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Introduction Aspiration pneumonia is one of the most common complications of gastrostomy feeding. Jejunal feeding through a trans-gastric jejunostomy (TGJ) may reduce the risk of aspiration pneumonia, but data are limited in this area. This study aimed to compare the frequency of aspiration pneumonia in enterally-fed patients before and after TGJ placement.Methods This was a retrospective case note review of enterally-fed patients who underwent TGJ placement due to aspiration pneumonia between 2014 and 2024 at Sheffield Teaching Hospitals NHS Foundation Trust. We evaluated the number of aspiration pneumonia events before and after TGJ placement. Aspiration pneumonia was defined based on clinical evidence of reflux/ vomiting and radiological evidence of consolidation. Outcomes at one-year post-TGJ insertion were recorded.Results Thirty-five patients had their gastrostomy tubes converted to TGJ feeding tubes during the study period; of these, 16/35 (50%; n=8 female) patients had the TGJ placed for aspiration pneumonia. The median age of patients was 54 years (range 20-82 years); indications for enteral feeding are listed in table 1. Median time of gastrostomy feeding was 19.6 (1.3-95.3) months, and TGJ feeding was 9.1 (0.2-101.6) months. The total number of aspiration pneumonia events during gastrostomy feeding was 22, compared with 15 events during TGJ feeding. The median number of aspiration pneumonia events was 0.08 (0.0-1.3) per month for gastrostomy-fed patients, compared with 0.01 (0.0-0.3) episodes per month for TGJ-fed patients (p <0.05). Mortality at one year after TGJ placement was 25% (4/16), which was related to underlying chronic diseases; other outcomes at one year are listed in table 1.Conclusions Our data suggests that TGJ feeding may reduce the risk of aspiration in enterally fed patients. Further prospective studies with appropriate controls are warranted to help guide decision-making in this area.Abstract P378 Table 1Indications for enteral feeding and outcomes at one-year post-TGJ insertionReason for tube feedingN, (%)Mortality (N)Continued TGJ feeding (N)Conversion to surgical jejunostomy (N)Reversal to gastrostomy (N)Stroke3 (19%)0210Neurodegen. disorders5 (31%)2201Cerebral palsy1 (6%)0100Traumatic brain injury2 (13%)0110H&N cancer/ surgery2 (13%)0101Other*3 (18%)2100*Other: Chronic respiratory diseases, metastatic oesophageal cancer, epilepsy.