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.
Jejunostomy stomas require similar care to Gastrostomy stomas. J-tube stomas, however, have a tendency to leak around the tube more often. Because of this leakage, children may have more problems with granulation tissue and irritation.
J-tubes, and particularly J-tubes that have been placed without a Roux-en-Y, also may become displaced by coming out of the tract. This is a more serious problem, as formula may enter the abdominal cavity. Symptoms may include leakage of formula or systemic symptoms such as fever and unstable vital signs. Many physicians prefer tubes be replaced and then checked by X-ray to avoid this problem.
Feeding through a J-tube is identical to feeding through a GJ-tube. Continuous feeds over 18-24 hours are necessary.