Direct percutaneous endoscopic jejunostomy tube placement using a fine needle for jejunal anchoring

Karhadkar, Arati S.; Rengen, Mohan; Dubin, Ethan; Schwartz, Howard J.; Dutta, Sudhir K.

doi:10.1055/s-2006-925159

Cited by 3 publications

(2 citation statements)

References 0 publications

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“…The seeker needle is then used to determine an optimal position prior to the trocar/needle pass. Grasping the tip of the seeker needle with a snare or a forceps helps to stabilize the jejunal segment and allows proper orientation for insertion of the larger trocar/needle alongside the indwelling seeker needle [41]. As described for the "pull" PEG insertion technique, a dedicated thread/wire is advanced through the plastic sheath by the second operator (after the trocar has been withdrawn).…”

Section: Percutaneous Endoscopic Gastrostomy With Jejunal Extension (mentioning

confidence: 99%

Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2020

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Main recommendationsESGE recommends the “pull” technique as the standard method for percutaneous endoscopic gastrostomy (PEG) placement.Strong recommendation, low quality evidence.ESGE recommends the direct percutaneous introducer (“push”) technique for PEG placement in cases where the “pull” method is contraindicated, for example in severe esophageal stenosis or in patients with head and neck cancer (HNC) or esophageal cancer.Strong recommendation, low quality evidence.ESGE recommends the intravenous administration of a prophylactic single dose of a beta-lactam antibiotic (or appropriate alternative antibiotic, in the case of allergy) to decrease the risk of post-procedural wound infection.Strong recommendation, moderate quality evidence.ESGE recommends that inadvertent insertion of a nasogastric tube (NGT) into the respiratory tract should be considered a serious but avoidable adverse event (AE).Strong recommendation, low quality evidence.ESGE recommends that each institution should have a dedicated protocol to confirm correct positioning of NGTs placed “blindly” at the patient’s bedside; this should include: radiography, pH testing of the aspirate, and end-tidal carbon dioxide monitoring, but not auscultation alone.Strong recommendation, low quality evidence.ESGE recommends confirmation of correct NGT placement by radiography in high-risk patients (intensive care unit [ICU] patients or those with altered consciousness or absent gag/cough reflex).Strong recommendation, low quality evidence.ESGE recommends that EN may be started within 3 – 4 hours after uncomplicated placement of a PEG or PEG-J.Strong recommendation, high quality evidence.ESGE recommends that daily tube mobilization (pushing inward) along with a loose position of the external PEG bumper (1 – 2 cm from the abdominal wall) could mitigate the risk of development of buried bumper syndrome.Strong recommendation, low quality evidence.

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Section: Percutaneous Endoscopic Gastrostomy With Jejunal Extension (mentioning

confidence: 99%

Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2020

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“…Thereafter, the same seeker needle will be used to anchor the jejunal loop against the abdominal wall and determine the optimal direction that the trocar should follow to safely penetrate the jejunal wall. To do this, the seeker needle can be grasped using a polypectomy snare once endoscop-ically identified in the jejunal loop [15], thus stabilizing it. Similarly to the ‘pull’ PEG technique, attention should be paid for gas bubbles within the seeker needle before it is seen endoscopically, since that could be indicative of the inadvertent puncture of an interposed viscus.…”

Section: How Should I Place a Direct Percutaneous Endoscopic Jejunost...mentioning

confidence: 99%

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

Gkolfakis

Arvanitakis

2022

Current Opinion in Gastroenterology

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Purpose of reviewThe 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.Recent findingsDPEJ 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.SummaryDPEJ 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.

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