4735 Direct pej vs. transgastric pej for jejunal feeding: a retrospective analysis.

Abstract

Background: D-PEJ may be performed with a high success rate in a cancer population (Shike, GIE,'96). However, jejunal feeding is more commonly achieved by inserting jejunal extension tubes or single-piece transgastric jejunal tubes (PEG-J). Data comparing D-PEJ and PEG-J techniques are lacking. Methods: Using the Mayo endoscopy database, we identified all patients referred for a D-PEJ since the implementation of this procedure at our institution. Medical records for D-PEJ patients were reviewed to assess technical success, complications, and need for repeat procedures. Patient satisfaction with D-PEJ was evaluated during standardized phone interviews. Patients were asked to rate pain and drainage at the feeding tube site on a 4-point scale (0-none, 1-mild, 2-moderate, 3-severe) and to give an overall rating of satisfaction on a 10-point scale (1-completely dissatisfied through 10-completely satisfied). A comparison group of patients with a PEG-J performed over the past 10 years were identified using our home enteral nutrition database. Data on these patients were collected prospectively by a dietitian during regular phone follow-ups and recorded on an enteral nutrition flow sheet. Results: D-PEJ placement was successful in 18 of 26 patients (69%) over a 12 month-period. Failure was secondary to an inability to transilluminate in six patients and small bowel stricturing in two. Pain (mean duration, 26 days) and drainage (mean duration, 52 days) at the tube site was rated as 2 or higher by 38% and 46% of patients, respectively. 85% of patients reported an overall satisfaction rating of 7 or higher. The comparison PEG-J group consisted of 21 patients (see table). Conclusions: 1. D-PEJ insertion is possible in the majority of patients requiring jejunal feeding. 2. The type and frequency of complications are similar with D-PEJ and PEG-J. 3. At 2 months, less frequent tube replacement was observed among patients undergoing D-PEJ. A longer follow-up period is required to assess whether this trend continues. Background: D-PEJ may be performed with a high success rate in a cancer population (Shike, GIE,'96). However, jejunal feeding is more commonly achieved by inserting jejunal extension tubes or single-piece transgastric jejunal tubes (PEG-J). Data comparing D-PEJ and PEG-J techniques are lacking. Methods: Using the Mayo endoscopy database, we identified all patients referred for a D-PEJ since the implementation of this procedure at our institution. Medical records for D-PEJ patients were reviewed to assess technical success, complications, and need for repeat procedures. Patient satisfaction with D-PEJ was evaluated during standardized phone interviews. Patients were asked to rate pain and drainage at the feeding tube site on a 4-point scale (0-none, 1-mild, 2-moderate, 3-severe) and to give an overall rating of satisfaction on a 10-point scale (1-completely dissatisfied through 10-completely satisfied). A comparison group of patients with a PEG-J performed over the past 10 years were identified using our home enteral nutrition database. Data on these patients were collected prospectively by a dietitian during regular phone follow-ups and recorded on an enteral nutrition flow sheet. Results: D-PEJ placement was successful in 18 of 26 patients (69%) over a 12 month-period. Failure was secondary to an inability to transilluminate in six patients and small bowel stricturing in two. Pain (mean duration, 26 days) and drainage (mean duration, 52 days) at the tube site was rated as 2 or higher by 38% and 46% of patients, respectively. 85% of patients reported an overall satisfaction rating of 7 or higher. The comparison PEG-J group consisted of 21 patients (see table). Conclusions: 1. D-PEJ insertion is possible in the majority of patients requiring jejunal feeding. 2. The type and frequency of complications are similar with D-PEJ and PEG-J. 3. At 2 months, less frequent tube replacement was observed among patients undergoing D-PEJ. A longer follow-up period is required to assess whether this trend continues.