Abstract
procedural attempts at DPEJ, procedure duration, technical success rate, causes for failed DBE-DPEJ placement, and adverse events. Results: A total of 90 patients (55 women; mean age 55 18 years; mean BMI 22.9 6.3) underwent DBE-DPEJ placement (Table 1). Indications for DPEJ included: gastroparesis (nZ29), previous failed PEG (e.g., intrathoracic stomach, nZ16), nutritional support in altered gut anatomy unsuitable for PEG (nZ16), recurrent or high risk for aspiration (nZ13), gastric outlet obstruction (nZ11), and miscellaneous (e.g., nutritional support in setting of necrotizing pancreatitis, nZ5). Altered gut anatomy was noted in 35 (39%) patients. DBE-DPEJ was successful in all patients (nZ12) who had prior failed DPEJ attempts by extended push endoscopy or single balloon endoscopy. Mean duration of the DBE-DPEJ procedure was 31 minutes (range 10-49). DBE-DPEJ placement was successful in 83 (92%) patients. Reasons for failed DBE-DPEJ placement in 7 (8%) patients included: small bowel fixation from adhesions precluding endoscope advancement (nZ5), duodenal stenosis (nZ1), and lack of transillumination (nZ1). Post-procedural adverse events occurred in 8 (9%) patients and included: gastrointestinal bleed secondary to DPEJ site ulceration (nZ3), abdominal hematoma (nZ2), cellulitis (nZ1), kinking of the PEJ tube requiring replacement (nZ1) and gastric interposition (nZ1). Conclusion: Compared to published outcomes of DPEJ placement by conventional endoscopy, DBE-assisted DPEJ was technically successful in a high proportion of patients and with a relatively low rate of significant adverse events.
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