Direct Percutaneous Endoscopic Jejunostomy Research Articles

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

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.

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 tube placement in patients post Roux-en-Y gastric bypass, a single tertiary care center experience

Background and study aims Obesity prevalence continues to rise in the United States with Roux-en-Y gastric bypass (RYGB) surgery being one of the most common bariatric procedures. With this trend, more patients with altered upper gastrointestinal (UGI) anatomy have required endoscopic intervention including direct percutaneous endoscopic jejunostomy (DPEJ) placement. We aimed to assess the safety and success rates of DPEJ in RYGB patients. Patients and methods All patients at a tertiary care referral center who underwent DPEJ during an 8-year period were queried from a prospectively maintained registry of all enteroscopy procedures. Duplicate cases and altered upper UGI anatomy subtypes other than RYGB were excluded. The final cohort consisted of two groups: RYGB vs native anatomy (NA). Demographic, procedural, readmission, follow-up, and complication data were recorded. Comparative analysis was performed. Results Seventy-two patients were included where 28 had RYGB and 44 had NA. Both groups had similar baseline and pre-procedure data. Procedure success rate was 89 % in RYGB patients and 98 % in NA patients ( P = 0.13). There were no intraprocedural complications. Early and late postprocedural complication rates were similar between the groups (both 4 % vs 7 %). Average follow-up times in the RYGB and NA groups were 12.97 ± 9.35 and 13.44 ± 9.21 months, respectively. Although readmission rates at 1 and 6 months were higher in the NA versus the RYGB group (21 % vs 7 % and 25 % vs 15 %), these differences were not significant. Conclusions DPEJ can be successful and safely placed in RYGB patients with no significant difference in procedure success, complication, or readmission rates when compared to control.

The Outcomes of Nutritional Support Techniques in Patients with Gastrointestinal Cancers

Gastrointestinal cancers represent a major cause of morbidity and mortality worldwide. A significant issue regarding the therapeutic management of these patients consists of metabolic disturbances and malnutrition. Nutritional deficiencies have a negative impact on both the death rates of these patients and the results of surgical or oncological treatments. Thus, current guidelines recommend the inclusion of a nutritional profile in the therapeutic management of patients with gastrointestinal cancers. The development of digestive endoscopy techniques has led to the possibility of ensuring the enteral nutrition of cancer patients without oral feeding through minimally invasive techniques and the avoidance of surgeries, which involve more risks. The enteral nutrition modalities consist of endoscopy-guided nasoenteric tube (ENET), percutaneous endoscopic gastrostomy (PEG), percutaneous endoscopic gastrostomy with jejunal tube extension (PEG-J), direct percutaneous endoscopic jejunostomy (DPEJ) or endoscopic ultrasound (EUS)-guided gastroenterostomy.

Direct percutaneous endoscopic jejunostomy (DPEJ) and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) technical success and outcomes: Systematic review and meta-analysis.

Background and study aims Endoscopic methods of delivering uninterrupted feeding to the jejunum include direct percutaneous endoscopic jejunostomy (DPEJ) or PEG with jejunal extension (PEG-J), validated from small individual studies. We aim to perform a meta-analysis to assess their effectiveness and safety in a variety of clinical scenarios. Methods Major databases were searched until June 2021. Efficacy outcomes included technical and clinical success, while safety outcomes included adverse events (AEs) and malfunction rates. We assessed heterogeneity using I 2 and classic fail-safe to assess bias. Results 29 studies included 1874 patients (983 males and 809 females); mean age of 60 ± 19 years. Pooled technical and clinical success rates with DPEJ were 86.6 % (CI, 82.1–90.1, I 2 73.1) and 96.9 % (CI, 95.0–98.0, I 2 12.7). The pooled incidence of malfunction, major and minor AEs with DPEJ were 11 %, 5 %, and 15 %. Pooled technical and clinical success for PEG-J were 94.4 % (CI, 85.5–97.9, I 2 33) and 98.7 % (CI, 95.5–99.6, I 2 < 0.001). The pooled incidence of malfunction, major and minor AEs with DPEJ were 24 %, 1 %, and 25 %. Device-assisted DPEJ performed better in altered gastrointestinal anatomy. First and second attempts were 87.6 % and 90.2 %. Conclusions DPEJ and PEG-J are safe and effective procedures placed with high fidelity with comparable outcomes. DPEJ was associated with fewer tube malfunction and failure rates; however, it is technically more complex and not standardized, while PEG-J had higher placement rates. The use of balloon enteroscopy was found to enhance DPEJ performance.

