WO2008121603A1

WO2008121603A1 - Self-advanceable feeding tube

Info

Publication number: WO2008121603A1
Application number: PCT/US2008/058098
Authority: WO
Inventors: Christopher D. Bosel; Therese J. O'day
Original assignee: Cook Critical Care Incorporated
Priority date: 2007-03-30
Filing date: 2008-03-25
Publication date: 2008-10-09

Abstract

A self-advanceable feeding tube configured for movement through the gastrointestinal tract of a patient by peristaltic contractions. The tube comprises an elongated tubular member having a lumen extending between the proximal and distal portions. The tube includes at least one aperture at the distal portion in communication with the lumen, wherein the aperture is sized and positioned for passage of fluid material therethrough from the lumen to a target area external to the tubular member. An inflatable member is disposed about a portion of the elongated tubular member distal portion. The inflatable member is sized and configured such that upon inflation, it projects outwardly from the surface of the tubular member so as to be engageable with the interior surface of the gastrointestinal tract, whereby ingress of the tube through the gastrointestinal tract is promoted responsive to the peristaltic contractions.

Description

SELF-ADVANCEABLE FEEDING TUBE

Background of the Invention

[0001] Technical Field. The present invention relates to tubular medical devices. More particularly, the invention relates to a feeding tube having one or more inflatable members along a distal length of the tube for use in advancing the distal end of the tube into the jejunum of a patient utilizing peristaltic contractions.

[0002] Background Information. Patients for whom normal ingestion of food becomes difficult or impossible may require placement of a feeding tube to assist in providing their nutritional needs. For some individuals, such as comatose patients, stroke victims, or those with a compromised gastrointestinal tract, this may require placement of a tube that is introduced percutaneously into the stomach for delivery of nutritional products directly into the stomach. Such tubes for delivery of nutritional products into the stomach are generally referred to as gastrostomy tubes, or "G"-tubes.

[0003] In some situations, feeding a patient through a G-tube can be problematic. Such situations include, among others, the presence of certain congenital abnormalities in the patient, as well as the possibility of severe gastric reflux and a high aspiration risk. In other situations, nutritional targets may not be attained at a satisfactory rate through G-tube feeding. In such patients, feeding may often be accomplished by inserting a feeding tube, referred to as a jejunostomy tube, or a "J"-tube, directly into the jejunum (the middle section of the small intestines) of the patient. The J-tube bypasses the stomach, thereby decreasing the risk of gastric reflux and aspiration. In addition, the J-tube often provides better success in reaching nutritional targets than a G-tube, and allows the targets to be reached more rapidly.

[0004] Notwithstanding the foregoing, however, there are some difficulties associated with the use of jejunostomy tubes. For example, due to the generally offset position of the jejunum relative to the stomach, it is often difficult to properly direct the distal end of a J-tube into the jejunum. J-tubes are typically very flexible, which contributes to the difficulty in directing the tubes to the desired area. In addition, once positioned, J-tubes are subject to dislodgement. To alleviate these problems, imaging techniques, such as x-ray, are frequently utilized to verify proper placement of such tubes, and to monitor continued proper placement. These techniques can be burdensome, and often do not fully alleviate the problem, as the placement may continue to be problematic even in the presence of medical imaging.

