous Endoscopic Jejunostomy), or an open or laparascopic surgical procedure. In this method, the tube is placed using a similar method to a Gastrostomy, by creating a hole directly into the small intestine and then securing the intestine to the abdominal wall. The tube can be replaced with a variety of long tubes and buttons. Typically, tubes need to be replaced by radiology to ensure they are positioned correctly, but in some cases, they may be able to be changed at home.
J-tubes may also be placed incorporating a Roux-en-Y or gastric bypass procedure. This method creates a small “limb” out of a portion of the jejunum, which is then attached to the abdominal wall, creating a “tunnel” into the jejunum. The feeding tube is placed inside this limb. While this method allows for a more stable tract and easy tube changes that can be performed at home, it is a much more complicated and difficult surgery that fundamentally alters the anatomy of the jejunum. Some children, especially those who have motility or sensory problems of the nerves in the gut, may have significant side effects from such a procedure.