Percutaneous endoscopic jejunostomy: when, how, and when to avoid it.

The current review summarizes current evidence regarding the indications, contraindications, and technical aspects of placing a direct percutaneous endoscopic jejunostomy (DPEJ), as well as procedure-related and patient-related outcomes. DPEJ is indicated for patients who require long-term (>4 weeks) jejunal nutrition due to existing altered foregut anatomy (e.g., previous gastrectomy) or because the gastric route is not an option (e.g., due to high risk of aspiration, intolerance, gastroparesis). DPEJ may also offer decompression of the gastrointestinal tract in cases of small bowel obstruction (e.g., peritoneal carcinomatosis). Absolute contraindications include active peritonitis, uncorrectable coagulopathy, and ongoing bowel ischemia. Technically, the 'pull' technique using a paediatric colonoscope will be sufficient for most cases. Recent publications demonstrate high rates of technical success (>85%), while patient outcomes do not differ among patients undergoing percutaneous endoscopic gastrostomy (PEG) and those undergoing DPEJ. Obesity is a risk factor for technical failure, while age more than 80 years, diabetes mellitus, and ongoing inflammatory status may be considered risk factors for DPEJ-associated mortality. DPEJ is a safe and efficacious modality for long-term jejunal nutrition with an acceptable risk of mild complications. Careful patient selection and respect of preprocedural, periprocedural, and postprocedural precautions are of the utmost importance to ensuring a favourable outcome.

Effectiveness of decompression catheter placement through direct percutaneous endoscopic jejunostomy (DPEJ) into the remnant stomach for a case of impaired gastric drainage after distal gastrectomy

Effectiveness of decompression catheter placement through direct percutaneous endoscopic jejunostomy (DPEJ) into the remnant stomach for a case of impaired gastric drainage after distal gastrectomy

Prognostic outcomes after direct percutaneous endoscopic jejunostomy in elderly patients: comparison with percutaneous endoscopic gastrostomy

Direct percutaneous endoscopic jejunostomy (DPEJ) is an alternative method of enteral feeding to percutaneous endoscopic gastrostomy (PEG). Although long-term outcomes of PEG have been reported, little is known regarding the outcomes of DPEJ. A retrospective cohort study was conducted including 115 and 651 consecutive attempts of DPEJ and PEG, respectively, in a total of 766 elderly patients between April 2004 and March 2019. Patients' clinical background, procedural and long-term outcomes, survival analysis, and cause of death were analyzed. Successful placement rates were 93.9% and 97.1% for DPEJ and PEG, respectively. There was no significant difference in procedure-related adverse events (AEs) between the DPEJ and PEG groups. Rates of pneumonia, vomiting, and upper GI bleeding were significantly lower, whereas those of fistula enlargement and ileus were significantly higher in the DPEJ group as long-term AEs. The median survival periods were 694 and 734 days for DPEJ and PEG, respectively, with no significant differences between the 2 groups. Multivariate analysis revealed that age 80 years old or older, C-reactive protein level of 1.0 mg/dL or higher, and the presence of diabetes were independent risk factors for mortality after DPEJ. Respiratory tract infection was the primary cause of death in both groups. DPEJ is considered a safe and feasible method of access for enteral feeding as well as PEG. Although the survival period after DPEJ may be expected to be as long as that with PEG, DPEJ-specific AEs should be kept in mind on long-term feeding.

