Randomized Prospective Comparison of Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Feeding Tube Placement Versus Percutaneous Endoscopic Gastrostomy Feeding Tube Placement with Jejunal Extension (PEG-J), for Enteral Feeding

Abstract

Randomized Prospective Comparison of Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Feeding Tube Placement Versus Percutaneous Endoscopic Gastrostomy Feeding Tube Placement with Jejunal Extension (PEG-J), for Enteral Feeding Mark Delegge, Greg Buck, John Fang, James Disario, Glen Lehman, Gregory Ginsberg, Steve Mcclave PEG-J and DPEJ are accepted procedures for enteral feeding into the jejunum. The prospective comparison of DPEJ to PEG-J methods of percutaneous, endoscopic, jejunal access has not been previously examined. This study aimed to compare the clinician re-intervention rates related to complications of DPEJ versus PEG-J placement with regard to retrograde jejunal (J)-tube migration and J-tube failure within three to six months. The primary endpoint was re-intervention rate within three to six months related to J-tube migration and J-tube failure. Re-intervention rate was defined as the percentage of subjects with successful J-tube placement requiring any intervention at a hospital/clinic by the investigator and/or medical Staff, related to tube repositioning, tube repair, tube trade-out, or tube removal. Clinical assessment, physical exam, procedure data, device performance, patient satisfaction, and adverse events were tracked at baseline and at 1, 2, 3, 4, 5, and 6 months post placement. Eligible patients were randomized to receive either a DPEJ or a PEG-J tube. A total of 40 patients were treated. Nineteen (19) patients were treated with DPEJ, 20 patients with PEG-J, and 1 patient with both devices. The demographics of both groups were comparable. The primary reasons for receiving jejunal feeding included gastroparesis (8, 20.5%), chronic pancreatitis (23, 59%), and increased risk of reflux and aspiration (8, 20.5%). Sixteen (16) (84.2%) patients in the DPEJ group had a successful device placement as compared to 18 (90%) patients in the PEG-J group (p Z 0.59). The device was retained in place for 57.5 days for the DPEJ group and 51.5 days for the PEG-J group (p Z 0.77). Reintervention rate difference between the two groups was statistically significant with 31% of the DPEJ patients receiving a re-intervention and 75% of PEG-J patients (p Z .007). Both groups were satisfied with the feeding tube. A total of 31 patients experienced an adverse event, with 14 (73.7%) patients in the DPEJ group and 17 (85%) in the PEG-J group (p Z 0.38). Eight (8) events were serious and device related (1 DPEJ, 7 PEG-J). None were unanticipated. One patient in the PEG-J group experienced pneumonia.Re-intervention rates and serious device related events were statistically significantly lower in the DPEJ group than in the PEG-J group. No serious complications were unanticipated.