Safety and efficacy of direct percutaneous endoscopic jejunostomy tube placement compared with surgical jejunostomy: a tertiary care analysis

Abstract

Background and AimsJejunostomy tube placements provides enteral access for feeding in eligible patients who cannot meet the nutritional needs by mouth. They can be surgically placed laparoscopically (lap-J) or using conventional open laparotomy (open-J) approach. Recently, direct percutaneous endoscopic jejunostomy (DPEJ) has emerged as an alternative because of its low cost and shorter recovery times. We sought to retrospectively compared the procedural success rates and complications of these methods. MethodsPatients were identified by a querying of our health system patient database and the departmental database of patients who underwent DPEJ. The patients were divided into three cohorts based on the procedure: DPEJ, lap-J, and open-J. Patient age and BMI, procedure success rate, and complications rate were compared among the three groups. Results201 patients met inclusion criteria (65 DPEJ, 111 lap-J and 25 open-J). Procedural success rates were similar between the 3 groups (DPEJ 96.9%, Lap-J 99.1%, Open-J 100%, p=0.702). Rates of infection and bleeding were also similar between the 3 groups. There were no cases of GI perforation. Tube dysfunction for any reason that required complete removal and/or replacement within 90 days occurred more often in the surgical groups than in the DPEJ group (DPEJ 0%, lap-J 35.1%, open-J 40.0%, p<0.001). This was driven largely by increased rates of tube clogging and tube dislodgement in the surgical groups. ConclusionDPEJ is a safe and effective alternative to surgical jejunostomy in eligible patients and may be associated with decreased complication rates at 90-days.