Direct Percutaneous Endoscopic Jejunostomy Placement Research Articles

Safety and efficacy of direct percutaneous endoscopic jejunostomy placement in patients with previous upper gastrointestinal resection: A retrospective cohort study.

Percutaneous jejunal enteral access can be obtained with percutaneous endoscopic gastric jejunostomy (PEGJ) and direct percutaneous endoscopic jejunostomy (DPEJ) tubes. PEGJ may not be feasible in patients with previous gastric resection (PGR) and DPEJ may be the only option. Our aim is to determine if DPEJ tubes can be placed successfully in patients with history of gastrointestinal (GI) surgery and if success rates are comparable to DPEJ or PEGJ in those without prior GI surgery. We reviewed all tube placements performed from 2010 to present. Procedures were performed using a pediatric colonoscope. Previous upper GI surgery was defined as PGR or esophagectomy with gastric pull-up. Adverse events (AEs) were graded perAmerican Society for Gastrointestinal Endoscopy criteria. Mild events included unplanned medical consultation or hospitalization <3 days, and moderate events included repeat endoscopy without surgical intervention. Successful placement rates were high regardless of GI surgical history. Patients receiving a DPEJ with a history of GI surgery were significantly less likely to experience an AE compared with those receiving DPEJ with no history and compared with PEGJ patients with or without a history. DPEJ placement in patients with previous upper GI surgery has very high success rate. It is associated with lower AE rates than patients receiving DPEJ without previous gastric surgery, or PEGJ regardless of previous gastric surgery. Patients with a history of upper GI surgery requiring enteral access may benefit from DPEJ over PEGJ placement considering its very high success rate and lower incidence of AEs.

Direct percutaneous endoscopic jejunostomy using single-balloon enteroscopy without fluoroscopy: a case series.

Direct percutaneous endoscopic jejunostomy (DPEJ) is a useful method to provide enteral nutrition to individuals when gastric feeding is not possible or contraindicated. The aim of this study was to analyze the efficacy and safety of DPEJ tube placement with the Gauderer-Ponsky technique by the pull method, using single-balloon enteroscopy (SBE) without fluoroscopy. This is a retrospective analysis of patients undergoing SBE for DPEJ placement in a referral hospital between January 2010 and March 2016. Technical success, clinical success and procedure related complications were recorded. Twenty-three patients were included (17 males, median age 71 years, range 37-93 years). The most frequent indications for DPEJ were gastroesophageal cancer (n = 10) and neurological disease (n = 8). Eighty-seven percent of the patients had a contraindication to percutaneous endoscopic gastrostomy (PEG) and PEG was unsuccessful in the remaining patients. The technical success rate was 83% (19/23), transillumination was not possible in three patients and an accidental exteriorization of the bumper resulting in a jejunal perforation occurred in one patient. The clinical success was 100% (19/19). The median follow-up was five months (range 1-35 months). Apart from the case of jejunal perforation and the two cases of accidental exteriorization, there were no other complications during follow-up. The 6-month survival was 65.8% and the 1-year survival was 49.3%. DPEJ can be carried out successfully via SBE without fluoroscopy with a low rate of significant adverse events. Although, leaving the overtube in place during the bumper pulling can be useful for distal jejunal loops, it can be safely removed in proximal loops to minimize complications.

PTU-056 Highly Successful, Minimally Invasive Enteral Access By Double-balloon Enteroscopy (dbe) And Laparoscopic-assisted Dbe

IntroductionPatients with chronic gastroparesis frequently require prolonged enteral feeding via the jejunal route. This is often achieved through the placement of a percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) or...

Sa1467 Outcomes of Double Balloon Endoscopy-Assisted Direct Percutaneous Endoscopic Jejunostomy Placement

Conventional direct percutaneous endoscopic jejunostomy (DPEJ) tube placement using pediatric or adult colonoscopes fails in approximately one third of cases, primarily due to lack of abdominal transillumination or limited instrument insertion into the jejunum. In a small pilot study, double balloon endoscopy (DBE)-assisted DPEJ placement was successful in all patients in whom attempted conventional DPEJ failed.