[0005] Recently, self-advancing J-tube placement procedures have been developed that utilize peristaltic contractions to pull the tube, and to direct it safely into the small bowel for jejunal feeding. Such tubes are described, for example, in U.S. Patent Nos. 6,589,213 and 6,767,339, both incorporated by reference herein. In particular, the '339 patent describes a naso-jejunal feeding tube having an arrangement of alternating cilia-like flaps cut from the outer surface of the catheter. These flaps are configured in a manner to promote the advancement of the distal end of the tube into the small bowel via peristaltic contractions. This self-advancing placement reduces the risk of perforations or misplacement that may occur with weighted-tipped feeding tubes, and often avoids the necessity of utilizing costly endoscopy or fluoroscopy procedures. [0006] Self-advancing tubes, such as the tubes described in the '339 patent, are available commercially from Cook Incorporated, of Bloomington, Indiana, and are sold under the trademark TIGER TUBE®. Such tubes have been well received in the medical community, and have been found to achieve a high success rate in post pyloric placement. In order to facilitate frictional placement utilizing this tube, the cilia-like flaps are arranged and positioned along the distal length of the tube in a manner that enhances the ability of the tube to be propelled forwardly via the peristaltic contractions. However, once successful placement is attained, there is little or no benefit to maintaining the flaps on the exterior of the tube. In addition, even though the flaps are generally flexible, the presence of such flaps is unnecessary when the tube is withdrawn, and the additional diameter occupied by the flaps may impose an unnecessary impediment to withdrawal. [0007] It would be desirable to provide a feeding tube for advancement into the jejunum by peristaltic contraction, wherein the tube is structured to include one or more members along a distal portion of the tube that may be inflated to assist in advancement of the tube into the jejunum, and that thereafter may be deflated to facilitate withdrawal of the tube.

Brief Summary

[0008] In one form thereof, the present invention is directed to a tube configured for movement through the gastrointestinal tract of a patient by peristaltic contractions. The tube comprises an elongated tubular member having a proximal portion, a distal portion, a lumen extending between the proximal and distal portions, and at least one aperture at the distal portion communicating with the lumen. The aperture is sized and positioned for passage of fluid material therethrough from the lumen to a target area external to the tubular member. An inflatable member is disposed about a portion of the elongated tubular member distal portion. The inflatable member is sized and configured such that upon inflation, it projects outwardly from the surface of the tubular member so as to be engageable with the interior surface of the gastrointestinal tract, in a manner such that ingress of the tube through the gastrointestinal tract is promoted responsive to the peristaltic contractions. [0009] In another form thereof, the present invention is directed to a tube configured for insertion into a patient and movement through the gastrointestinal tract by peristaltic contractions, for transmission of nutritional products to the patient. The tube comprises an elongated tubular member having a proximal portion and a distal portion. The elongated tubular member is dimensioned such that at least an end of the proximal portion is extendable external of the patient, and such that an end of the distal portion is extendable into the jejunum of the patient when the proximal end is external of the patient. The elongated tubular member has a first lumen and a second lumen therein. The first lumen extends between the proximal and distal portions, and the second lumen is configured for transmitting an inflation fluid therethrough. The elongated tubular member has a plurality of apertures at the distal portion, wherein the apertures communicate with the first lumen and are sized and positioned for passage of fluid material therethrough from the first lumen to a target area in the jejunum. An inflatable member is disposed about a portion of the elongated tubular member distal portion. The inflatable member is configured to receive the inflation fluid through the second lumen, and is further configured such that upon inflation, it projects radially outwardly from the surface of the tubular member so as to be engageable with a surface of the gastrointestinal tract, in a manner such that ingress of the tube through the gastrointestinal tract is promoted responsive to the peristaltic contractions.

Brief Description of the Drawings

[0010] Fig. 1 is a side view of the distal end of a tube according to an embodiment of the present invention; and

[0011] Fig. 2 is a sectional view of the tube taken along line 2 — 2 of Fig. 1 ;

[0012] Fig. 3 is a side view of the proximal end of the tube of Fig. 1 ;

[0013] Figs. 4 and 5 are side distal views of alternative embodiments of a tube according to the present invention;

[0014] Figs. 6 and 7 illustrate alternative embodiments of a tubular member of the present invention; and

[0015] Fig. 8 is a side distal view of another alternative embodiment of a tube according to the present invention.

Description of Preferred Embodiments

[0016] For purposes of promoting an understanding of the present invention, reference will now be made to the embodiments illustrated in the drawings, and specific language will be used to describe the same. It should nevertheless be understood that no limitation of the scope of the invention is thereby intended, such alterations and further modifications in the illustrated device, and such further applications of the principles of the invention as illustrated therein being contemplated as would normally occur to one skilled in the art to which the invention relates.

