Direct endoscopic percutaneous jejunostomy (EPJ)

Abstract

Direct puncture of the small bowel under endoscopic guidance (direct EPJ) is possible in patients whose stomach has been removed or whose small bowel cannot be punctured by other methods. From January 1990 to June 1992 a total of 39 patients underwent successful direct EPJ at our institution. The indications were malnutrition after partial or total gastrectomy (n = 19), insufficient anastomosis or a stenosis after esophageal resection and esophagojejunostomy (n = 13), esophageal perforation (n = 3), fistulas (n = 2), or severe trauma (n = 2). The tubes were inserted at the bedside under local anesthesia using the string pull-through technique. The procedure was attempted in five other patients but it was technically impossible to insert the tubes in these patients. Postoperative enteral feeding was possible in all 39 patients whose direct EPJ was successful. Complications included tube dysfunction due to plugging and fracture in five patients, pressure-induced enteric ulcers in two, and local infections in three patients. The ulcers and infections were managed conservatively. We conclude that direct EPJ is a safe, effective alternative to surgical catheter-jejunostomy.

Endoscopic Palliation and Nutritional Support in Advanced Gastric Cancer

“…D-EPJ can normally placed without problems in patients with partial or post-gastrectomy and is considerably more diffi cult prior to surgery [52][53][54] .…”

Internal Hernia with Small Bowel Volvulus in a Patient with Altered Gut Motility: A Complication of Direct Percutaneous Endoscopic Jejunostomy

“…Several series examining the safety of surgical jejunostomy and DPEJ have reported favorable results with few complications [4,[6][7][8][9]. Myers [7].…”

“…During the mean follow-up of 107 days, none of the patients with DPEJ required reintervention for tube malfunction or displacement. Mellert et al reported their experience with DPEJ in 44 patients over a 2-year period [9]. The predominant indication was malnutrition.…”

Endoscopic identification of the jejunum facilitates minimally invasive jejunostomy tube insertion in selected cases

“…For a Mayo clinic series, the success rate of direct percutaneous jejunostomy tube insertion was 73% [18]. The insertion of the PEJ carries a success rate of 64 to 92.3% [17,[19][20][21][22]. For ultrasound/fluoroscopically guided PEJ placement, the success rate is 87% [23].…”