Endoscopic approaches to enteral feeding and nutrition core curriculum

Endoscopic approaches to enteral feeding and nutrition core curriculum

Single-balloon enteroscopy-assisted direct percutaneous endoscopic jejunostomy

Direct percutaneous endoscopic jejunostomy (DPEJ) has emerged as a viable alternative for percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) in patients who cannot tolerate gastric feeding. Reportedly, DPEJ placement with regular endoscopes fails in up to one-third of cases. The aim of the current study was to assess the efficacy and safety of single-balloon enteroscopy (SBE)-assisted DPEJ. The DPEJ placement technique was comparable to conventional PEG placement. A total of 12 DPEJ procedures were performed in 11 patients (mean age 55 years [range 24-83 years]; seven males). SBE-assisted DPEJ was successful in 11 of the 12 procedures (92%). Post-procedural complications included gastroparesis and aspiration pneumonia in one case each. We conclude that SBE-assisted DPEJ placement seems a safe and successful approach for patients requiring jejunal enteral feeding.

Tu1593 Placement of Percutaneous Endoscopic Jejunostomy With Single-Balloon Enteroscopy

Direct percutaneous endoscopic jejunostomy (DPEJ) has emerged as a viable alternative for percutaneous endoscopic gastrostomy (PEG) or percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) in patients not tolerating gastric feedings. Reportedly, DPEJ placement with regular endoscopes fails in up to one third of cases, mainly due to inadequate transillumination or failure to pass the scope into the jejunum. Single-balloon enteroscopy (SBE), with its ability to provide controlled small-bowel intubation, may facilitate direct percutaneous jejunal feeding tube placement.

Enteral Access by Double-Balloon Enteroscopy: An Alternative Method of Direct Percutaneous Endoscopic Jejunostomy Placement

Although direct percutaneous endoscopic jejunal feeding tube placement is an increasingly accepted method of providing small-bowel access for long-term enteral nutrition, it is reliant on push enteroscopy and remains a technically challenging procedure with significant failure rates. Double-balloon enteroscopy, with its ability to provide controlled small-bowel intubation may facilitate direct percutaneous endoscopic jejunal tube placement. We report a prospective series of ten consecutive cases of double-balloon enteroscopy-assisted direct percutaneous endoscopic jejunal placement, accompanied by a step-by-step illustrated overview of the technique. Direct percutaneous endoscopic jejunal tube placement by double-balloon enteroscopy was successful in nine of the ten attempted cases. In the first case, direct percutaneous endoscopic jejunal placement was abandoned due to inadequate transillumination; there were no procedure-related complications in any of our patients. This first reported prospective case series of double-balloon enteroscopy-assisted direct percutaneous endoscopic jejunal placement shows a promisingly high success rate; larger comparative studies are required to clearly establish any advantages over the originally described push enteroscopy method.

DPEJ Tube Placement Prevents Aspiration Pneumonia in High‐Risk Patients

Percutaneous endoscopic gastrostomy (PEG) or PEG tube with transgastric jejunostomy tube (PEG-J) feeding has not been shown to decrease aspiration pneumonia. The aim of this study was to determine if direct percutaneous endoscopic jejunostomy (DPEJ) tube placement results in a decreased incidence of aspiration pneumonia in high-risk patients. The design was a retrospective review of all patients receiving DPEJ tube for aspiration pneumonia from 1999 to 2005. Demographics, incidence of aspiration pneumonia, and outcomes were collected and compared before and after the DPEJ placement. Eleven patients (4 women, 7 men) were identified; their mean age was 44.9 years (range, 18-94 years). The etiologies for recurrent aspiration pneumonia were neurologic disease (9), esophageal surgery (1), and severe debilitation (1). The mean follow-up was 20.9 months (range, 6-48 months). The patients' mean weight increased from 43.8 kg (range, 19-55 kg) to 48.3 kg (range, 30-65 kg) after placement (P < .001). The total number of documented aspiration pneumonia episodes for all patients decreased from 29 (mean, 3.64; range, 1-6) before DPEJ placement to 3 (mean, 0.27; range, 0-2) after DPEJ placement (P < .001). The mean number of aspiration pneumonia events per month prior to the DPEJ placement was 3.39 and postplacement was 0.42 (P < .001). DPEJ placement appears to decrease recurrent aspiration pneumonia in patients with history of aspiration pneumonia.

