Enteral Feeding via Percutaneous Endoscopic Gastrojejunostomy(PEGJ) Tubes Decreases Risk of Aspiration and Tube Dislodgement Related Complications Compared to PEGs

Background: Protein-calorie malnutrition is a common problem that develops in patients requiring management in the surgical intensive care unit (SICU). The use of durable enteral feeding tubes to help meet their nutritional needs has grown dramatically over that past three decades. However, prepyloric enteral feeding has been associated with increased aspiration risks. Hypothesis: We hypothesize that the percutaneous endoscopic gastrojejunostomy (PEGJ) tubes decrease the risk of aspiration compared to PEG in critically ill SICU patients. Materials and Methods: We retrospectively reviewed the medical records of 106 ICU patients who underwent PEG/PEGJ tube placement at an urban teaching hospital between September 2009 and May 2013. We evaluated the records for aspiration events, aspiration pneumonia, tube dislodgement, intra-abdominal sepsis, reoperation, pre-albumin, hospital and ICU length of stay, and outcome, including mortality. This study was approved by the MSM Institutional Review Board. Results: There were 54 PEG tubes (34.9% male 16% female) and 52 PEGJ tubes (34.9% male and 14.2%) placed. Aspiration occurred in 5 (9.3%) patients with PEG tubes and 2 (3.80%) with PEGJ tubes. Aspiration pneumonia occurred in 1 (1.90%) patient in both groups. Tube dislodgment occurred in 11 (20.4%) patients with PEG tubes versus 4 (7.7%) with PEGJ tubes. Preoperative prealbumin was 11.2mg/dL(PEG) and 12.2mg/dL(PEGJ). Discharge pre-albumin was 16.3mg/dL(PEG) versus 17.5mg/dL(PEG) (normal=15-