The Button Jejunostomy for Long-Term Jejunal Feeding: Results of a Prospective Randomized Trial

Abstract

Low profile, self-retaining feeding conduits ("buttons") inserted percutaneously through a mature gastrostomy stoma are ideal for prepyloric feeding. We tested the efficacy of a surgically inserted button (Button, C.R. Bard, Inc) in the jejunum for long-term postpyloric feeding. Forty-two aspiration risk patients were prospectively randomized to receive a standard No. 14 French red rubber catheter (n = 21, mean age 68 ± 17 years) or the button (n = 21, mean age 68 ± 18 years). Common indications for jejunal feeding were aphagia due to obtundation (41%) and esophageal dysmotility (41%). All feeding devices were inserted 20 cm distal to the ligament of Treitz via a serosal tunnel (catheter) or double pursestring (button) technique. No patient required reoperation, and cardiopulmonary failure was the most frequent cause of death, occurring in 11 patients (26%). Goal feedings were obtained in 91% of the catheter patients and 100% of the button patients by postoperative day 4.7 ± 1.9 and 4.2 ± 2.2, respectively. At a follow-up of 43 ± 13 days, 12 (92.3%) of 13 catheter patients and 9 (81.8%) of 11 button patients were receiving goal feedings. Three patients in the catheter group and four patients in the button group had resumed an oral diet. Device-related complications (dislodgment, occlusion, peritubular leak, or bowel obstruction) and total number of patients with complications were significantly lower in the button group (one [5%] vs eight [38%] for device-related complications and one [5%] vs six [29%] for incidence of complications for the button and catheter groups, respectively). The jejunostomy button appears to be an attractive alternative for selected patients requiring long-term postpyloric feeding. (Journal of Parenteral and Enteral Nutrition 17:428-431, 1993)