Jejunostomy tube (J tube)

The jejunum is the middle part of the small intestine, where most nutrients are absorbed. A jejunostomy tube is a thin, soft tube that passes through the belly wall directly into a loop of the jejunum. Unlike a GJ tube, it does not pass through the stomach.

A direct J tube is less common than a G or GJ tube. We usually recommend it when the stomach is not available. Surgeons can also place J tubes during an operation. Interventional radiologists place them through the skin using X-ray, and sometimes ultrasound or CT, to find a loop of bowel close to the belly wall.

On X-ray, contrast dye through the new tube outlines the small intestine as a white, feathery pattern, which is different from the smooth folds of the stomach.

Because a loop of small intestine is thin and moves, a direct J tube is harder to place than a G tube. Not everyone has a loop of bowel in a safe position. If a safe path is not found, surgery is the alternative.

The procedure is done at El Camino Hospital by your interventional radiologist with a nurse and technologist. Your heart rate, blood pressure and oxygen are watched throughout.

1. 1
   Relaxing and planning

   Moderate sedation helps you relax. We use X-ray, and sometimes ultrasound or CT, to find a loop of jejunum near the belly wall. Sometimes a thin tube through the nose or an existing tube is used to fill the bowel with a little air or dye.

2. 2
   Anchoring the bowel

   After numbing the skin, we place small anchors called T-fasteners to hold the loop of intestine against the belly wall.

3. 3
   Placing the tube

   A needle and guidewire enter the intestine. The opening is widened a little and the J tube is passed over the wire, pointing downstream.

4. 4
   Checking and finishing

   Contrast dye confirms the tip is in the intestine. The tube is secured to the skin and covered with a dressing.

1. First hours
   You recover while nurses check your site and vital signs. Feeding is started slowly as your team directs.
2. Next day
   You may shower. Pat the site dry afterward. Soreness is expected for 2 to 3 days.
3. First week
   Avoid heavy lifting and strenuous activity. Watch the site for redness or leaking.
4. 1 to 4 weeks
   The T-fasteners loosen and fall off, or we remove them in clinic.

Most of my patients who need a direct J tube have been through a lot already, often a major stomach or esophagus operation. Before the procedure, I study the CT slice by slice to find a loop of bowel that sits right under the belly wall, with nothing in between. If I cannot find a safe window, I will tell you honestly and we will talk about the surgical option instead.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos

Duopa is a gel form of carbidopa and levodopa for advanced Parkinson disease. Pills have to pass through the stomach first, and in Parkinson disease the stomach often empties slowly and unpredictably. That can make the medicine kick in late or wear off early. Pumping the gel directly into the jejunum gives steadier absorption.

Duopa is usually delivered through a special tube that enters the stomach and extends into the jejunum, a type of GJ tube often called a PEG-J or intestinal port. Placement and care are the same as described on our GJ tube page. Your neurologist manages the medicine and pump. We take care of the tube, including clogs, leaks and changes.

If you need to stop the Duopa pump for more than a short time, follow your neurologist's instructions about taking your carbidopa-levodopa pills. A clogged tube does not usually need the emergency room; call us during office hours and we can usually fix it within a day.