Direct percutaneous endoscopic jejunostomy: a case series in pediatric patients

Direct percutaneous endoscopic jejunostomy (DPEJ) is a well-known approach to deliver postpyloric enteral nutrition support to individuals who cannot tolerate gastric feeding. DPEJ addresses many of the shortcomings of jejunal feeding tubes placed through percutaneous endoscopic gastrostomy tubes. The safety and efficacy of DPEJ in adults has been previously reported. There are no reports on the use of DPEJ in pediatric patients. Our purpose was to report on 5 pediatric patients who underwent DPEJ placement between January 2000 and January 2003 over the available follow-up periods. Retrospective case series. University of Utah Health Sciences Center and the Medical University of South Carolina. Five patients, age range 4 to 17 years. Rate of successful tube placement, major and minor complications, and outcomes including weight gain and recurrent aspiration after DPEJ placement. All 5 attempted DPEJs were placed successfully with 2 minor complications of peristomal leakage and peristomal skin infection. One DPEJ was replaced 2 years after placement because of fungal degradation. The mean weight gain among all patients was 10.3 kg in a mean of 22.6 months. Retrospective, small series. DPEJ placement appears to be a safe and effective approach to enteral nutritional support in pediatric patients requiring long-term access to the jejunum. No major complications occurred and all patients gained weight after tube placement.

Success rate of direct percutaneous endoscopic jejunostomy in patients who are obese

Direct percutaneous endoscopic jejunostomy (DPEJ) is increasingly used as a method for obtaining jejunal enteral access. The most cited reason of unsuccessful placement is poor transillumination, which may be related to obesity. Whether obesity affects failure and complication rates has not been previously described. To compare the success rate and adverse events (AEs) associated with DPEJ placement in patients who were overweight and patients who were obese compared with patients who were normal or underweight defined by body mass index (BMI). Retrospective database review. A tertiary-referral center. Eighty DPEJ placements between February 2000 and September 2005. DPEJ placement success in patients who were overweight/obese (BMI >or= 25) versus patients who were normal or underweight (BMI <25). Secondary end points included procedure time and AEs. Eighty DPEJs were placed in 75 patients. Of these DPEJs, 65 (81%) succeeded and 15 (19%) failed. Success rates were 23 of 24 for patients who were underweight (96%), 25 of 31 for patients with normal BMI (81%), 8 of 11 for patients who were overweight (73%), and 6 of 10 for persons who were obese (60%) (odds ratio 3.43, 95% CI 1.03-11.44; P< .05 for BMI >or= 25 vs BMI<25). Overall, AEs were not significantly different for patients with BMI <25 versus BMI >or=25 (24/55 vs 9/21, respectively; P= .64). However, 4 of the 5 severe AEs occurred in patients with a BMI >or= 25 (P= .07). Retrospective single center. DPEJ placement in patients who were overweight or obese was feasible, but procedural success was less frequent, and a trend toward more frequent major AEs was seen than in persons with normal or decreased BMI. BMI was an easily assessed preprocedural factor for DPEJ success and complication rates.

