A simple technique for insertion of PEJ via PEG

Abstract

Percutaneous endoscopic jejunostomy provides good access for enteral nutrition in those patients at high risk for aspiration and poor tolerance of gastric feeding. Positioning the jejunostomy tube through the PEG tube and into the duodenum can be difficult and time consuming. We describe a simple method for gaining rapid control of the jejunal tube and its duodenal insertion.

Recent experience with percutaneous endoscopic gastrostomy/jejunostomy (PEG/J) for enteral nutrition

“…Several approaches to PEG/J placement have been described [1,2,3,4,6,7,9,10,12,13,14]. These include using the biopsy forceps to pull the J-tube into the duodenum by a string attached to the tube [2,3] and threading the J-tube over a previously placed guidewire directly into the small intestine [1,6].…”

Enteral nutrition access devices

“…Jejunal extension tubes are inserted through certain larger diameter PEG tubes (Table 4). [28][29][30] These PEGJ tubes are available as a single kit. Extension tubes are also available individually.…”

Clinical management of post-pyloric enteral feeding in children

“…The presence of devices in the small intestine can also induce duodenogastric reflux [75][76][77][78] or aspiration [74,76,78,79]. JF may eventually become GF because of the formation of a fistula between the gastric and jejunal tubes [84].…”

“…Most jejunostomies are placed at least 20 cm beyond the ligament of Treitz. A PEJ can be inserted indirectly via a previously placed gastrostomy [51,73,74] or directly [75][76][77][78].…”