[0017] In the following discussion, the terms "proximal" and "distal" will be used to describe the opposing axial ends of the inventive feeding tube, as well as the axial ends of various component features. The term "proximal" is used in its conventional sense to refer to the end of the feeding tube (or component thereof) that is closest to the operator during use. The term "distal" is used in its conventional sense to refer to the end of the feeding tube (or component thereof) that is initially inserted into the patient, or that is closest to the patient during use. [0018] Figs. 1 -3 illustrate one embodiment of a self-advanceable tube 10 according to the present invention. For convenience, tube 10 will be referred to herein as a naso-jejunal feeding tube in light of its primary intended use, that is, as a feeding tube that is inserted into the jejunum via the nasal cavity. However, those skilled in the art will appreciate that in an appropriate case tube 10 may be inserted into the jejunum other than through the nose, e.g., through the stomach or through the mouth. In addition to providing nutritional products into the jejunum, tube 10 may also be used for delivering other fluid materials, such as drugs and/or contrast materials, to the jejunum.

[0019] Feeding tube 10 comprises an elongated tubular member 12 having a proximal portion 14 and a distal portion 16. Feeding tubes, such as naso-jejunal tubes, are well known in the art, and tube 10 may be formed from any compositions commonly used and/or appropriate for such purposes, such as PVC, polyurethane and silicone. Typically such tubes have a length of about 150-160 cm, and an outer diameter of between about 8 and 16 French (2.6 to 5.3 mm). Most commonly, the length of the tube is about 155 cm and the outer diameter is about 14 French (4.6 mm). Those skilled in the art will appreciate that the length and diameter of a feeding tube may be varied to account for differences in patient size.

[0020] As shown in Fig. 2, two lumens 24, 26 extend through at least a portion of elongated tubular member 12. A large diameter lumen 24 is sized to enable passage therethrough of the fluid material, such as nutritional products. A small diameter lumen 26 comprises an inflation lumen, and is sized for passage therethrough of an inflation fluid, such as air or saline.

[0021] Fig. 3 illustrates the proximal portion 14 of tube 10. In the embodiment shown, proximal portion 14 includes an adapter 32 suitable for engagement with a reservoir (not shown) of the fluid material, such as nutritional products. Adapter 32 includes an entryway 33 or like member that is sized and shaped for engagement by any well-known means with the fluid reservoir. A plug 34 may be provided for selectively opening and closing entryway 33. Adapter distal portion

36 is sized to snugly fit over tube proximal portion 14 in any conventional manner, and to establish communication between entryway 33 and large diameter lumen 24 for transmission therethrough of the fluid material.

[0022] A luer fitting 38 or other suitable connector is provided for connection to a source (not shown) for the inflation fluid. An extension tube 37 extends from luer fitting 38 to establish communication by any conventional means with small diameter lumen 26 for transmission of the inflation fluid. A valve or clamp 39 may be provided for controlling flow of the inflation fluid through extension tube

37 in conventional fashion.

[0023] Proximal tube portion 14 and adapter 32 as shown and described are conventional, and further discussion of them is not germane to an understanding of the features of the present invention. Those skilled in the art will appreciate that other conventional proximal fittings used for establishing communication with the various lumens of a multi-lumen catheter may be substituted for the arrangement illustrated in Fig. 3, and are considered within the scope of the present invention.

