Direct percutaneous endoscopic jejunostomy – Should we move on to single- and double-balloon enteroscopy techniques?

Abstract

Direct percutaneous endoscopic jejunostomy (DPEJ) is a useful technique to access the jejunum in order to: a) provide enteral nutrition to individuals when the gastric route is absent or contraindicated; and b) to decompress the jejunum in patients with malignant small bowel obstruction. Traditionally, DPEJ is performed using a colonoscope or enteroscope, which is advanced as deep as possible into the jejunum. The insertion technique of the feeding tube is identical to the one used for a gastrostomy tube (Ponsky-Gauderer method).

Nutritional Support in Pancreatic Diseases

“…However, no studies have been performed comparing both enteral tube access, so the evidence in ChP is scarce. Currently, experts advise the use of a NJ tube for these patients [ 41 ], or, in case the nutrition is expected to last more than 30 days, experts advise the placement of a jejunostomy, through a gastrostomy or a direct percutaneous jejunostomy, that can be placed safely and effectively by balloon enteroscopy [ 42 ]. This recommendation has stronger support in cases where a patient suffers from intense abdominal pain or persistent nausea.…”