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Direct percutaneous endoscopic jejunostomy with small bowel enteroscopy and fluoroscopy.
Gastrointest Endosc. 2001 May; 53(6):633-8.GE

Abstract

BACKGROUND

Approaches to the creation of a percutaneous jejunostomy (PEJ) include enteroscopy with jejunal transillumination, fluoroscopy with small bowel distension and tract dilation, and jejunal enteral tube placement through a percutaneous endoscopic gastrostomy. Although all have been successful, the combination of enteroscopy and fluoroscopy may improve visualization and the success of PEJ placement. This is a description of such a technique and its successful use in 7 patients.

METHODS

The procedure was performed with the patient under conscious sedation in a manner similar to standard PEG placement. The proximal jejunum was visualized and a standard snare was passed though the enteroscope and was opened. A needle and guidewire were directed percutaneously though the snare by using fluoroscopic guidance. Under direct endoscopic visualization the snare was closed around the guidewire. A standard 20F push-type "gastrostomy" tube was passed over the guidewire and through the mouth and the dome seated in the jejunum. A bumper was passed externally over the tube and tightened at the skin.

RESULTS

PEJ placement was successful in all 7 patients. The average length of the procedure was 40 minutes (range 22-64 minutes). There were no major complications. Mean follow-up was 124 days (range 28-308 days). Feeding tubes remained functional until removal (2), death (1), or surgical removal for an unrelated reason (1). Three tubes are still in use.

CONCLUSIONS

Percutaneous endoscopic jejunostomy tube placement can be performed successfully with enteroscopy and fluoroscopy. This technique is safe and efficient and provides distal enteral nutritional support for patients in whom PEG cannot be used.

Authors+Show Affiliations

Department of Medicine, Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina 27710, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11323594

Citation

Shetzline, M A., et al. "Direct Percutaneous Endoscopic Jejunostomy With Small Bowel Enteroscopy and Fluoroscopy." Gastrointestinal Endoscopy, vol. 53, no. 6, 2001, pp. 633-8.
Shetzline MA, Suhocki PV, Workman MJ. Direct percutaneous endoscopic jejunostomy with small bowel enteroscopy and fluoroscopy. Gastrointest Endosc. 2001;53(6):633-8.
Shetzline, M. A., Suhocki, P. V., & Workman, M. J. (2001). Direct percutaneous endoscopic jejunostomy with small bowel enteroscopy and fluoroscopy. Gastrointestinal Endoscopy, 53(6), 633-8.
Shetzline MA, Suhocki PV, Workman MJ. Direct Percutaneous Endoscopic Jejunostomy With Small Bowel Enteroscopy and Fluoroscopy. Gastrointest Endosc. 2001;53(6):633-8. PubMed PMID: 11323594.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Direct percutaneous endoscopic jejunostomy with small bowel enteroscopy and fluoroscopy. AU - Shetzline,M A, AU - Suhocki,P V, AU - Workman,M J, PY - 2001/4/27/pubmed PY - 2001/8/10/medline PY - 2001/4/27/entrez SP - 633 EP - 8 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 53 IS - 6 N2 - BACKGROUND: Approaches to the creation of a percutaneous jejunostomy (PEJ) include enteroscopy with jejunal transillumination, fluoroscopy with small bowel distension and tract dilation, and jejunal enteral tube placement through a percutaneous endoscopic gastrostomy. Although all have been successful, the combination of enteroscopy and fluoroscopy may improve visualization and the success of PEJ placement. This is a description of such a technique and its successful use in 7 patients. METHODS: The procedure was performed with the patient under conscious sedation in a manner similar to standard PEG placement. The proximal jejunum was visualized and a standard snare was passed though the enteroscope and was opened. A needle and guidewire were directed percutaneously though the snare by using fluoroscopic guidance. Under direct endoscopic visualization the snare was closed around the guidewire. A standard 20F push-type "gastrostomy" tube was passed over the guidewire and through the mouth and the dome seated in the jejunum. A bumper was passed externally over the tube and tightened at the skin. RESULTS: PEJ placement was successful in all 7 patients. The average length of the procedure was 40 minutes (range 22-64 minutes). There were no major complications. Mean follow-up was 124 days (range 28-308 days). Feeding tubes remained functional until removal (2), death (1), or surgical removal for an unrelated reason (1). Three tubes are still in use. CONCLUSIONS: Percutaneous endoscopic jejunostomy tube placement can be performed successfully with enteroscopy and fluoroscopy. This technique is safe and efficient and provides distal enteral nutritional support for patients in whom PEG cannot be used. SN - 0016-5107 UR - https://www.unboundmedicine.com/medline/citation/11323594/Direct_percutaneous_endoscopic_jejunostomy_with_small_bowel_enteroscopy_and_fluoroscopy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(01)70267-2 DB - PRIME DP - Unbound Medicine ER -