Single-balloon enteroscopy-assisted direct percutaneous endoscopic jejunostomy

Abstract

Direct percutaneous endoscopic jejunostomy (DPEJ) has emerged as a viable alternative for percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) in patients who cannot tolerate gastric feeding. Reportedly, DPEJ placement with regular endoscopes fails in up to one-third of cases. The aim of the current study was to assess the efficacy and safety of single-balloon enteroscopy (SBE)-assisted DPEJ. The DPEJ placement technique was comparable to conventional PEG placement. A total of 12 DPEJ procedures were performed in 11 patients (mean age 55 years [range 24-83 years]; seven males). SBE-assisted DPEJ was successful in 11 of the 12 procedures (92%). Post-procedural complications included gastroparesis and aspiration pneumonia in one case each. We conclude that SBE-assisted DPEJ placement seems a safe and successful approach for patients requiring jejunal enteral feeding.

Double-balloon enteroscopy as a rescue technique for failed direct percutaneous endoscopic jejunostomy when using conventional push enteroscopy (with video)

“…PEJ placement via single-balloon enteroscopy may also be more successful than conventional DPEJ. 13 There are additional advantages for using BAE over standard push endoscopes for DPEJ placement. In contrast to push enteroscopy, BAE minimizes instrument looping within the stomach and small bowel, which can result in marked patient discomfort.…”

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

“…This procedure may be carried out with adult or pediatric endoscopes via a percutaneous gastrostomy orifice or with push enteroscopes or balloon-assisted enteroscopes. 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).…”

Endoscopic solutions to challenging enteral feeding problems

“…Refinement of DBE PEJ placement is currently being studied in porcine models, with the emphasis on improving jejunal stabilization with magnetic anchors [9]. Similar successful PEJ placement rates were also noted in a 12-case series using SBE [10]. These deep enteroscopy techniques may be more reliable compared with push enteroscopy because of more reliable jejunal access and because they create a more stable jejunal platform for PEJ placement.…”