4740 The mucosal clip assisted method for the placement of percutaneously placed jejunal enteral tubes is safe and effective.

Abstract

Jejunal enteral tubes (JET) are often placed as an extension of the percutaneous gastrostomy tube in debilitated patients(pts) who are at high risk for aspiration. Proximal migration into the stomach due to friction between the endoscope (EGD) and the JET often occurs. Thus, procedural time may be increased and repeat EGDs may be required. The literature is sparse regarding the MCAM technique. A total of 9 pts; 8 had naso-jejunal tubes and 1 a JET/PEG with successful placement in 83% and an average procedure time of 30 minutes (GIE 1994;40:220-22 & JPEN 1996;20:306-8). The objective is to determine if MCAM: 1) is effective in delivering and keeping the JET in place in the descending duodenum (DD), 2) involves less procedural time, 3) prevented less proximal migration of the JET and 4) is safe and without complications. We prospectively used this method in 31 pts. There were 19 males. 34 total EGDs were performed. The major indications were: neurologic deficits, cancer and dysphagia. A Bard or Microvasive 20F G-tube was placed using the Ponsky-Pull Method. A 9F JET with a distal suture was then placed through the G-tube. The suture was grasped with the Olympus mucosal clip (MC) device, closed and pulled back into the standard upper EGD. The EGD and the JET were placed as far down in the DD. The MC was deployed between the suture loop and fastened to the duodenal wall. X-rays (KUB) were obtained to confirm placement. The procedure time, number of attempts, timing of feeding and complications were assessed. Results: The mean procedure time was 23.5 minutes. Only 1 attempt was required in 94% (32/34) and 2 attempts in 6%(2/34). Feeding was initiated within 24 hrs in 44% (15/34) and after 24 hrs in 56% (19/34) pts. JET migration occurred in only 2 pts requiring repeat EGD. 24/34 cases had at least 2 KUBs confirming JET placement. Conclusion: The MCAM method is technically simple, well tolerated and is a reliable method of performing a JET/PEG. In addition to lowering the aspiration risk by securing the JET to the duodenal wall, feedings may be initiated on the same day. No complications of ulcerations, bleeding or perforation occurred. A randomized trial comparing the MCAM with the conventional method is required to determine its true efficacy, costs and ease of use.