[0024] As shown in Fig. 1 , tube distal portion 16 further comprises one or more feeding tube side ports, or apertures, 40 disposed along the distal portion of the tube. Apertures 40 provide openings through which nutritional products or other fluid material can exit the interior of the feeding tube, and enter the jejunum. Typically, apertures 40 are elliptical and have dimensions of, e.g., 2.5 mm x 4 mm. Those skilled in the art will appreciate that apertures of other configurations and dimensions may be substituted. Due to the relatively small outer diameter (O. D.) of the tube, elliptical apertures are generally preferred for providing a suitable flow rate. The feeding tube apertures 40 may be sequentially disposed along opposite sides of the feeding tube, e.g., at approximately 2 cm intervals. Alternatively, apertures 40 may be randomly distributed along tube distal portion 16 in any fashion that permits passage therethrough of liquid products in a manner suitable for the intended use of tube 10.

[0025] Preferably, the distal tip 17 of tube 10 is closed. When the distal tip is closed, all fluid material passes through apertures 40. In addition, with a closed end tube, a conventional torque cable can be used to aid initial insertion of the tube if desired. In some instances, however, it may be preferred to maintain an open distal tip. An open distal tip permits flow therethrough, and also may minimize the possibility of clotting.

[0026] An arrangement comprising one or more inflatable members, such as balloon 20, is positioned along tube distal end 16. In the non-limiting embodiment of Fig. 1 , balloon 20 comprises a plurality of rib members 22 disposed along the length of balloon 20. Alternatively, balloon 20 need not necessarily include the rib members, and may simply have a smooth elongated surface. As a further alternative, balloon 20 may have a surface with one or more radial projections of a different configuration. [0027] When present, balloon rib members 22 or other projections are configured in a manner such that, upon inflation, they provide a grasping surface such that peristaltic contractions carry the distal end of the feeding tube to the target site within the jejunum. Distal portion 16 of elongated tubular member 12 includes at least one inflation port 18 sized and positioned for transmission of the inflation fluid via inflation lumen 26 to the interior space of balloon 20. Preferably, balloon 20 is positioned proximal of apertures 40 along the length of elongated tubular member 12, to prevent interference with the flow of the nutritional products or other fluid from large diameter lumen 24 through the apertures. [0028] Balloon 20 is preferably formed of a composition that is amenable to inflation at a variety of possible diameters. In this way, a particular balloon 20 can be used with patients of various sizes, and having anatomic features of a variety of sizes and shapes. In addition, balloon 20 should be sufficiently flexible to prevent trauma to the tissue of the body canal upon insertion of the tube 10. The use of inflatable balloons in interior body passageways is well known in the medical arts, and those skilled in the art can readily arrive at a suitable balloon composition and size for a particular use. A non-limiting list of balloon compositions that may be suitable for use with tube 10 includes PET, nylon, polyethylene, polyurethane, PVC, silicone and latex. From the standpoint of ease of manufacturing, it is often preferred to utilize a balloon formed of the same or a similar material as the elongated tubular member. Once inflated, the configuration and orientation of the balloon 20 causes the tube to be propelled forwardly by the naturally occurring peristaltic contractions of the circular and longitudinal smooth muscles of the gastrointestinal (Gl) tract. In addition to the peristaltic action as described, the presence of the radially extending balloon structure also enables the tube to resist egress while in the Gl tract. [0029] The following example describes one preferred use of the inventive tube, namely as a naso-jejunal feeding tube for transmitting nutritional products from the nasal cavity to the jejunum. With the balloon uninflated, the distal end of tube 10 is advanced nasally, initially about 50-70 cm into the stomach. As indicated above, a torque cable may be inserted into the tube prior to placement in the patient if desired. When utilized, the torque cable is removed after advancement into the stomach is achieved. Insufflation and/or auscultation may be used to confirm the position of the distal tip of tube 10 in the stomach. At this time, valve 39 is opened, and the inflation fluid passes through extension tube 37, small diameter lumen 26, and inflation port 18 into the interior of balloon 20. Following inflation of the balloon, the valve is closed. Peristaltic activity in the Gl tract directs the distal end 16 of tube 10 to its target destination within the jejunum. In the event that balloon 20 becomes snagged or is otherwise difficult to advance, the balloon can be deflated, and the tube can thereafter be repositioned and reinflated. If desired, the tube can be removed in favor of reinsertion, or insertion of a substitute tube. Deflation of the balloon may be carried out, e.g., by opening valve clamp 39, and applying a vacuum (e.g., via a syringe) to remove the inflation fluid from the interior space of the balloon. [0030] As stated above, it may not be necessary or appropriate to inflate the balloon to its maximum diameter in all cases. In this way, an appropriate degree of inflation can be determined by the physician on a case-by-case basis. Factors to be considered by the physician may include, for example, the size of the patient and/or the particular anatomical features encountered upon insertion. Those skilled in the art will appreciate that in cases of weak peristaltic activity, pharmacological agents may be used to increase this activity pursuant to well- known techniques. Following placement of the tube, an abdominal x-ray can be taken to confirm proper positioning in the small intestine. Once placement is confirmed, the tubing may be secured to the patient in conventional fashion. The adapter 32 at the proximal end of the feeding tube may be engaged by conventional means to an appropriate fluid reservoir.

