Nutritional support by tube jejunostomy.

Access to the jejunum by orogastric intubation or insertion of a surgical tube provides a method for nutrient infusion in clinical conditions that involve abnormal upper gastrointestinal function. Despite the physiologically extraordinary nature of jejunostomy intubation-with enteral infusions beyond the stomach, biliary tract, pancreas, and duodenum--the current view is that jejunal feeding is an acceptable alternative to parenteral nutritional support. Because jejunostomies utilize the gastrointestinal tract, administering feedings by this route can minimize some of the major adverse effects of total intravenous nutrition. The problems with jejunal intubation relate to the technical difficulty of the procedure itself, indications for its general use, and its adaptation as an adjunct in the management of the surgical patient. The timing, composition, and metabolic effects of jejunal nutrient infusions are the subject of continuing debate and study.