New method of direct percutaneous endoscopic jejunostomy tube placement using balloon‐assisted enteroscopy with fluoroscopy

Velázquez‐Aviña, Jacobo; Beyer, Ryan; Diaz-Tobar, C; Peter, Shajan; Baig, Kondal R. Kyanam Kabir; Wilcox, C. Mel; Mönkemüller, Klaus

doi:10.1111/den.12352

Cited by 21 publications

(19 citation statements)

References 16 publications

(82 reference statements)

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“…For this purpose, the technique described here includes grasping the needle with a snare after puncture of the intestinal loop which ensured its anchorage and avoided needle exteriorization. Velázquez-Avinã et al used fluoroscopic guidance to confirm the puncture site, and recommended leaving the overtube in place while the string is removed with the scope and then it is reintroduced with the PEJ-bumper (14). In our experience, fluoroscopy is not necessary as there were no complications during or after puncture of the selected loop when transillumination and finger indentation were achieved.…”

Section: Discussionmentioning

confidence: 71%

“…This procedure may be carried out with adult or pediatric endoscopes via a percutaneous gastrostomy orifice or with push enteroscopes or balloon-assisted enteroscopes. Several techniques have been described, such as the "T" pexies triangulation system, magnetic jejunal anchors, and overtube maintenance during bumper pulling or with fluoroscopy guidance (8)(9)(10)(11)(12)(13)(14)(15). In spite of all different approaches, DPEJ is considered to be a technically difficult procedure with success rates ranging from 68% to 100% (3,16).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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Background: Direct percutaneous endoscopic jejunostomy (DPEJ) is a useful method to provide enteral nutrition to individuals when gastric feeding is not possible or contraindicated. The aim of this study was to analyze the efficacy and safety of DPEJ tube placement with the Gauderer-Ponsky technique by the pull method, using single-balloon enteroscopy (SBE) without fluoroscopy.Methods: This is a retrospective analysis of patients undergoing SBE for DPEJ placement in a referral hospital between January 2010 and March 2016. Technical success, clinical success and procedure related complications were recorded.Results: Twenty-three patients were included (17 males, median age 71 years, range 37-93 years). The most frequent indications for DPEJ were gastroesophageal cancer (n = 10) and neurological disease (n = 8). Eighty-seven percent of the patients had a contraindication to percutaneous endoscopic gastrostomy (PEG) and PEG was unsuccessful in the remaining patients. The technical success rate was 83% (19/23), transillumination was not possible in three patients and an accidental exteriorization of the bumper resulting in a jejunal perforation occurred in one patient. The clinical success was 100% (19/19). The median follow-up was five months (range 1-35 months). Apart from the case of jejunal perforation and the two cases of accidental exteriorization, there were no other complications during follow-up. The 6-month survival was 65.8% and the 1-year survival was 49.3%.Conclusion: DPEJ can be carried out successfully via SBE without fluoroscopy with a low rate of significant adverse events. Although, leaving the overtube in place during the bumper pulling can be useful for distal jejunal loops, it can be safely removed in proximal loops to minimize complications.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…With SBE, Velázquez-Aviña et al have reported a successful placement rate of 96% in 25 patients. 48 Aktas et al have reported the success rate as 92% in 12 patients. 49 With DBE, a technical success rate of 93 to 100% has been reported, with the 93% rate being in one of the largest reported series with 94 patients.…”

Section: Direct Percutaneous Endoscopic Jejunostomy Tubementioning

confidence: 97%

Endoscopic Feeding Access

McCormack

Tariq

2018

Dig Dis Interv

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The need for enteral access for nutritional support has become increasingly important. It is estimated up to a third of hospitalized patients will suffer from malnourishment. There is evidence that enteral is preferable over parenteral nutrition for improved outcomes. Various approaches for enteral access exist today including blind placement of enteral catheters, radiographically, and surgically placed catheters. However, the endoscopic approach for enteral access is a well-established, reliable, safe, and quick method of obtaining enteral access. In this review article, we will cover the various endoscopic approaches for enteral access. We believe there is no single best approach for enteral access and that it should be tailored to the individual patient. This article will cover both temporary options such as nasoenteric catheters and more permanent options such as percutaneous endoscopic stomas (gastrostomy, gastrojejunostomy, direct jejunostomy) and describe their techniques, indications, contraindications, and pitfalls. Additionally, with the rise of weight loss surgery, we will cover how to manage the patient with altered gastrointestinal anatomy. Lastly, we will also review difficult post procedure scenarios associated with all of these endoscopic methods for enteral access and how to either prevent or properly manage them.

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“…However, their study included no patients with abnormal upper GI tract anatomy (10). These patients represent a challenge for traditional DPEJ, and the use of fluoroscopy may increase success rate (8). Additionally, their failed cases might have been successful with the aid of fluoroscopy.…”

mentioning

confidence: 99%

“…In these cases, the traditional Ponsky-Gauderer technique without overtube is fully appropriate. The key message regarding the various DPEJ techniques is that all of them should be mastered, and then used on a patient-by-patient basis -easy cases will benefit from the least complex approach, whereas fluoroscopy and overtubes are appropriate for patients with adhesions, complex anatomy, or obesity (5)(6)(7)(8)(9)(10).…”

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confidence: 99%

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

2017

Self Cite

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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).

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New method of direct percutaneous endoscopic jejunostomy tube placement using balloon‐assisted enteroscopy with fluoroscopy

Abstract: This new method of inserting a DPEJ using balloon enteroscopy and fluoroscopy was safe and successful. Future comparative studies are now warranted.

Cited by 21 publications

References 16 publications

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

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

Endoscopic Feeding Access

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

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New method of direct percutaneous endoscopic jejunostomy tube placement using balloon‐assisted enteroscopy with fluoroscopy

Abstract: This new method of inserting a DPEJ using balloon enteroscopy and fluoroscopy was safe and successful. Future comparative studies are now warranted.

Cited by 21 publications

References 16 publications

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

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

Endoscopic Feeding Access

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

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