[0031] Once tube 10 is in place, the balloon 20 can be deflated. Deflation of the balloon enables the enzymes secreted by the small intestine proximal to the balloon to flow through. The balloon can be reinflated if the tube needs to be repositioned, and thereafter deflated again. Alternatively, the balloon can remain inflated until it is time for removal.

[0032] When tube 10 is to be removed, it may be withdrawn in a slow, controlled manner in the opposite direction from which it was inserted. Unlike the prior art designs, deflation of the balloon substantially removes unnecessary structural impediments to withdrawal, and also reduces the effective radial diameter of the tube, thereby facilitating withdrawal of the tube. [0033] Figs. 4 and 5 illustrate alternative embodiments of a tube 100, according to the present invention. Only the distal portion 110 of tube 100 is shown in Figs. 4 and 5. Tube 100 is provided with respective large and small diameter lumens (not shown), in the same manner as lumens 24, 26 in tube 10. In addition, tube distal end 110 includes an inflation port 118 in communication with the interior space of each balloon, in the same manner as port 18 in tube 10. A plurality of apertures 140 are spaced along the length of tube distal portion 110, distal to the balloons, through which the fluid material can exit the interior of the tube and enter the body canal or cavity.

[0034] Unlike the single ribbed balloon 20 of tube 10, tubes 100 are provided with a plurality of balloons 120 and 120A, respectively. Balloons 120 and 120A are sized and spaced for gripping by the muscles of the gastrointestinal tract during peristaltic activity, in the same manner as ribbed balloon 20. As a result, tube 100 is guided to its desired position in the small bowel, in the same manner as tube 10. Balloons 120 in Fig. 4 have a truncated design with a large diameter end 122 and a smaller diameter end 124. Balloons 120A are generally spherical. Those skilled in the art will appreciate that other geometrical configurations may be substituted for the balloon designs of Figs. 4 and 5, as long as the balloon design is provided with a radial extension suitable for gripping in the Gl tract as described above.

[0035] Although not shown in the drawing of the illustrative embodiment, those skilled in the art will appreciate that the balloons can be arranged in numerous other configurations. For example, any combination of ribbed, spherical, truncated, or other shaped balloons can be provided for a particular tube. Utilizing a plurality of discrete balloons as shown in Figs. 4 and 5 provides an additional measure of versatility to the tube by allowing certain balloons (e.g., the more proximal balloons) to remain inflated while other balloons (e.g., the more distal balloons) are deflated. This arrangement may be beneficial in allowing balloon placement to be maintained via the inflated proximal balloons, while facilitating the passage of enzymes via the deflated distal balloons. Those skilled in the art will appreciate that alternative arrangements may require some routine modification to the tube, such as the presence of one or more additional inflation lumens, inflation ports and/or conduits.

