358 Experience With the Monarch Capsule Feeding Jejunostomy Tube – Outcomes and Technical Tips

Abstract Aim To present our experience of the Monarch capsule feeding jejunostomy tube; it is ideally suited to laparoscopic insertion, has a flexible internal bumper which deploys once in the small bowel lumen, is traction removable, and can easily be exchanged in the outpatient setting. Outcomes and technical tips for placement discussed. Method Primary jejunostomy tube placements between 2012-2025 were retrospectively identified from the enteral-feeding database and cross-referenced with electronic patient records. Indications for jejunostomy feeding, tube exchange and resource utilisation were evaluated, and tube-related complications. Results Between 2012-2025, 41 patients had primary jejunostomy feeding tubes inserted. Gastroparesis (n=11) and major abdominal surgery (n=22) were the most common indications. 21 patients had a MIC jejunostomy tube inserted and 20 patients a Monarch jejunostomy tube. Superficial skin infection occurred in both MIC (24%) and Monarch (10%) tube placements. Leakage from the jejunostomy tube occurred more frequently with a Monarch (40% vs. 5% for MIC). Accidental displacement requiring tube replacement occurred in 5 patients (20%) with MIC tube, and 4 patients (20%) with Monarch tubes. Tubes requiring planned or emergency replacement, 50% of Monarch tube exchanges were performed in the outpatient clinic. MIC tube changes typically required a local anaesthetic procedure, with or without fluoroscopic support. Conclusions With the recent withdrawal from market of the MIC jejunostomy tube, the Monarch capsule jejunostomy tube is a viable alternative, with the advantage that can be easily exchanged in the outpatient or community setting.