Background: Percutaneous access to the jejunum is an important approach if gastrostomy feeding is not possible. Objective: To analyze success, short- and long-term complications (STCs, LTCs) in patients with percutaneous endoscopic jejunostomy (PEJ) and jejunal access through percutaneous endoscopic gastrostomy (Jet-PEG). Methods: A retrospective analysis of endoscopically placed PEJs and Jet-PEGs. Success rates, mortality, STCs and LTCs were investigated for risk factors comprising demographic data, underlying disease, previous surgery and experience of the endoscopist. Results: 205 PEJ and 58 Jet-PEG placements were included in the study. PEJs and Jet-PEGs were successfully placed in 65.4 and 89.7%, respectively. Billroth II surgery predisposed in favor of a significantly higher success rate for PEJ placement (p = 0.014, OR = 2.27). Inexperienced examiners have a significantly (p = 0.040) lower success rate for tube insertion than examiners with a medium level of experience. STCs and LTCs occurred evenly in PEJ and Jet-PEG patients. Dislocation of the tube occurred significantly more frequently in Jet-PEG patients (33.3%, p = 0.005). Aspiration was most common for bedridden patients. Conclusion: PEJ has a significantly lower success rate for insertions, but fewer LTCs. The experience of the endoscopist correlates with the success rate of tube insertion.

Journal Section:
Original Paper
Keywords:
Percutaneous endoscopic jejunostomy, Jejunal access through percutaneous endoscopic gastrostomy, Nutrition, Complication, risk factors
1.
Gauderer MW: Percutaneous endoscopic gastrostomy and the evolution of contemporary long-term enteral access. Clin Nutr 2002;21:103–110.
[PubMed]
https://doi.org/10.1054%2Fclnu.2001.0533
2.
Ponsky JL, Aszodi A: Percutaneous endoscopic jejunostomy. Am J Gastroenterol 1984;79:113–116.
[PubMed]
3.
Shike M, Schroy P, Ritchie MA, et al: Percutaneous endoscopic jejunostomy in cancer patients with previous gastric resection. Gastrointest Endosc 1987;33:372–374.
[PubMed]
https://doi.org/10.1016%2FS0016-5107%2887%2971642-3
4.
Barrera R, Schattner M, Nygard S, et al: Outcome of direct percutaneous endoscopic jejunostomy tube placement for nutritional support in critically ill, mechanically ventilated patients. J Crit Care 2001;16:178–181.
[PubMed]
https://doi.org/10.1053%2Fjcrc.2001.30667
5.
Bueno JT, Schattner MA, Barrera R, et al: Endoscopic placement of direct percutaneous jejunostomy tubes in patients with complications after esophagectomy. Gastrointest Endosc 2003;57:536–540.
[PubMed]
https://doi.org/10.1067%2Fmge.2003.155
6.
Fan AC, Baron TH, Rumalla A, Harewood GC: Comparison of direct percutaneous endoscopic jejunostomy and PEG with jejunal extension. Gastrointest Endosc 2002;56:890–894.
[PubMed]
https://doi.org/10.1016%2FS0016-5107%2802%2970366-0
7.
Henderson JM, Strodel WE, Gilinsky NH: Limitations of percutaneous endoscopic jejunostomy. JPEN J Parenter Enteral Nutr 1993;17:546–550.
[PubMed]
https://doi.org/10.1177%2F0148607193017006546
8.
Rumalla A, Baron TH: Results of direct percutaneous endoscopic jejunostomy, an alternative method for providing jejunal feeding. Mayo Clin Proc 2000;75:807–810.
[PubMed]
https://doi.org/10.4065%2F75.8.807
9.
Varadarajulu S, Delegge MH: Use of a 19-gauge injection needle as a guide for direct percutaneous endoscopic jejunostomy tube placement. Gastrointest Endosc 2003;57:942–945.
[PubMed]
https://doi.org/10.1016%2FS0016-5107%2803%2970049-2
10.
Shetzline MA, Suhocki PV, Workman MJ: Direct percutaneous endoscopic jejunostomy with small bowel enteroscopy and fluoroscopy. Gastrointest Endosc 2001;53:633–638.
[PubMed]
https://doi.org/10.1067%2Fmge.2001.114420
11.
R Development Core Team: A Language and Environment for Statistical Computing. Vienna, R Foundation for Statistical Computing, 2008. ISBN 3–900051–07–0.
12.
Shike M, Latkany L, Gerdes H, Bloch AS: Direct percutaneous endoscopic jejunostomies for enteral feeding. Gastrointest Endosc 1996;44:536–540.
[PubMed]
https://doi.org/10.1016%2FS0016-5107%2896%2970005-6
13.
Freeman ML: Adverse outcomes of ERCP. Gastrointest Endosc 2002;56(suppl):S273–S282.
https://doi.org/10.1016%2FS0016-5107%2802%2970025-4
14.
Rabenstein T, Schneider HT, Nicklas M, et al: Impact of skill and experience of the endoscopist on the outcome of endoscopic sphincterotomy techniques. Gastrointest Endosc 1999;50:628–636.
[PubMed]
https://doi.org/10.1016%2FS0016-5107%2899%2980010-8
15.
Maiss J, Dumser C, Zopf Y, et al: ‘Hemodynamic efficacy’ of two endoscopic clip devices used in the treatment of bleeding vessels, tested in an experimental setting using the compact Erlangen Active Simulator for Interventional Endoscopy (compactEASIE) training model. Endoscopy 2006;38:575–580.
[PubMed]
https://doi.org/10.1055%2Fs-2006-925000
16.
Varnier A, Iona L, Dominutti MC, et al: Percutaneous endoscopic gastrostomy: complications in the short and long-term follow-up and efficacy on nutritional status. Eura Medicophys 2006;42:23–26.
[PubMed]
17.
DiSario JA, Foutch PG, Sanowski RA: Poor results with percutaneous endoscopic jejunostomy. Gastrointest Endosc 1990;36:257–260.
[PubMed]
https://doi.org/10.1016%2FS0016-5107%2890%2971018-8
18.
Patterson DJ, Kozarek RA, Ball TJ, Botoman VA: Comparison of percutaneous endoscopic gastrostomy (PEG) alone versus PEG with jejunal feeding tube (PEG-J). Gastrointest Endosc 1987;33:176.
19.
Kaplan DS, Murthy UK, Linscheer WG: Percutaneous endoscopic jejunostomy: a long-term follow-up of 23 patients. Gastrointest Endosc 1989;35:403–406.
[PubMed]
https://doi.org/10.1016%2FS0016-5107%2889%2972844-3
20.
Wolfsen HC, Kozarek RA, Ball TJ, et al: Tube dysfunction following percutaneous endoscopic gastrostomy and jejunostomy. Gastrointest Endosc 1990;36:261–263.
[PubMed]
https://doi.org/10.1016%2FS0016-5107%2890%2971019-X
21.
Huxley EJ, Viroslav J, Gray WR, Pierce AK: Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 1978;64:564–568.
[PubMed]
https://doi.org/10.1016%2F0002-9343%2878%2990574-0
22.
Shang E, Kähler G, Meier-Hellmann A, Scheele J: Advantages of endoscopic therapy of gastrojejunal dissociation in critical care patients. Intensive Care Med 1999;25:162–165.
[PubMed]
https://doi.org/10.1007%2Fs001340050810
© 2009 S. Karger AG, Basel
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2009
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