Efficacy of percutaneous endoscopic gastro‐jejunostomy (PEG‐J) decompression therapy for patients with chronic intestinal pseudo‐obstruction (CIPO)

Abstract

Percutaneous endoscopic gastro-jejunostomy decompression therapy can contribute greatly to improvement of abdominal symptoms and nutritional status in CIPO patients. Although sufficient attention should be paid to acid reflux symptoms, PEG-J has the potential to be a non-invasive novel decompression therapy for CIPO available at home. However, accumulation of more CIPO patients and long-term observation are needed (UMIN000017574).

A Rare Case of Chronic Small Bowel Pseudo-Obstruction

“…Despite recent advances, there is no satisfactory treatment for CIPO. A percutaneous endoscopic gastrojejunostomy or caecostomy may be used as a minimally invasive alternative treatment [14,15]. However, as with our patient, conservatively management is probably the best option unless there is evidence of ischaemia or perforation; this is in line with previous case reports.…”

Chronic intestinal pseudo‐obstruction: Progress in management?

“…However, conventional methods are limited by temporary efficacy in GI decompression, whereas surgery shows a high rate of stoma prolapse along with a considerable risk of dehydration due to enteric fluid loss . Nonetheless, recent data in this issue of Neurogastroenterology and Motility provide new insights into the management of patients with CIPO by using percutaneous endoscopic gastrostomy (PEG), a commonly applied method for long‐term home enteral nutrition . However, PEG is often associated with aspiration pneumonia, therefore current management suggests a gastro‐jejunostomy tube insertion via PEG (hence, PEG‐J) as a measure to prevent such a life‐threatening complication .…”

“…All patients required at least once nasogastric tube or transnasal small intestinal tube insertion for intestinal decompression. PEG tube (24 F caliber) was placed using the introducer method . If distended small bowel loops were interposed between the stomach and the abdominal wall, a preceding decompression was obtained via transnasal small intestinal tube.…”

“…None of the treated CIPO patients had ulcer formation and perforation due to the tube placement at 1‐year follow‐up after the procedure. PEG‐J is, therefore, suggested as a safe and minimally invasive method to improve abdominal symptoms, including pain, and nutritional status in CIPO . Depending on symptom fluctuation, the use of PEG‐J can be modulated (open vs closure intervals) ensuing control of fluid output and avoiding dehydration, a common complication of conventional jejunostomy/ileostomy.…”

“…Taken together, these challenges and intrinsic difficulties surrounding CIPO hinder thorough phenotyping of patients, mechanistic studies and, more importantly, patients’ management . Nonetheless, recent data by Ohkubo et al, in the current issue of Neurogastroenterology and Motility , propose percutaneous endoscopic gastro‐jejunostomy (PEG‐J) as a method to alleviate symptoms (including pain) and nutritional consequences related to intestinal distension, a key feature of CIPO …”