S1306 Outcomes of Enteroscopy-Assisted Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Tube Placement – A Single Center Experience

INTRODUCTION: To study and report the clinical experience of direct percutaneous endoscopic jejunostomy (DPEJ) in a single tertiary care center. METHODS: Forty-eight (48) patients underwent DPEJ tube placement over the last 6 years (9/2013-10/2019) at a single tertiary care center. The main outcome measurements were a technical success in native and altered anatomy, and short- and long-term follow up. DPEJ was attempted in 48 patients – 63% females, age 52.5 ± 15.4 years, BMI 21.1 ± 6.8 kg/m2. Indications included gastroparesis (n = 12), Parkinson’s disease (n = 4), chronic pancreatitis (n = 7), chronic malnutrition with multiple abdominal surgeries (n = 12), intractable nausea and vomiting (n = 8) and others (n = 5). RESULTS: DPEJ was successful in 42/48 (87.5%) patients. It was placed using double-balloon enteroscopy (DBE) in 34 patients, single balloon enteroscopy in 1 patient, and push enteroscopy in 7 patients based on the endoscopist’s discretion and experience. Technical failures were due to lack of trans-illumination (n = 4), ventral hernia (n = 1), and previous adhesions hampering the advancement of the DBE (n = 1). All these patients underwent DBE to attempt the placement of DPEJ. Thirty-day complications were very few. There was no difference in the complications between altered and native anatomy (29% vs 20%, P = 0.32). There was no difference in the other outcomes (failure rates, tube removed, duration of PEJ tube) as well between the two groups. DPEJ was a short term bridge for 14 patients with a mean time to removal being 8 ± 7 months. Only one patient requested the DPEJ to be removed after 4 months due to discomfort and did not require any other supplemental nutrition. Patients who had DPEJ removed had a significant improvement in their serum albumin as compared to the patients who did not have their removed DPEJ removed (1 ± 0.6 g/dL vs 0.4 ± 0.5 g/dL, P = 0.05). 61% of all patients did not have the DPEJ removed. The mean duration of follow up in those patients was 23 ± 17 months with the first tube lasting for a mean duration of 12 ± 8 months and requiring exchanges of DPEJ. CONCLUSION: DPEJ is associated with a high technical success rate that is not influenced by altered anatomy and offers nutritional support with a low perioperative complication rate. It can often be used as a short term bridging therapy in some patients.Table 1.: Demographics of the 48 patients who underwent enteroscopy-assisted direct percutaneous endoscopic jejunostomy procedure

Direct Percutaneous Endoscopic Jejunostomy for the Management of Gastroparesis in Pregnancy

Providing meaningful nutrition in cases of refractory hyperemesis during pregnancy can be challenging; although intragastric enteral nutrition is the most common approach, it is contraindicated in certain cases and carries the risk of increased nausea and vomiting. A 36-year-old primigravid woman with a history of gastroparesis presented at 16 weeks of gestation with nausea and vomiting. With no improvement with conventional approaches and signs of malnutrition, a direct percutaneous endoscopic jejunostomy was placed. Her nutritional status improved, and the pregnancy ended in the delivery of a healthy neonate. Direct percutaneous endoscopic jejunostomy in pregnancy is an option in patients in whom intragastric feeding is contraindicated and may offer a more secure approach than percutaneous gastrojejunostomy.

Direct Percutaneous Endoscopic Jejunostomy: Procedural and Nutrition Outcomes in a Large Patient Cohort.

