Tube dysfunction following percutaneous endoscopic gastrostomy and jejunostomy

Wolfsen, Herbert C.; Kozarek, Richard A.; Ball, Terrence J.; Patterson, David J.; Botoman, V. Alin

doi:10.1016/s0016-5107(90)71019-x

Cited by 140 publications

(58 citation statements)

References 16 publications

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“…DiSario et al [17] found the incidence of aspiration to be as high as 60%, whereas Patterson et al [18] reported no episode. Kaplan et al [19] and Wolfsen et al [20] found the incidence of aspiration in their series to be 13 and 17%, respectively. In our study, we determined aspiration in 18% of PEJ and in 31% of Jet-PEG patients.…”

Section: Discussionmentioning

confidence: 99%

“…Wolfsen et al [20] actually encountered Jet-PEG tube dislocation in 53%. The reason can probably be found in the position of the gastric stoma: if it is directed cranially, the jejunal tube produces an intragastric loop which is predisposed to dislocation; in case of a stoma directed towards the pylorus, the jejunal tube usually is placed in a stable position.…”

Section: Discussionmentioning

confidence: 99%

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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

Digestion

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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

Digestion

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“…DiSario et al [5] reported a surprising incidence of 67% aspiration with PEJ. While it was not clear from Wolfsen's report [20] where the tip of the PEJ was positioned, in DiSario's series [5] the tip was placed in the second or third position of the duodenum. It has also been observed that there is proximal migra- Fig.…”

Section: Discussionmentioning

confidence: 97%

“…Endoscopic percutaneous jejunostomies have been used by some authors [2,10,17] with promising results. Recently, Wolfsen et al [20] showed a 17% incidence of aspiration after PEJ placement in contrast to only 5% with PEGs. DiSario et al [5] reported a surprising incidence of 67% aspiration with PEJ.…”

Section: Discussionmentioning

confidence: 99%

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Concomitant placement of percutaneous endoscopic gastrostomy and jejunostomy

et al. 1992

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Percutaneous endoscopic gastrostomies have gained wide use for long-term enteral nutrition. However, gastroesophageal reflux and aspiration pneumonia have occurred following this procedure. Initial enthusiasm concerning the ability of intrajejunal feeding to negate the risk of aspiration has been challenged by some reports. In this report, a new method is described for concomitant placement of endoscopic gastrostomy and feeding jejunostomy wherein the tip of the feeding jejunostomy is placed at least 40 cm distal to the pylorus while the gastrostomy tube is used for drainage. Twenty critically ill patients underwent the procedure utilizing general or local anesthesia. Sixty-day follow-up showed one uneventful episode of pulmonary aspiration (5%) after retrograde migration of the jejunal tube into the duodenum. All but two patients (90%) tolerated their tube feedings well. This technique can be easily performed with accurate placement of the PEJ tube distal to the pylorus and is associated with minimal risk of aspiration.

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The Efficacy and Limitations of Percutaneous Endoscopic Gastrostomy

Jarnagin

Duh²,

Mulvihill³

et al. 1992

Arch Surg

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We analyzed 64 percutaneous endoscopic gastrostomy procedures performed by us between 1986 and 1990. Thirty patients had neurologic disease; 16 had head and neck cancers; eight had other malignancies; two had acquired immunodeficiency syndrome; and eight had other problems. Seven patients died within 30 days of complications (n = 4) or the primary illness (n = 3). Mean follow-up was 6 months; an additional patient died of aspiration and eight others died of their underlying illness. There were 19 complications (32%). Four wound complications occurred. Nine patients developed aspiration pneumonia within 3 days of the procedure, four of whom died in the hospital. Of the 24 patients with a history of aspiration, nine experienced aspiration during or after percutaneous endoscopic gastrostomy. Patients with a history of aspiration were more likely to have perioperative aspiration pneumonia, and patients who experienced aspiration were more likely to die.

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Tube dysfunction following percutaneous endoscopic gastrostomy and jejunostomy

Cited by 140 publications

References 16 publications

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

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

Concomitant placement of percutaneous endoscopic gastrostomy and jejunostomy

The Efficacy and Limitations of Percutaneous Endoscopic Gastrostomy

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