Successful placement of percutaneous gastrojejunostomy using steerable glidewire—a modified controlled push technique

Abstract

Percutaneous gastrojejunostomy (PEG-J) is now increasingly utilized to maintain long-term enteral nutrition in patients with recurrent aspiration pneumonia. 1-3 Despite significant advances in accessories and the technology and various techniques used to place percutaneous jejunostomy tubes, 3-6 precise and consistent placement (defined as placement of the jejunostomy tube beyond the ligament of Treitz) is, as yet, not always possible. Recently, Teflon-coated con: ventional guidewires have been utilized to facilitate placement, but with limited success. 5 Glidewires have been utilized in biliary tract maneuvers for some time, but they have not been exploited in the placement of PEG-J tubes. Glidewire features advantageous for PEG-J placement include resistance to formation of kinks and a hydrophilic coating that, when wet, makes the wire extremely slippery. This combination makes the glidewire easily steerable, thus facilitating negotiation of the angles of the upper intestine. The purpose of our study was to evaluate a new technique for placement of a percutaneous jejunostomy tube utilizing a glidewire. MATERIALS AND METHODS Five patients who required gastrostomy for maintenance of enteral nutrition and prevention of recurrent aspiration were studied. They included two cases of severe neurologic deficit secondary to cerebrovascular accidents, two of trauma, and one of mental retardation.