Direct percutaneous endoscopic jejunostomy (DPEJ) is used for enteral nutrition (EN) in patients with postoperative anastomotic leaks after esophagectomy/gastrectomy and at high risk for aspiration. We characterized the indications, technical success, procedural/nutrition outcomes, and adverse events in a large cohort of patients undergoing DPEJ insertion. Patients undergoing DPEJ insertion between January 2009 and March 2015 were identified from an institutional endoscopy database. Demographic, procedural, and nutrition outcome data were collected from electronic medical records. Regression analyses were used to identify predictors of adverse events and procedural success. A total of 452 patients underwent 480 attempts at DPEJ insertion. Indications included preoperative or postoperative weight loss (64%), postoperative upper gastrointestinal (UGI) anastomotic leak (13%), aspiration prevention (10%), and other (13%). Of attempted procedures, 398 (83%) were successful. Feeding was initiated in 389 (98%) of patients; a median of 1775 calories was delivered daily. Median body mass index (BMI) at baseline was 22.9 (11.4-44.7) and did not change over follow-up. Median change in BMI after DPEJ was similar in groups that received EN with palliative and curative intent. Adverse events following 480 attempted DPEJ insertions included 13 (3%) immediate and 74 (15%) delayed, 13 (3%) of which were serious. Patients with head and neck cancer had more adverse events than those with esophageal cancer (P = .020). DPEJ is a successful and safe procedure that effectively provides access for EN support in malnourished patients and patients with postoperative UGI cancer.

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.

Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Tube Placement: A Single Institution Experience and Outcomes to 30 Days and Beyond

IntroductionPatients with prior foregut surgery requiring long-term enteral access typically undergo operative jejunostomy tube placement; however, direct percutaneous endoscopic jejunostomy (DPEJ) is a viable alternative. MethodsAll de novo DPEJ procedures performed by surgical and advanced endoscopists from May 2003 to June 2015 were retrospectively reviewed following approval by the Institutional Review Board. There were 59 cases identified. ResultsOur cohort had a mean age of 50.3±16.9 years and 35 (59.3%) were female. All but two patients previously had foregut surgery including 19 patients (34.5%) with prior bariatric surgery. The composite of malnutrition and dehydration was the indication for DPEJ in 29 patients (49.1%) and was the initial enteral access placed in 47 patients (79.7%). Moderate sedation was used in 32 cases (54.2%), and 29 procedures (49.2%) were performed in the operating room. Within 30 days, there were six complications in five patients, giving a peri-procedural complication rate of 12.5%. Beyond 30 days, the most common complications were peri-tube leakage and dislodgement (each 16.9%). The median time to complication was 197 days. ConclusionsIn patients with surgically altered foregut anatomy, DPEJ offers a less invasive alternative to operative jejunostomy tube placement. DPEJ can be placed in the endoscopy suite or operating room with an acceptable risk of perioperative complications.

PTU-103 How Best to Deliver Enteral Access for Post-Pyloric Home Enteral Tube Feeding? A 2-Year Review