Randomized Prospective Comparison of Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Feeding Tube Placement Versus Percutaneous Endoscopic Gastrostomy Feeding Tube Placement with Jejunal Extension (PEG-J), for Enteral Feeding

Randomized Prospective Comparison of Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Feeding Tube Placement Versus Percutaneous Endoscopic Gastrostomy Feeding Tube Placement with Jejunal Extension (PEG-J), for Enteral Feeding Mark Delegge, Greg Buck, John Fang, James Disario, Glen Lehman, Gregory Ginsberg, Steve Mcclave PEG-J and DPEJ are accepted procedures for enteral feeding into the jejunum. The prospective comparison of DPEJ to PEG-J methods of percutaneous, endoscopic, jejunal access has not been previously examined. This study aimed to compare the clinician re-intervention rates related to complications of DPEJ versus PEG-J placement with regard to retrograde jejunal (J)-tube migration and J-tube failure within three to six months. The primary endpoint was re-intervention rate within three to six months related to J-tube migration and J-tube failure. Re-intervention rate was defined as the percentage of subjects with successful J-tube placement requiring any intervention at a hospital/clinic by the investigator and/or medical Staff, related to tube repositioning, tube repair, tube trade-out, or tube removal. Clinical assessment, physical exam, procedure data, device performance, patient satisfaction, and adverse events were tracked at baseline and at 1, 2, 3, 4, 5, and 6 months post placement. Eligible patients were randomized to receive either a DPEJ or a PEG-J tube. A total of 40 patients were treated. Nineteen (19) patients were treated with DPEJ, 20 patients with PEG-J, and 1 patient with both devices. The demographics of both groups were comparable. The primary reasons for receiving jejunal feeding included gastroparesis (8, 20.5%), chronic pancreatitis (23, 59%), and increased risk of reflux and aspiration (8, 20.5%). Sixteen (16) (84.2%) patients in the DPEJ group had a successful device placement as compared to 18 (90%) patients in the PEG-J group (p Z 0.59). The device was retained in place for 57.5 days for the DPEJ group and 51.5 days for the PEG-J group (p Z 0.77). Reintervention rate difference between the two groups was statistically significant with 31% of the DPEJ patients receiving a re-intervention and 75% of PEG-J patients (p Z .007). Both groups were satisfied with the feeding tube. A total of 31 patients experienced an adverse event, with 14 (73.7%) patients in the DPEJ group and 17 (85%) in the PEG-J group (p Z 0.38). Eight (8) events were serious and device related (1 DPEJ, 7 PEG-J). None were unanticipated. One patient in the PEG-J group experienced pneumonia.Re-intervention rates and serious device related events were statistically significantly lower in the DPEJ group than in the PEG-J group. No serious complications were unanticipated.

Direct Percutaneous Endoscopic Jejunostomy Placement in a Patient with Intracorporeal Left Ventricular Assist Device

We present a case involving a patient who required enteral feeding after implantation of an abdominally positioned left ventricular assist device. The position of the device occupied most of the abdomen, precluding percutaneous endoscopic gastrostomy tube placement. However, in the case presented, direct percutaneous endoscopic jejunostomy (DPEJ) tube placement was achieved without interfering with the intracorporeal device. To our knowledge, there are no previous reports in the literature of successful DPEJ placement in a patient with an abdominally positioned heart assist device. DPEJ should be considered as a long-term enteral feeding route when structural barriers prevent percutaneous gastric access.

