Application of percutaneous endoscopic gastrostojejunostomy in a case of amyotrophic lateral sclerosis associated with the superior mesenteric artery syndrome

Abstract

A 64‐year‐old woman who was diagnosed as suffering from amyotrophic lateral sclerosis (ALS) of bulbar type was admitted to our hospital for long‐term care. After admission, she underwent percutaneus endoscopic gastrostomy (PEG) and enteral feeding was initiated. However, the PEG alimentation was disrupted by aspiration pneumonia owing to the superior mesenteric artery syndrome (SMAS), diagnosed by gross anatomy and endoscopic studies. Conservative treatment for SMAS was not successful and sepsis developed. After recovery from this, an operation was recommended, but it was rejected by her and her family members. We therefore selected the method of placing a thin jejunostomy tube through the PEG, called percutaneous endoscopic gastrojejunostomy (PEGJ) and pulling it endoscopically into the proximal jejunum, thereby allowing delivery of nutrients. Thereafter, she was well and showed gradual improvement of nutritional parameters such as serum albumin and total cholesterol, as well as the lymphocyte subset. It is concluded that PEGJ is effective for long‐term enteral nutrition in ALS patients complicated with SMAS.