Introduction Home enteral tube feeding (HETF) has grown in the past 2 decades and there is now also a growing demand for post-pyloric HETF (PP-HETF) for selected cases. 1,2 The optimum route for delivering this is not established, with several options available including surgical jejunostomy (SJ), direct percutaneous endoscopic jejunostomy (DPEJ), and PEG with jejunal extension (PEG-J). We have reviewed our experience to help identify comparative outcomes. Methods Choice of feeding device was clinician-led according to indication, surgical and endoscopic risk. A 2 year review was done from Jan 2014 onwards. Patients were included if they were (1) already undergoing PP-HETF as of January 2014 or (2) had an interventional procedure to start PP-HETF at any time thereafter during the study period. Cases were identified from the community dietetic and electronic endoscopy databases. Case files were reviewed to identify outcome measures which were categorised as: Success of planned procedures; longevity of feeding device, premature removal (removal because of sepsis, migration, blockage or accidental), procedural complications or mortality Results 26 patients were identified (M:F 14:12, median age 55, range 22–83). Indications for PP-HETF were learning difficulties with Gastro-oesophgeal(GO) reflux (8), neurodegenerative or cerebrovascular disease with GO reflux (5), upper GI cancers(9) & others (4). Feeding interventions done successfully prior to or during the study period were SJ (10), DPEJ (14), PEG-J (14).Procedural success rates during study period were; SJ; 10/10 (100%), DPEJ;7/11 (64%), PEG-J; 12/13 (92%).Longevity of feeding devices at review census point (in months, median & range) was: SJ, 11 (3–23); DPEJ,18 (3–48); PEG-J, 6 (0.25–23). Tube premature removal rates (and reasons) were: SJ; 3/10 (30%; all fell out), DPEJ; 3/14(21%; 1 accidental, 2 infected), PEG-J; 6/14 (43%; 4 accidental, 2 blocked). There were no procedural complications recorded but one patient (DPEJ) died Conclusion In this case series which includes similar numbers of the common PP-HETF options, SJ had the highest, and DPEJ the lowest, procedure success rate.DPEJ had the highest longevity. Choice of feeding device for PP-HETF will depend on co-morbidity and surgical/ endoscopic risk but when DPEJ can be placed this may be the preferred option for long-term feeding. References 1 Ojo O. Managing patients on enteral feeding tubes in the community. Br J Community Nurs 2010; 15 :S6–S13. 2 Ojo O. The challenges of home enteral tube feeding: a global perspective. Nutrients 2015; 7 (4):2524–2538. doi:10.3390/nu7042524. Disclosure of Interest None Declared

Mo1377 Direct Percutaneous Endoscopic Jejunostomy - Procedural and Nutritional Outcomes in a Large Patient Cohort

Mo1377 Direct Percutaneous Endoscopic Jejunostomy - Procedural and Nutritional Outcomes in a Large Patient Cohort

Outcomes of double-balloon enteroscopy-assisted direct percutaneous endoscopic jejunostomy tube placement.

In a large series, conventional direct percutaneous endoscopic jejunostomy (DPEJ) tube placement with push endoscopes failed in approximately one-third of patients. In a pilot study, double-balloon enteroscopy (DBE)-assisted DPEJ tube placement was successful in all patients in whom attempted conventional DPEJ had failed. The study aim was to assess the technical success of and adverse events related to DBE-DPEJ tube placement in a large cohort of patients. The medical records of all patients who underwent DBE-DPEJ tube placement between July 2010 and November 2013 were reviewed using a prospectively maintained electronic database. Data were abstracted for patient demographics, indications for DPEJ, gut anatomy, technical success rate, causes of failure, and adverse events. The study comprised a total of 94 patients (39 men; mean age 56 years; body mass index [BMI] 23 ± 6.4 kg/m(2)). The most common indication for DPEJ was gastroparesis (n = 29). Altered gut anatomy was present in 36 patients (38 %). DBE-DPEJ tube placement was technically successful in 87 patients (93 %). The mean procedure duration was 33 minutes (range 15 - 88). DBE-DPEJ tube placement failed in seven patients (7 %), primarily because of limited instrument advancement in the setting of presumed surgical adhesions. Post-procedural adverse events occurred in eight patients (9 %), with one serious adverse event, which was a gastric interposition requiring surgical repair. Compared with the published outcomes of DPEJ by conventional endoscopy, DBE-DPEJ tube placement was technically successful in a high proportion of patients (93 %) and with a relatively low rate of significant adverse events.

Management of Postprandial Hypoglycemia due to Late Dumping Syndrome after Direct Percutaneous Endoscopic Jejunostomy (D-PEJ) with Miglitol and an Isomaltulose-containing enteral formula

Management of Postprandial Hypoglycemia due to Late Dumping Syndrome after Direct Percutaneous Endoscopic Jejunostomy (D-PEJ) with Miglitol and an Isomaltulose-containing enteral formula

Endoscopic Management of Esophageal Anastomotic Leaks After Surgery for Malignant Disease