Direct Percutaneous Endoscopic Jejunostomy: Outcomes in 307 Consecutive Attempts

Clinical utilization of direct percutaneous endoscopic jejunostomy (DPEJ) is increasing. However, little data exist regarding important clinical outcomes with DPEJ. To describe the indications, success, and complications of DPEJ in a large cohort of >300 consecutive attempted DPEJ cases at our institution. Institutional databases identified 316 consecutive attempted DPEJ placements between January 1996 and August 2004. The medical records of consenting patients were abstracted for demographics, indication, success, complications, and follow-up. A scheme for classifying complication severity was designed. Three hundred and seven attempts at DPEJ were made on 286 patients. Of these, 209 succeeded (68%). The most common indications for DPEJ included resectable distal esophageal cancer, other malignancies causing obstruction, gastroparesis, prior esophageal or gastric resection, and high aspiration risk. Overall, 81 adverse events (AEs) were associated with DPEJ placement or removal in 69 (22.5%) cases. There were 14 serious AEs, 20 moderate AEs, and 47 mild AEs. Serious AEs included 7 bowel perforations, 3 jejunal volvuli, 3 major bleeds, and 1 aspiration. The only death was due to profound jejunal mesenteric bleeding after an unsuccessful trocar pass. Moderate AEs included 9 chronic enterocutaneous fistulae. Many of the 47 mild AEs were site infections requiring oral antibiotics (23) or persistent site pain (14). DPEJ was associated with a moderate or severe complication in approximately 10% of cases. While DPEJ is a useful technique to gain enteral access that obviates the need for surgery and is more reliable than percutaneous gastrostomy with jejunal extension, patients and physicians should be aware of the risks involved.

The Frequency, Severity, and Spectrum of Adverse Events Associated with Direct Percutaneous Endoscopic Jejunostomy (DPEJ)

Background: DPEJ is increasingly utilized as a method for obtaining enteral access. Though it has been described for more than 15 years, scant data exists regarding the safety profile of DPEJ. Aims: To describe the frequency and type of complications associated with DPEJ. Methods: Institutional databases identified 316 attempted DPEJ placements at Mayo Clinic Rochester from 1996 to August 2004. All but 9 patients had consented to have their records used for research. These records were abstracted with attention to adverse events (AEs). Severe AEs were defined as those requiring urgent surgery or endoscopy or seriously threatening a patient's health. Moderate AEs were defined as those requiring non-urgent surgery or endoscopy, or any hospitalization (not meeting criteria for severe). All other AEs were categorized as mild. Mean follow-up (f/u) time was 251 days, median f/u time was 88 days, and 91% of patients had at least 48 hours of f/u. Results: 307 attempts at DPEJ were made on 286 patients. Of these, 209 succeeded (68%) and 98 failed (32%). Overall, 89 AEs were associated with DPEJ placement or removal in 73 (23.7%) of the cases, with a clear causal relationship in 65 cases. In 16 cases more than one AE occurred. There were 13 serious AEs (4.2% of all cases), 18 moderate AEs, and 58 mild AEs. Serious AEs included 7 bowel perforations, 3 cases of jejunal volvulus, and 3 major bleeding events. The only death in this group was due to profound jejunal mesenteric bleeding after an unsuccessful trocar pass. Moderate AEs included 8 chronic enterocutaneous fistulae that required surgical or endoscopic closure and 2 significant site infections requiring hospitalization for IV antibiotics and/or abscess drainage. Many of the mild AEs were site infections requiring oral antibiotics (22/58) or persistent site pain (14/58). Conclusions: DPEJ was associated with a moderate or severe complication in 29/307 (9.4%) of cases. While DPEJ is a useful technique to gain enteral access that often obviates the need for surgery and is more reliable than percutaneous endoscopic gastrostomy with jejunal extension, patients and physicians should be aware of the risks involved. Given incomplete follow-up in many patients, these complication rates may be an underestimate.

Strategies in Managing Chronic Pancreatitis–Placement of Direct Percutaneous Endoscopic Jejunostomy Feeding Tubes

Patients with chronic pancreatitis (CP) often have maldigestion and malnutrition. Nutrition support during acute and CP traditionally has been provided by parenteral nutrition. In acute pancreatitis, jejunal feeding may accelerate resolution of the inflammatory process, protect against infection, and improve outcomes at a reduced cost when compared with parenteral nutrition. Jejunal feeding may also be beneficial for patients with CP. Prolonged jejunal access may be achieved via a direct percutaneous endoscopic jejunostomy (DPEJ). This article will review the rationale and evidence for jejunal feeding, indications and contraindictions for DPEJ placement, and the technique and outcomes of DPEJ in patients with CP.

