Jéjunostomie endoscopique percutanée (JEP)

Abstract

While percutaneous endoscopic gastrostomy (PEG) today is a well established standard method for enteral nutrition, direct puncture of the jejunum is rarely performed even by experienced endoscopists.Such a direct puncture of the jejunum for percutaneous enterostomy is indicated if the stomach is no longer accessible (esophagectomy, partial or total gastrectomy etc.), cannot be punctured (due to extensive tumour) or if esophageal leakage (anastomotic insuffiency, perforation or fistula) occurs.Some technical aspects have to be respected—in contrast to simple PEG-procedures—to achieve good results and a low complication rate: even if the standard equipment for PEG can be used, application of spasmolytic medication and careful examination of the abdomen for transillumination is mandatory in EPJ. To prevent the needle from slipping out of the bowel after puncture it should be hold tightly by an alligator forceps from inside. Endoscopic and/or x-ray-control of the interior plate is mandatory after pull-through.From January 1990 to September 2002, 180 endoscopic guided direct punctures of the jejunum with subsequent insertion of a tube for nutrition (PEJ) have been performed beneath 1149 “normal” PEGs. Technical failure was seen in 8% (14/180), multiple attempts were necessary in 11% (20/180). Mild complications occurred in 10% (16/166); 1.8% (3/166) of the patients showed signs of intermittent local peritonitis. 2.4% (4/166) had to be operated again due to severe complications, mortality was 1.8% (3/166).Although the complication rate in EPJ is slightly higher than in PEG, complications can be kept low by careful indication and correct technique. In comparison to open operative techniques, endoscopic direct puncture of the jejunum represents a safe and effective alternative to conventional methods with significantly lower risk and low invasiveness.