Direct Percutaneous Endoscopic Jejunostomy for the Management of Gastroparesis in Pregnancy

Abstract

Direct percutaneous endoscopic jejunostomy in pregnancy is an option in patients in whom intragastric feeding is contraindicated and may offer a more secure approach than percutaneous gastrojejunostomy.

Gastric electrical stimulation is safe during pregnancy and delivery: Results from a French cohort

“…Only one case report in nondiabetic gastroparesis was reported, which was treated by endoscopic jejunostomy; this ended in the delivery of a healthy neonate. 14 In this series, there were three pregnancies (18.8%) with gestational diabetes, which is similar to the overall prevalence of gestational diabetes in pregnancy, reported to be 13%. 18 As the prevalence of gestational diabetes rises with age, it should be noted that the patients in the presented report were 28, 35, and 40 years old at the time of delivery.…”

“…Reports about pregnancy in patients with gastroparesis are lacking. There are only some case reports in the literature 12–14 . Although the epidemiology of gastroparesis shows that the mean age at the diagnosis is around 50 years old, female predominance is reported in all studies, accounting for 63% to 69% of patients 5,15 .…”

“…There are only some case reports in the literature. [12][13][14] Although the epidemiology of gastroparesis shows that the mean age at the diagnosis is around 50 years old, female predominance is reported in all studies, accounting for 63% to 69% of patients. 5,15 Moreover, this condition is being more frequently diagnosed, with the number of hospitalizations increasing by 160% between 1995 and 2004.…”

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“…Other surgical options have been described including Per-endoscopic jejunostomy (PEJ), that is more technically challenging and per-endoscopic gastrotomy with Jejunal extension (PEG-J), an intervention that is plagued by the difficulties caused by ongoing vomiting and gastric coiling [20]. A prior case report described the successful placement of a percutaneous endoscopic jejunostomy in a pregnant patient with gastroparesis secondary to T1DM and proposed this as a more secure alternative to percutaneous gastrojejunostomy in those patients in whom intragastric feeding is contraindicated [2]. This procedure, however, has lower rates of successful placement because it requires deep bowel endoscopy, expertise that is not always accessible.…”

“…Traditionally diabetic gastroparesis has been considered a contraindication to pregnancy due to its potential risks to the life of the mother and her fetus, especially when presenting with hyperemesis gravidarum [1]. Management can be difficult and there are limited reports describing surgical treatment for refractory gastroparesis in the pregnant population [2,3].…”