Percutaneous Endoscopic Gastrojejunostomy in Patients with Delayed Gastric Emptying

Abstract

Objective: Percutaneous endoscopic gastrojejunostomy (PEGJ) has become the method of choice to achieve an enteral access route in patients who require long-term enteral nutrition, especially in patients with delayed gastric emptying. Here, we discuss a successful approach for PEGJ used in our hospital. Materials and Methods: Thirteen of 145 percutaneous endoscopic gastrostomy patients (9%) with delayed gastric emptying had indications for PEGJ, which was performed in two steps. Percutaneous endoscopic gastrostomy (PEG) was performed first, and feeding was started through the PEG tube 24 hours later. PEG was converted to PEGJ because of delayed gastric emptying. Under fluoroscopic guidance to confirm the tube position, a stiffened jejunal tube was passed through the PEG tube and pushed downward as deep as possible to the jejunum. Feeding was accomplished by continuous infusion using a feeding pump in all patients. A daily follow-up of the patients was carried out during the hospitalization period. Result Thirteen PEG patients underwent 37 attempts at feeding tube placement. Thirty-three initial procedures were successful and eventually all procedures succeeded in these patients. Therefore, there was a successful rate in initial placement of feeding tubes of 89% (33/37) in these patients. The average time was about 20 minutes for the PEG placement and about 10 minutes for the PEGJ placement. Enteral nutrition with a polymeric diet was initiated the day after the PEGJ placement. All patients obtained good enteral feeding through the PEGJ, and 10 patients achieved the nutrition goal four days later. The average duration of enteral nutrition through the PEGJ was 68 days. Only one patient developed aspiration pneumonia. There were some minor complications including peristomal infection in two patients and gastrojejunostomy tube replacements in two patients. No death resulted from a PEGJ-related complication. Conclusion: PEGJ provides a better choice for a long-term nutritional support, especially in patients with delayed gastric emptying. PEGJ shows good efficacy and safety when combined with good enteral nutrition support, can reduce aspiration pneumonia, and has a low complication rate compared with previously described methods.