Direct Percutaneous Endoscopic Jejunostomy: Procedural and Nutrition Outcomes in a Large Patient Cohort

Simoes, Priya; Woo, Kaitlin M.; Shike, Moshe; Mendelsohn, Robin B.; Gerdes, Hans; Markowitz, Arnold J.; Ludwig, Emmy; Shah, Pari; Schattner, Mark

doi:10.1002/jpen.1023

Cited by 19 publications

(20 citation statements)

References 26 publications

(35 reference statements)

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“…The 1-year survival rate was reported to be around 50%. 19,22 We demonstrate that the mortality after DPEJ was 34.3% at 1 year and 51.4% at 2 years, and the survival curve for DPEJ patients was similar to that of PEG patients in our study with similar demographic data. However, the survival curve of the DPEJ group dropped more than that of the PEG group after 2 years of placement.…”

Section: Discussionsupporting

confidence: 77%

“…Previously reported severe AEs of DPEJ included bleeding, bowel or gastric perforation, ileus, volvulus, abscess, sepsis, and aspiration, with frequency ranging from 1.1% to 7.7%. 9,11,13,14,17,19 In these AEs, bowel perforation, ileus, and volvulus are characteristic of DPEJ but not PEG. Although PEG is placed in the epigastrium region in most cases, an appropriate DPEJ site depends on each patient in view of his/her entire abdomen.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic outcomes after direct percutaneous endoscopic jejunostomy in elderly patients: comparison with percutaneous endoscopic gastrostomy

Nishiwaki¹,

Kurobe²,

Baba³

et al. 2021

Gastrointestinal Endoscopy

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Background and Aims: Direct percutaneous endoscopic jejunostomy (DPEJ) is an alternative method of enteral feeding to percutaneous endoscopic gastrostomy (PEG). Although long-term outcomes of PEG have been reported, little is known regarding the outcomes of DPEJ.Methods: A retrospective cohort study was conducted including 115 and 651 consecutive attempts of DPEJ and PEG, respectively, in a total of 766 elderly patients between April 2004 and March 2019. Patients' clinical background, procedural and long-term outcomes, survival analysis, and cause of death were analyzed.Results: Successful placement rates were 93.9% and 97.1% for DPEJ and PEG, respectively. There was no significant difference in procedure-related adverse events (AEs) between the DPEJ and PEG groups. Rates of pneumonia, vomiting, and upper GI bleeding were significantly lower, whereas those of fistula enlargement and ileus were significantly higher in the DPEJ group as long-term AEs. The median survival periods were 694 and 734 days for DPEJ and PEG, respectively, with no significant differences between the 2 groups. Multivariate analysis revealed that age 80 years old or older, C-reactive protein level of 1.0 mg/dL or higher, and the presence of diabetes were independent risk factors for mortality after DPEJ. Respiratory tract infection was the primary cause of death in both groups.Conclusions: DPEJ is considered a safe and feasible method of access for enteral feeding as well as PEG. Although the survival period after DPEJ may be expected to be as long as that with PEG, DPEJ-specific AEs should be kept in mind on long-term feeding.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Prognostic outcomes after direct percutaneous endoscopic jejunostomy in elderly patients: comparison with percutaneous endoscopic gastrostomy

Nishiwaki¹,

Kurobe²,

Baba³

et al. 2021

Gastrointestinal Endoscopy

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“…Though similar to PEG placement, D-PEJ is a considerably more challenging technique. In the two largest retrospective cohorts on D-PEJ outcome involving a total of 738 patients, successful placement was achieved in 68 % -83 % [35,38]; this may be higher if a double-balloon or single-balloon enteroscope is used [39].…”

Section: Percutaneous Endoscopic Gastrostomy With Jejunal Extension (mentioning

confidence: 97%

“…Moreover, a prospective comparative study suggested that early feeding after PEG tube insertion could also help reduce inpatient stay [84]. Finally, in the two largest series of D-PEJ, the initiation of enteral feeding was reported to be within 4 to 24 hours after placement [35,38]. [85,86,90,91], respectively.…”

Section: Using the Percutaneous Enteral Tube (Peg Peg-j D-pej) For mentioning

confidence: 99%

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Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2020

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Main recommendationsESGE recommends the “pull” technique as the standard method for percutaneous endoscopic gastrostomy (PEG) placement.Strong recommendation, low quality evidence.ESGE recommends the direct percutaneous introducer (“push”) technique for PEG placement in cases where the “pull” method is contraindicated, for example in severe esophageal stenosis or in patients with head and neck cancer (HNC) or esophageal cancer.Strong recommendation, low quality evidence.ESGE recommends the intravenous administration of a prophylactic single dose of a beta-lactam antibiotic (or appropriate alternative antibiotic, in the case of allergy) to decrease the risk of post-procedural wound infection.Strong recommendation, moderate quality evidence.ESGE recommends that inadvertent insertion of a nasogastric tube (NGT) into the respiratory tract should be considered a serious but avoidable adverse event (AE).Strong recommendation, low quality evidence.ESGE recommends that each institution should have a dedicated protocol to confirm correct positioning of NGTs placed “blindly” at the patient’s bedside; this should include: radiography, pH testing of the aspirate, and end-tidal carbon dioxide monitoring, but not auscultation alone.Strong recommendation, low quality evidence.ESGE recommends confirmation of correct NGT placement by radiography in high-risk patients (intensive care unit [ICU] patients or those with altered consciousness or absent gag/cough reflex).Strong recommendation, low quality evidence.ESGE recommends that EN may be started within 3 – 4 hours after uncomplicated placement of a PEG or PEG-J.Strong recommendation, high quality evidence.ESGE recommends that daily tube mobilization (pushing inward) along with a loose position of the external PEG bumper (1 – 2 cm from the abdominal wall) could mitigate the risk of development of buried bumper syndrome.Strong recommendation, low quality evidence.

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Chinese expert consensus on prevention and intervention for the elderly with malnutrition (2022)

Mao

Liu

et al. 2022

Aging Medicine

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Malnutrition is a state of altered body composition and body cell mass due to inadequate intake or utilization of energy or nutrients, leading to physical and mental dysfunction and impaired clinical outcomes. As one of the most common geriatric syndromes, malnutrition in the elderly is a significant risk factor for poor clinical outcomes, causing a massive burden on medical resources and society. The risk factors for malnutrition in the elderly are diverse and include demographics, chronic diseases, and psychosocial factors. Presently, recommendations for the prevention and intervention of malnutrition in the elderly are not clear or consistent in China. This consensus is based on the latest global evidence and multiregional clinical experience in China, which aims to standardize the prevention and intervention of malnutrition in the elderly in China and improve the efficacy of clinical practice and the prognosis of elderly patients.

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Direct Percutaneous Endoscopic Jejunostomy: Procedural and Nutrition Outcomes in a Large Patient Cohort

Abstract: DPEJ is a successful and safe procedure that effectively provides access for EN support in malnourished patients and patients with postoperative UGI cancer.

Cited by 19 publications

References 26 publications

Prognostic outcomes after direct percutaneous endoscopic jejunostomy in elderly patients: comparison with percutaneous endoscopic gastrostomy

Prognostic outcomes after direct percutaneous endoscopic jejunostomy in elderly patients: comparison with percutaneous endoscopic gastrostomy

Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Chinese expert consensus on prevention and intervention for the elderly with malnutrition (2022)

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