Concomitant placement of percutaneous endoscopic gastrostomy and jejunostomy

Abstract

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.

One‐step Percutaneous Gastrojejunostomy in Early Infancy

“…Gastrojejunal tubes are superior to nasojejunal tubes in terms of patient comfort and minimization of activity limitation. In parallel with jejunal feeding, the gastric tube can be used for decompression and drug administration; however, this technique requires the presence of a preexisting gastrostomy to allow the tube to be placed through a mature gastrostomy tract (6,7).…”

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

“…While PEG has gained wide use for long‐term enteral nutrition, jejunal feeding, such as PEGJ and direct percutaneous endoscopic jejunostomy (DPEJ), 18 is preferable to gastric delivery, particularly in the following situations: high risk of aspiration, gastric resection (partial or total),; gastric pull up, gastric outlet obstruction, obstructed or non‐functioning gastrojejunostomy, and gastric dysmotility 14 . Percutaneous endoscopic gastrjejunostomy is a concomitant placement of endoscopic gastrostomy and feeding jejunostomy in which a jejunostomy tube is inserted through a gastrostomy tube and the tip of the tube is placed at least 40 cm distal to the pylorus while the gastrostomy tube is used for drainage 3 . Such a tube has been called a PEJ in the literature 19 .…”

“…Therefore, it is dangerous to begin enteral feeding through PEG for patients with SMAS. Percutaneous endoscopic gastrojejunostomy (PEGJ) is thought to be one of the useful methods of solving this problem because the tube is put into the jejunum across the duodenal constrictive section 3 …”