[0036] Although the feeding tube in the preferred embodiments described herein includes two lumens, the tube can be fashioned to have more, or fewer, lumens. For example, although the inflation lumen 26 in Fig. 2 is shown passing through the interior of tube 10, the inflation lumen may alternatively be fashioned as a tube extending along, and adhered to, the external surface of the tube. As shown in Fig. 6, a small diameter tube 50 extends longitudinally along the outer surface of elongated tubular member 12. The distal end of tube 50 may terminate within the interior space of balloon 20 in conventional manner. Inflation lumen 26A extends through the interior of small diameter tube 50. Preferably, tube 50 is glued or otherwise adhered to the outer surface of tubular member 12. Thus, in this embodiment, large diameter lumen 24 is the only lumen passing through elongated tubular member 12.

[0037] Fig. 7 illustrates a variation of the embodiment of Fig. 6. In this embodiment, elongated tubular member 12 is provided with a shallow longitudinal channel 54 along its outer surface. Small diameter tube 56 tracks the channel from the source for the inflation fluid to the interior of the balloon. Inflation lumen 26B extends through tube 56 and communicates with the interior space of the balloon, in a similar manner as the embodiment of Fig. 6. In this embodiment, large diameter lumen 24 is also the only lumen passing through elongated tubular member 12.

[0038] As a further variation, the elongated tubular member can be provided with one or more additional lumens that extend through at least a portion of the length of the tubular member. Such additional lumens could be used, e.g., to provide an additional fluid source, such as providing a liquid medication in addition to the liquid nutritional products, and/or to monitor various pressures or functions within the patient's body. An alteration in the number of lumens may necessitate minor alteration in the features of the inventive tube as described herein; however those skilled in the art can readily make such alterations when following the teachings of the present invention. [0039] Fig. 8 illustrates another alternative embodiment of a tube 150 according to the present invention. Only the distal portion 160 of tube 150 is illustrated in Fig. 8. The proximal end is conventional, and further description of this portion of tube 150 is not germane to the present discussion. Tube 150 comprises an elongated tubular member 152 as before. Elongated tubular member 152 may be provided with respective large and small diameter lumens (not shown), in the same manner as lumens 24, 26 in tubular member 12. In this embodiment, an inflatable spiral-shaped balloon 170 is wrapped around at least tube distal end portion 160. Tube distal portion 160 further includes an inflation port 154 in communication with an interior space of spiral-shaped balloon 170, in the same manner as port 18 in tube 10. At least one, and preferably a plurality, of apertures 164 are spaced along the length of tube distal portion 160. Preferably, apertures 164 are positioned distal to the distal end of the spiral- shaped balloon 170 in the same manner as the embodiments described hereinabove, although at least some apertures 164 may be positioned intermediate successive wrappings of the spiral-shaped balloon if desired. Tube 150 may be advanced and inflated in the same manner as tube 10. [0040] Spiral-shaped balloon 170 may be wrapped around the entire length of elongated tubular member 152, or alternatively, only along the distal portion of the tubular member. When wrapped around only the distal portion of the tubular member, an inflation lumen may be provided in elongated tubular member 152 in the same manner as lumen small diameter lumen 26 of tubular member 12. Alternatively, the inflation lumen may extend longitudinally along the outer surface of elongated member 152 as illustrated in the embodiment of Fig. 6, or may track a longitudinal channel formed along the outer surface of elongated member 152, as illustrated in the embodiment of Fig. 7. [0041] While these features have been disclosed in connection with the illustrated preferred embodiments, other embodiments of the invention will be apparent to those skilled in the art that come within the spirit of the invention as defined in the following claims.

Claims

What is claimed is:

1. A tube for insertion into a patient, said tube configured for movement through the gastrointestinal tract of the patient by peristaltic contractions, comprising: an elongated tubular member having a proximal portion, a distal portion, a lumen extending between said proximal and distal portions, and at least one aperture at said distal portion communicating with said lumen, said aperture sized and positioned for passage of fluid material therethrough from said lumen to a target area external to said tubular member; and an inflatable member disposed about a portion of said elongated tubular member distal portion, said inflatable member sized and configured such that upon inflation, said inflatable member projects outwardly from the surface of the tubular member so as to be engageable with an interior surface of the gastrointestinal tract, in a manner such that ingress of the tube through the gastrointestinal tract is promoted responsive to said peristaltic contractions.

