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

Abstract

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 I2 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, I2 73.1) and 96.9 % (CI, 95.0–98.0, I2 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, I2 33) and 98.7 % (CI, 95.5–99.6, I2 < 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.

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

“…Technical failures are reported mostly because of limited enteroscope advancement in patients with a history of abdominal surgery and adhesions. DPEJ by DAE has a significant adverse event rate of 3.5 % [273][274][275][276]; these include bleeding and SB perforation. DAE-assisted PEJ can represent an alternative to surgical jejunostomy according to local availability and expertise.…”

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

“…Buneo et al reported a case series of DPEJ in esophagectomy patients with overall low incidence PEJ related complications 15 . Recent metanalysis has investigated DPEJ and PEG-J across several patient populations with limited numbers of RYGB included within these studies 23 . Al-Bawardy et al included 17 RYGB patients in their 94-patient single center study, Strong et al included 19 RYGB patients in their 59 cases, and Wong Kee Song et al included two RYGB in their cohort of 33 patients 4 12 24 .…”

“…With the growing number of patients receiving bariatric surgeries within the US, our study demonstrates that DPEJ can be successfully performed in RYGB. Endoscopic driven enteral feeding tube placement more often has shorter procedure times, less cost, less exposure to anesthesia, and quicker recovery time when compared to surgery 23 . The low procedural failure rate (11%) was secondary to appropriate parameters to avoid endoscopic placement given inability to find ideal transillumination or an inflamed jejunum unsuitable for DPEJ placement.…”

“…Buneo et al reported a case series of DPEJ in esophagectomy patients with overall low incidence PEJ related complications [15]. Recent metanalysis has investigated DPEJ and PEG-J across several patient populations with limited numbers of RYGB included within these studies [23] [4,12,24]. These studies, however, did not perform stratified analysis of RYGB patients with regards to procedure success and other outcome variables.…”

“…Our overall procedure success and complication rate is comparable to those amongst other studies. [23] Regarding RYGB patients, our study sheds light on the safety and efficacy of DPEJ placement based on specific procedure components in both the inpatient and outpatient setting. SBE and DBE are routine employed however small bowel push enteroscopy was effectively implemented in those with lower BMIs.…”