Percutaneous endoscopic duodenostomy (PED)

Abstract

Surgeons are increasingly using endoscopy to place transabdominal feeding tubes for enteral nutrition or gastric decompression. A possible extension for the application of this new technique is the direct placement of the feeding tube into the duodenal bulb. Two patients are presented in whom percutaneous endoscopic duodenostomy was successfully performed, although percutaneous endoscopic gastrostomy was not possible. It shows that this new method is technically possible. In both patients the positive influence of this technique on the patient's quality of life could be shown using the Spitzer Quality of Life Index and the Karnofsky Performance Status. Enteral nutrition was maintained for more than 6 weeks.

Percutaneous endoscopic duodenostomy: the relief of obstruction in advanced gastric carcinoma

“…8,9 Alberti-Flor reported the use of a PED in a patient who had undergone subtotal oesophagectomy and subsequently developed severe postoperative duodeno-gastro-oesophageal reflux with recurrent bouts of aspiration pneumonia. 8,9 Alberti-Flor reported the use of a PED in a patient who had undergone subtotal oesophagectomy and subsequently developed severe postoperative duodeno-gastro-oesophageal reflux with recurrent bouts of aspiration pneumonia.…”

“…8,9 Alberti-Flor reported the use of a PED in a patient who had undergone subtotal oesophagectomy and subsequently developed severe postoperative duodeno-gastro-oesophageal reflux with recurrent bouts of aspiration pneumonia. 9 In both cases, however, the PED was performed in the duodenal bulb (intraperitoneal and just beyond the pylorus) and in patients whose duodenum had been mobilized into a more favourable position by a Kocher manoeuvre during their previous surgery. Instead, a PED was placed allowing decompression and enteral feeding with excellent symptom palliation.…”

“…6,7,9 That the use of a PED has not become more widely adopted since the original descriptions over 10 years ago may lie in the limited indications for its use and that the duodenum is predominantly retroperitoneal, creating technical difficulties coupled with the risk of damage to overlying structures such as the transverse colon. 6,7,9 That the use of a PED has not become more widely adopted since the original descriptions over 10 years ago may lie in the limited indications for its use and that the duodenum is predominantly retroperitoneal, creating technical difficulties coupled with the risk of damage to overlying structures such as the transverse colon.…”

“…The percutaneous endoscopic siting of a feeding tube in the duodenum has previously been described. 8,9 Alberti-Flor reported the use of a PED in a patient who had undergone subtotal oesophagectomy and subsequently developed severe postoperative duodeno-gastro-oesophageal reflux with recurrent bouts of aspiration pneumonia. 8 This patient's stomach had been brought up into the thorax for the formation of an oesophagogastrostomy, thus precluding its use for a PEG.…”

“…Paul et al reported the use of a PED in a similar patient with dysphagia who had developed local recurrence at the anastomosis following oesophagectomy for adenocarcinoma. 9 In both cases, however, the PED was performed in the duodenal bulb (intraperitoneal and just beyond the pylorus) and in patients whose duodenum had been mobilized into a more favourable position by a Kocher manoeuvre during their previous surgery.…”