2. The tube of claim 1 , comprising a plurality of apertures at said distal portion, wherein said inflatable member comprises at least one balloon disposed along a length of said tubular member distal portion.

3. The tube of claim 2, wherein said at least one balloon includes a plurality of radially extending ribs, said balloon disposed proximal to at least some of said apertures along said length of said tubular member.

4. The tube of claim 2, wherein said inflatable member comprises a plurality of balloons disposed along said length of said tubular member.

5. The tube of claim 4, wherein at least one of said balloons is disposed proximal to at least one of said apertures.

6. The tube of claim 1 , wherein said inflatable member comprises a tubular element spirally wound around a length of said tubular member distal portion.

7. The tube of claim 1 , wherein said lumen comprises a first lumen, and wherein said elongated tubular member further comprises a second lumen, said second lumen communicating with an interior space of said inflatable member for transmission of an inflation fluid into said interior space.

8. The tube of claim 1 , further comprising an inflation tube extending along a length of said elongated tubular member, wherein an end of said inflation tube communicates with an interior space of said inflatable member for transmission of an inflation fluid to said interior space.

9. The tube of claim 8, wherein said elongated tubular member includes a channel along said length, and wherein at least a portion of said inflation tube is received in said channel.

10. The tube of claim 1 , wherein said elongated tubular member distal portion terminates in a closed distal end.

11. The tube of claim 1 , wherein said inflatable member comprises one of PET, nylon, polyethylene, polyurethane, PVC, silicone and latex.

12. The tube of claim 1 , wherein the elongated tubular member and the inflatable member are formed from the same polymeric compositions.

13. The tube of claim 2, wherein said apertures are sequentially disposed at spaced intervals along opposite sides of said elongated tubular member.

14. The tube of claim 2, wherein said apertures have a generally elliptical configuration.

15. A tube configured for insertion into a patient and movement through the gastrointestinal tract by peristaltic contractions for transmission of nutritional products to the patient, comprising: an elongated tubular member having a proximal portion and a distal portion, said elongated tubular member dimensioned such that at least an end of said proximal portion is extendable external of said patient, and such that an end of said distal portion is extendable into the jejunum of the patient when said proximal end is external of the patient, said elongated tubular member having a first lumen and a second lumen therein, said first lumen extending between said proximal and distal portions, said second lumen configured for transmitting an inflation fluid therethrough, said elongated tubular member having a plurality of apertures at said distal portion, said apertures communicating with said first lumen and being sized and positioned for passage of fluid material therethrough from said first lumen to a target area in said jejunum; and an inflatable member disposed about a portion of said elongated tubular member distal portion, said inflatable member configured to receive said inflation fluid through said second lumen, said inflatable member configured such that upon inflation said member projects radially outwardly from the surface of the tubular member so as to be engageable with a surface of the gastrointestinal tract, whereby ingress of the tube through the gastrointestinal tract is promoted responsive to said peristaltic contractions.

16. The tube of claim 15, wherein said inflatable member comprises a balloon having a plurality of radially extending ribs, said balloon disposed proximal to at least some of said apertures along a length of said tubular member.

17. The tube of claim 15, wherein said inflatable member comprises a plurality of balloons disposed along a length of said tubular member.

18. The tube of claim 15, wherein said inflatable member comprises a tubular element spirally wound around a length of said tubular member distal portion.

19. The tube of claim 15, wherein said elongated tubular member distal portion terminates in a closed distal end.

20. The tube of claim 15, wherein said apertures are sequentially disposed at spaced intervals along opposite sides of said elongated tubular member.