Outcome of direct percutaneous endoscopic jejunostomy tube placement for nutritional support in critically ill, mechanically ventilated patients

Barrera, Rafael; Schattner, Mark; Nygard, Stephen; Ahdoot, Michael; Ahdoot, Allan; Adeyeye, Samuel; Groeger, Jeffrey S.; Shike, Moshe

doi:10.1053/jcrc.2001.30667

Cited by 27 publications

(15 citation statements)

References 26 publications

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“…14 However, as indicated previously, gastric feedings may fail because many critically ill patients have delayed gastric emptying. [8][9][10][11][12][13]21,22 Gastric dysfunction can range from a mild delay in gastric emptying to marked gastroparesis. When motility is only mildly impaired, intragastric feedings may be tolerated (although perhaps at a less than desirable flow rate) (Fig 1).…”

Section: Gastric Feedingsmentioning

confidence: 99%

Effect of gastrointestinal motility and feeding tube site on aspiration risk in critically ill patients: a review

2004

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Section: Gastric Feedingsmentioning

confidence: 99%

Effect of gastrointestinal motility and feeding tube site on aspiration risk in critically ill patients: a review

2004

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“…Several techniques have been described, such as the "T" pexies triangulation system, magnetic jejunal anchors, and overtube maintenance during bumper pulling or with fluoroscopy guidance (8)(9)(10)(11)(12)(13)(14)(15). In spite of all different approaches, DPEJ is considered to be a technically difficult procedure with success rates ranging from 68% to 100% (3,16). We present our experience of single-balloon enteroscopy (SBE)-assisted DPEJ placement without fluoroscopy and maintaining the overtube during the pull maneuver only for distal jejunal loops.…”

Section: Introductionmentioning

confidence: 99%

Direct percutaneous endoscopic jejunostomy using single-balloon enteroscopy without fluoroscopy: a case series

et al. 2017

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Background: 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.Methods: 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.Results: 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%.Conclusion: 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.

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“…Additionally, most papers report on rather small numbers of investigated procedures that further limit their scientific yield [4,5,6,7]. While most authors reported on success rates which appear to be markedly lower than in PEG placement [8,9,10], short- and long-term complications are widely unknown and studies comparing PEJs and Jet-PEGs, which may be used alternatively, are almost completely lacking.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Endoscopic Jejunostomy and Jejunal Extension Tube through Percutaneous Endoscopic Gastrostomy: A Retrospective Analysis of Success, Complications and Outcome

Zopf¹,

Rabe

Bruckmoser³

et al. 2009

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Background: Percutaneous access to the jejunum is an important approach if gastrostomy feeding is not possible. Objective: To analyze success, short- and long-term complications (STCs, LTCs) in patients with percutaneous endoscopic jejunostomy (PEJ) and jejunal access through percutaneous endoscopic gastrostomy (Jet-PEG). Methods: A retrospective analysis of endoscopically placed PEJs and Jet-PEGs. Success rates, mortality, STCs and LTCs were investigated for risk factors comprising demographic data, underlying disease, previous surgery and experience of the endoscopist. Results: 205 PEJ and 58 Jet-PEG placements were included in the study. PEJs and Jet-PEGs were successfully placed in 65.4 and 89.7%, respectively. Billroth II surgery predisposed in favor of a significantly higher success rate for PEJ placement (p = 0.014, OR = 2.27). Inexperienced examiners have a significantly (p = 0.040) lower success rate for tube insertion than examiners with a medium level of experience. STCs and LTCs occurred evenly in PEJ and Jet-PEG patients. Dislocation of the tube occurred significantly more frequently in Jet-PEG patients (33.3%, p = 0.005). Aspiration was most common for bedridden patients. Conclusion: PEJ has a significantly lower success rate for insertions, but fewer LTCs. The experience of the endoscopist correlates with the success rate of tube insertion.

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Outcome of direct percutaneous endoscopic jejunostomy tube placement for nutritional support in critically ill, mechanically ventilated patients

Cited by 27 publications

References 26 publications

Effect of gastrointestinal motility and feeding tube site on aspiration risk in critically ill patients: a review

Effect of gastrointestinal motility and feeding tube site on aspiration risk in critically ill patients: a review

Direct percutaneous endoscopic jejunostomy using single-balloon enteroscopy without fluoroscopy: a case series

Percutaneous Endoscopic Jejunostomy and Jejunal Extension Tube through Percutaneous Endoscopic Gastrostomy: A Retrospective Analysis of Success, Complications and Outcome

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