Trans-PEG ultra thin endoscopy for PEG/J Placement

Abstract

We read with interest the article by Adler et al.1Adler DG Gostout CJ Baron TH. Percutaneous transgastric placement of jejunal feeding tubes with an ultra-thin endoscope.Gastrointest Endosc. 2002; 55: 106-110Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar However, we call into question the “newness” of the technique they described. This was described by our group in 1994,2Baskin WN Johanson JF Trans-PEG endoscopy for rapid PEJ placement [abstract].Am J Gastroenterology. 1994; 89: 1701Google Scholar by Berger et al.3Berger WL Shaker R Dean RS. Percutaneous endoscopic gastrojejunal tube placement.Gastrointest Endosc. 1996; 43: 63-66Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar in 1996, and again in 2001.4Baskin WN. Percutaneous endoscopic gastrostomy and placement of a jejunal extension tube.Tech Gastrointest Endosc. 2001; 3: 30-41Abstract Full Text PDF Scopus (9) Google Scholar Trans PEG endoscopy for PEG/J placement allows periodic replacement of a PEJ tube over a guidewire without repeating endoscopy and without replacing the entire “single-piece” double lumen balloon tube device used by Adler et al.1Adler DG Gostout CJ Baron TH. Percutaneous transgastric placement of jejunal feeding tubes with an ultra-thin endoscope.Gastrointest Endosc. 2002; 55: 106-110Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar It does require a larger PEG lumen (i.e., Bard 28F) to allow passage of an ultrathin endoscope. Established gastrostomy tracts smaller than 28F can be “up-sized” by hydrostatic balloon dilation of the stoma. This allows 12F PEJ tube placement, the same size as used in the study of Adler et al.1Adler DG Gostout CJ Baron TH. Percutaneous transgastric placement of jejunal feeding tubes with an ultra-thin endoscope.Gastrointest Endosc. 2002; 55: 106-110Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar We agree fully with these investigators that the use of ultrathin endoscopes, either through established stomas or established large caliber PEG lumens, represents an advance in the ease of PEG/J insertion. The 8-year experience of our group with this technique continues to be rewarding, with near 100% success in deep jejunal access, this usually being accomplished in less than 10 minutes of procedure time.