Esophageal anastomotic leaks after cancer surgery remain a major cause of morbidity and mortality. Endoscopic interventions, including covered metal stents (cSEMS), clips, and direct percutaneous endoscopic jejunostomy (dPEJ) tubes are increasingly used despite limited published data regarding their utility in this setting. This study aimed to determine the efficacy and safety of a multimodality endoscopic approach to anastomotic leak management after operation for esophageal or gastric cancer. We performed a retrospective review of prospectively maintained databases of gastric and esophageal operations at our hospital between January 2003 and December 2012. Included patients had an operation for esophageal or gastric cancer, demonstrated evidence of an anastomotic leak at the esophageal anastomosis, and underwent attempted endoscopic therapy. Healing was defined as clinical and radiographic leak resolution. Forty-nine patients with leaks underwent endoscopic management. Of the 49 patients, 31 (63%) received cSEMS, 40 (82%) had dPEJ tubes inserted, and 3 (6%) received clips. Twenty-three (47%) patients underwent a combined approach. Overall, 88% of patients achieved healing in a median of 83 days. Twenty-two of 23 patients (96%) who underwent a multimodality endoscopic approach healed. Only 1 patient had a major complication associated with stent erosion into the pulmonary artery, which was successfully treated with operative repair. Esophageal anastomotic leaks after esophageal and gastric cancer operations can be managed successfully and safely with endoscopic therapy. Combining cSEMS for leak control and dPEJ tube placement for nutritional support was highly effective in achieving healing, without the need for surgical repair.

Long-term outcomes of direct percutaneous endoscopic jejunostomy: a 10-year cohort.

Study aim: To assess the clinical outcomes of patients who received direct percutaneous endoscopic jejunostomy (DPEJ) for enteral feeding. Materials and methods: This is a 10-year cohort study in a single tertiary center. Main outcome measurements were technical success, and short- and long-term outcomes. DPEJ was attempted in 83 patients (51 men; 55 ± 2 years) for dysphagia (n = 35), gastroparesis with recurrent aspiration (n = 30), and levodopa drug infusion for severe Parkinson’s disease (n = 18). Results: DPEJ was successful in 75 (90 %) patients. All technical failures were related to the inability to find adequate trans-illumination, and were not influenced by BMI, age, gender, or indication. Peri-operative (30-day) adverse events occurred in 11 (13 %) patients, including wound infection (3), leakage around the stoma (4), minor bleeding requiring no intervention (2), and aspiration (1). There was one case (1.2 %) of gastric perforation after PEJ insertion for levodopa drug infusion trial. This 60-year-old woman required an emergency laparotomy with nil complications, and levodopa drug infusion recommenced successfully. One case of intestinal perforation (1.2 %) occurred after jejunostomy tube replacement at 6 months of insertion, which was successfully managed with surgery. There were no peri-operative deaths. Adequate delivery of enteral feeding or Duodopa drug was achieved in 66/73 (90 %) patients, with evidence of weight gain or improvement in Parkinson’s disease. Seven (8 %) continued to have clinical regurgitation but not aspiration. After a median follow-up of 84 months, 27 (33 %) patients died of their underlying diseases. Seven (8 %) had marked improvement in their underlying disease and had PEJ removed after 5 months (range 1 – 8 months). Limitations: Single center study. Conclusions: DPEJ is associated with a high technical success rate (90 %), a relatively low rate of peri-operative adverse events (13 %) and an improvement in long-term nutritional support in the majority of patients (90 %). DPEJ should be the procedure of choice to gain enteral access for feeding or drug delivery prior to considering surgery.

Mo1568 New Technique of Balloon-Overtube- and Fluoroscopy-Assisted Direct Percutaneous Endoscopic Jejunostomy in Patients With Surgically Altered Upper GI Tract Anatomy

Mo1568 New Technique of Balloon-Overtube- and Fluoroscopy-Assisted Direct Percutaneous Endoscopic Jejunostomy in Patients With Surgically Altered Upper GI Tract Anatomy