Direct percutaneous endoscopic jejunostomy using single-balloon enteroscopy without fluoroscopy: a case series

Bernardes, Carlos; Pinho, Rolando; Rodrigues, Adélia; Proença, Luísa; Carvalho, João M. S.

doi:10.17235/reed.2017.4717/2016

Cited by 8 publications

(8 citation statements)

References 19 publications

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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: 76%

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: 76%

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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“…The average time to malfunction or replacement was 162 ± 135 days. Although this finding was reported in a few studies 22 24 25 27 28 37 38 40 45 47 , the wide confidence interval highlights the high variability in the duration of patency and function of endoscopically placed jejunal tubes. Weight gain was also reported in a few studies 21 31 38 47 , with a mean weight gain of 4.6 ± 4.4 Kg, confirming their clinical utility.…”

Section: Discussionmentioning

confidence: 76%

Direct percutaneous endoscopic jejunostomy (DPEJ) and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) technical success and outcomes: Systematic review and meta-analysis

et al. 2022

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Background and study aims Endoscopic methods of delivering uninterrupted feeding to the jejunum include direct percutaneous endoscopic jejunostomy (DPEJ) or PEG with jejunal extension (PEG-J), validated from small individual studies. We aim to perform a meta-analysis to assess their effectiveness and safety in a variety of clinical scenarios. Methods Major databases were searched until June 2021. Efficacy outcomes included technical and clinical success, while safety outcomes included adverse events (AEs) and malfunction rates. We assessed heterogeneity using I2 and classic fail-safe to assess bias. Results 29 studies included 1874 patients (983 males and 809 females); mean age of 60 ± 19 years. Pooled technical and clinical success rates with DPEJ were 86.6 % (CI, 82.1–90.1, I2 73.1) and 96.9 % (CI, 95.0–98.0, I2 12.7). The pooled incidence of malfunction, major and minor AEs with DPEJ were 11 %, 5 %, and 15 %. Pooled technical and clinical success for PEG-J were 94.4 % (CI, 85.5–97.9, I2 33) and 98.7 % (CI, 95.5–99.6, I2 < 0.001). The pooled incidence of malfunction, major and minor AEs with DPEJ were 24 %, 1 %, and 25 %. Device-assisted DPEJ performed better in altered gastrointestinal anatomy. First and second attempts were 87.6 % and 90.2 %. Conclusions DPEJ and PEG-J are safe and effective procedures placed with high fidelity with comparable outcomes. DPEJ was associated with fewer tube malfunction and failure rates; however, it is technically more complex and not standardized, while PEG-J had higher placement rates. The use of balloon enteroscopy was found to enhance DPEJ performance.

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“…Many SB strictures secondaries to NSAIDs, radiation, surgical anastomosis, or malignancy have been treated with balloon dilation [76,132,133] or stenting, using both over-the-wire or through-the-scope techniques [134][135][136]. DAE can also be used for percutaneous endoscopic jejunostomy [137] and SB intussusception [138].…”

Section: Miscelaneousmentioning

confidence: 99%

Small Bowel Enteroscopy – A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups

Pérez-Cuadrado-Robles

Pinho

González

et al. 2020

GE Port J Gastroenterol

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The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.

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Direct percutaneous endoscopic jejunostomy using single-balloon enteroscopy without fluoroscopy: a case series

Cited by 8 publications

References 19 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

Direct percutaneous endoscopic jejunostomy (DPEJ) and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) technical success and outcomes: Systematic review and meta-analysis

Small Bowel Enteroscopy – A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups

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