S1306 Outcomes of Enteroscopy-Assisted Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Tube Placement – A Single Center Experience

Abstract

INTRODUCTION: To study and report the clinical experience of direct percutaneous endoscopic jejunostomy (DPEJ) in a single tertiary care center. METHODS: Forty-eight (48) patients underwent DPEJ tube placement over the last 6 years (9/2013-10/2019) at a single tertiary care center. The main outcome measurements were a technical success in native and altered anatomy, and short- and long-term follow up. DPEJ was attempted in 48 patients – 63% females, age 52.5 ± 15.4 years, BMI 21.1 ± 6.8 kg/m2. Indications included gastroparesis (n = 12), Parkinson’s disease (n = 4), chronic pancreatitis (n = 7), chronic malnutrition with multiple abdominal surgeries (n = 12), intractable nausea and vomiting (n = 8) and others (n = 5). RESULTS: DPEJ was successful in 42/48 (87.5%) patients. It was placed using double-balloon enteroscopy (DBE) in 34 patients, single balloon enteroscopy in 1 patient, and push enteroscopy in 7 patients based on the endoscopist’s discretion and experience. Technical failures were due to lack of trans-illumination (n = 4), ventral hernia (n = 1), and previous adhesions hampering the advancement of the DBE (n = 1). All these patients underwent DBE to attempt the placement of DPEJ. Thirty-day complications were very few. There was no difference in the complications between altered and native anatomy (29% vs 20%, P = 0.32). There was no difference in the other outcomes (failure rates, tube removed, duration of PEJ tube) as well between the two groups. DPEJ was a short term bridge for 14 patients with a mean time to removal being 8 ± 7 months. Only one patient requested the DPEJ to be removed after 4 months due to discomfort and did not require any other supplemental nutrition. Patients who had DPEJ removed had a significant improvement in their serum albumin as compared to the patients who did not have their removed DPEJ removed (1 ± 0.6 g/dL vs 0.4 ± 0.5 g/dL, P = 0.05). 61% of all patients did not have the DPEJ removed. The mean duration of follow up in those patients was 23 ± 17 months with the first tube lasting for a mean duration of 12 ± 8 months and requiring exchanges of DPEJ. CONCLUSION: DPEJ is associated with a high technical success rate that is not influenced by altered anatomy and offers nutritional support with a low perioperative complication rate. It can often be used as a short term bridging therapy in some patients.Table 1.: Demographics of the 48 patients who underwent enteroscopy-assisted direct percutaneous endoscopic jejunostomy procedure