Percutaneous Fluoroscopically Guided Jejunostomy Placement

Abstract

Percutaneous direct jejunostomy placement is a relatively safe and effective means of gaining enteral access in patients who have enterocutaneous fistula or who have either postsurgical or neoplastic changes of the stomach that preclude traditional gastrostomy placement.

Multidisciplinary Practical Guidelines for Gastrointestinal Access for Enteral Nutrition and Decompression From the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, With Endorsement by Canadian Interventional Radiological Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE)

“…The success rate for secondary jejunostomy appears to be higher (115,117), but one group (21) reported a lower success rate for secondary jejunostomy (81%) than for primary jejunostomy (95%). Reported complications have been reported in 0%-15% of cases (21,114,116,117). The most severe complications were peritonitis as a result of puncture of the intestinal loop and subsequent loss of access (21) and GI bleeding (114).…”

“…Reported complications have been reported in 0%-15% of cases (21,114,116,117). The most severe complications were peritonitis as a result of puncture of the intestinal loop and subsequent loss of access (21) and GI bleeding (114).…”

“…Different jejunostomy techniques have been described, but, in general, they include the following steps. Identification of the target bowel loop is performed by advancing an angiographic catheter into the proximal jejunum and insufflating it with air and contrast agent (112) or placing an angioplasty balloon (21,113) or snare loop (114) in the desired location to serve as a target. Several authors describe the use of US guidance following injection of the saline solution and contrast agent into the proximal jejunal loop (115,116).…”

Sonographically Guided Jejunostomy Replacement

“…During direct percutaneous endoscopic jejunal feeding tube placement, the bowel loop is visualized and punctured under an endoscopic view, whereas in the fluoroscopic technique, the jejunum is distended by air or opacified with contrast through a transnasal or transoral jejunal catheter. 9,10 In this setting, sonography can be used to identify the bowel loop after saline infusion through the transnasal jejunal catheter and to guide the puncture under direct vision of the target loop; anchor sutures are usually applied to secure the bowel loop to the abdominal wall before catheter insertion. 11,12 However, in patients unsuitable for endoscopy or in whom transnasal jejunal catheterization is not feasible, these methods are not applicable, and surgical replacement is normally recommended.…”

“…Because the jejunal loop was sutured to the abdominal wall during the previous surgical intervention, a sonographically guided percutaneous attempt to replace the jejunostomy tube was considered. When the patient was in the operating room for the scheduled surgical intervention, a sonographic examination was performed using a Technos instrument (Esaote SpA, Genoa, Italy) with a linear probe (5)(6)(7)(8)(9)(10)(11): the disrupted sinus tract was visualized, and the jejunal loop adherent to the abdominal wall was identified ( Figure 1a). After local anesthesia, sonographically guided fine-needle catheter jejunostomy (Freka FKJ 9F; Fresenius Kabi AG, Bad Homburg, Germany) was performed through the adherent bowel loop: by freehand guidance with a longitudinal approach, the needle was introduced closely to the previous tract.…”