Use of a 19-gauge injection needle as a guide for direct percutaneous endoscopic jejunostomy tube placement

Background: Direct percutaneous endoscopic jejunostomy (DPEJ) tube placement is becoming an accepted means of achieving enteral nutrition. However, during DPEJ placement it can be difficult to maintain the position of the small bowel for insertion of the plastic sheath with stylet, thus limiting the success of the procedure. The results of a technique designed to overcome this problem are presented. Methods: During DPEJ placement, a 19-gauge injection needle was passed into the bowel at the site of transillumination. The needle was snared tightly, fixing the small bowel against the abdominal wall. The plastic sheath with stylet was then inserted adjacent to the 19-gauge needle and into the small bowel and was subsequently snared to facilitate guidewire passage. A 24F, pull-type PEJ tube was then placed in standard fashion. Results: A DPEJ was placed successfully in 24 of 26 (92.3%) patients with this technique. There was one (4%) major complication: inadvertent small bowel perforation during DPEJ placement. The average time to complete a procedure was 23.3 minutes; the mean time to achieve the dietary goal after DPEJ placement was 39 hours. One patient died of an unrelated illness 6 days after DPEJ placement; 23 were discharged with jejunal feeding. Conclusions: A DPEJ can be performed successfully by using a 19-gauge injection needle as guide for tube placement.

Outcome of direct percutaneous endoscopic jejunostomy tube placement for nutritional support in critically ill, mechanically ventilated patients

Purpose: Gastrointestinal function is adversely affected in critically ill mechanically ventilated patients. The most common abnormality is delayed gastric emptying. Among the options for postpyloric feeds, direct percutaneous endoscopic jejunostomy (PEJ) provides a permanent, reliable, and direct access to the small bowel and can be used for full enteral feedings, thus eliminating the need for parenteral nutrition. Patients and Methods: All patients who underwent direct PEJ tube placement while mechanically ventilated in the intensive care unit (ICU) were evaluated. For each patient the following factors were identified: age, indication for ICU admission and PEJ placement, nutritional support before and after PEJ placement, calories received, complications, and outcome. Results: Seventeen patients underwent the procedure. All had successful placement of direct PEJ tube. There was a single complication. Within 24 hours of PEJ placement, 16 of 17 patients tolerated jejunal feedings. All patients progressed to their established nutritional goals. There were no cases of aspiration of enteral feedings. In the 16 patients, total parenteral nutrition (TPN) was not required once PEJ tubes were placed. Thirteen patients were discharged home or to a rehabilitation facility with jejunal feedings. Conclusions: Direct PEJ placement is a safe and reliable device that can be successfully placed in critically ill, mechanically ventilated patients. With this procedure, all patients can meet their nutritional requirements and eliminate the need for TPN. Copyright © 2002 by W.B. Saunders Company

Results of Direct Percutaneous Endoscopic Jejunostomy, an Alternative Method for Providing Jejunal Feeding

To assess the results of direct percutaneous endoscopic jejunostomy (DPEJ) as a method for jejunal feeding. We conducted a retrospective study of all patients who were referred for DPEJ between October 1998, when the procedure was implemented at our institution, and January 2000. Medical records were reviewed to assess technical success, complications, and the need for repeat procedures. Patient satisfaction with DPEJ was also evaluated by means of standardized telephone interviews. In 26 (72%) of 36 patients, DPEJ placement was successful. During the mean follow-up of 107 days, none of the patients with DPEJ required reintervention for tube malfunction or displacement. Two patients developed a persistent enterocutaneous fistula following the removal of the DPEJ tube. No other procedure-related complications were noted. Fifteen (78%) of 19 patients who responded to follow-up questions reported an overall satisfaction rating of 8 or higher on a 10-point scale (1, completely dissatisfied, to 10, completely satisfied). We conclude that DPEJ is an effective and safe method for providing jejunal tube feeding. A low reintervention rate along with high patient satisfaction makes DPEJ an attractive alternative to the more commonly placed jejunostomy feeding tubes.