Limitations of Percutaneous Endoscopic Jejunostomy

Abstract

Thirty-six patients at the University of Kentucky Medical Center underwent percutaneous endoscopic jejunostomy placement between January 1 and December 31, 1989. We retrospectively reviewed their charts for indications and complications of the procedure. Experience and outcome with the initial placement of the percutaneous jejunostomy tube was evaluated. Primary diagnoses at the time of insertion included central nervous system disorders (28), ventilator dependence (5), cancer (2), and gastroparesis (1). The follow-up period ranged from 2 to 131 days (median 16 days). Tube dysfunction or dislodgment occurred in 31% of patients. Other complications included pulmonary aspiration (11%) and bleeding at the insertion site (3%). The 30-day mortality rate was 19% with all but one death caused by the severity of the underlying primary illness. It is concluded that problems with the currently performed technique of percutaneous endoscopic jejunostomy, along with tube-related problems, seriously limit the usefulness of this technique. Improvements in technology, along with routine postprocedure radiographs to allow early detection of malpositioned jejunostomy tubes, may improve the outcome of this procedure. Newer techniques that have a higher success of distal small intestinal placement need to be evaluated.

Does the Presence of Esophagitis Prior to PEG Placement Increase the Risk for Aspiration Pneumonia?

“…In comparison to PEG, PEG/J and DPEJ have been associated with a higher complication rate of tube dysfunction, dislodgement, and clogging (6,(10)(11)(12). Aspiration of oropharyngeal secretions has been hypothesized to be a common route of pulmonary aspiration, especially in patients with decreased sensorium (7,13,14).…”

Adverse events of upper GI endoscopy

“…128,129 Adverse events associated with percutaneous endoscopic jejunostomy are similar to those of standard PEG placement, although the rate is higher. [129][130][131][132][133][134] Adverse events unique to PEG with jejunal extension are typically caused by the small-diameter jejunal feeding extension and include clogging (4%-18%), unintentional removal (11%-18%), and tube migration (6%). 129,130,134,135 Adverse events of endoluminal therapy Resection techniques.…”

Enteral nutrition access devices

“…63 Among the long-term complications related to DPEJ, tube failure (blockage, breakage, leaking) is the most commonly reported. 117,119 Other complications include abdominal pain, peristomal infection, fever, ileus, enteric ulcers bleeding, abdominal wall abscess, and colon perforations. 61,118 The incidence of aspiration pneumonia may decrease in high-risk patients after DPEJ tube placement.…”