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Background: The purpose of the study was to evaluate the utilization and morbidity associated with feeding jejunostomy tubes (JT) placed at the time of gastro-esophageal (GE) resection. Methods: Under IRB approval a prospective database of patients undergoing GE resection from January 2004 to September 2010 was reviewed. Data analyzed included patient demographics, post-operative complications, JT use, and JT specific complications. Fisher’s Exact tests explored associations with utilization of a JT following resection. Results: 74 patients (51 males, 23 females, mean age 60.3±14.1 years) underwent placement of a JT at the time of resection (total gastrectomy=29, Ivor-Lewis=28, subtotal gastrectomy=8, proximal gastrectomy=6, transhiatal esophagectomy=3) of both malignant (98.6%) and benign (1.4%) disease processes. 22 JT specific complications (2 major, 19 minor) were identified. (Table 1) Re-operation was required in the management of 2 complications (small bowel obstructions), while all others were easily managed by an interventional radiologist (n=8), bedside physician (n=5), or did not require intervention (n=6). 86% of patients were discharged tolerating a post-gastrectomy diet, 7% a liquid diet, and 7% NPO. Inpatient enteral nutrition (EN) was initiated in 68.9%, but continued on discharge in only 54% secondary to failure to thrive (57.7%), dysphagia (20%), anastomic leak (15%), chyle leak (2.5%), esophagostomy (2.5%), and duodenal stump leak (2.5%). The mean time to discontinuance of EN and removal of the JT was 1.83 and 3.4 months respectively. Although only 17.8% (n=5) of patients requiring adjuvant therapy were utilizing their JT at the commencement of therapy, 75% (n=21) required EN during its course. The median time to adjuvant therapy was found to be slightly longer in those who required outpatient EN versus those who did not (61 vs 90 days, p=0.08). However, the median time to adjuvant therapy did not differ between those who were and weren’t receiving EN at the time of adjuvant therapy commencement (80 vs 92 days, p=0.27). Age (p=0.42), number of co-morbidities (p=0.21), pre-operative percent body weight loss (p=0.88), and clinical stage (p=0.78) were not significantly associated with outpatient JT use. Patients who suffered a post-operative complication were most likely to require EN (p=0.006), an association that strengthened as the number of complications increased (p=00006).Conclusions: Routine JT placement carries a low morbidity in patients undergoing GE resection. Because it is difficult to pre-operative ascertain who will need prolonged EN, the routine placement of a JT is recommended, particularly in those who will likely require adjuvant therapy or are at high risk for post-operative complications. Despite patient desires for early removal of unused JT, caution should be taken if adjuvant therapy is being considered.
Table 1. Jejunostomy tube associated complications

Complications	In-Patient		Out-Patient
	Major	Minor	Major	Minor
Dislodgment		2		5
Leak				5
Small bowel obstruction	2	2
Unable to unclog				1
Site infection				2
Pain requiring removal				1
Broken catheter		1
Non-functional		1

Major = Required operative intervention, Minor = Non-operative intervention or no intervention required; no prolongation of hospital stay.