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DPEJ placement in cases of PEG insertion failure.
Dig Liver Dis. 2008 Feb; 40(2):140-3.DL

Abstract

BACKGROUND AND STUDY AIMS

PEG placement is routinely used for enteral feeding; in some cases PEG is not feasible or indicated due to technical difficulties, such as gastric herniation, organ interposition, or presence of gastroparesis. In these cases, surgical gastrostomy or jejunostomy are possible alternatives; more recently, direct percutaneous jejunostomy (DPEJ) has been proposed to avoid surgical intervention. The aim of the study was to evaluate the necessity, technical feasibility and outcome of DPEJ in a group of patients consecutively proposed for PEG placement.

PATIENTS AND METHODS

In each patient proposed for PEG placement, an upper gastrointestinal endoscopy was performed, and then a pull traction removal gastrostomy tube (18-20 F) was inserted. When PEG was not feasible or contraindicated, a variable stiffness pediatric videocolonscope was used to reach the jejunum: then DPEJ was performed with the same technique and materials as PEG. In both groups enteral feeding was started 24h after the endoscopic procedure, using an enteral feeding pump and the same nutritional schedules.

RESULTS

In a 1-year period 90 patients were proposed for PEG placement; PEG could not be performed for technical reasons in 8 (gastric herniation in 1; organ interposition in 7) and gastroparesis in 1. In one patient both PEG and DPEJ were not feasible for organ interposition. The duration of the endoscopic procedure was slightly longer in DPEJ (mean 20 min versus 15 min). No complications related to the endoscopic procedure were observed in both DPEJ and PEG patients. No nutritional complication were observed in the DPEJ group.

CONCLUSION

In our experience, PEG was not feasible or contraindicated in about 10% of patients proposed for. In these patients, DPEJ was placed: the procedure resulted to be feasible and safe with the use of a pediatric videocolonscope to easily reach the jejunum. The insertion of DPEJ did not change the nutritional management of enteral feeding. However, long-term effects or complications remain to be evaluated in larger studies.

Authors+Show Affiliations

Del Piano M
Gastroenterology Unit, Azienda Ospedaliera Maggiore della Carità Corso Mazzini 18, 28100 Novara, Italy. mario.delpiano@alice.it <mario.delpiano@alice.it>
Ballarè M
No affiliation info available
Carmagnola S
No affiliation info available
Orsello M
No affiliation info available
Garello E
No affiliation info available
Pagliarulo M
No affiliation info available
Sartori M
No affiliation info available
Montino F
No affiliation info available

MeSH

AgedAged, 80 and overEnteral NutritionFeasibility StudiesGastroscopyGastrostomyHumansIntubation, GastrointestinalJejunostomyMiddle AgedProspective StudiesTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18160355

Citation

Del Piano, M, et al. "DPEJ Placement in Cases of PEG Insertion Failure." Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, vol. 40, no. 2, 2008, pp. 140-3.
Del Piano M, Ballarè M, Carmagnola S, et al. DPEJ placement in cases of PEG insertion failure. Dig Liver Dis. 2008;40(2):140-3.
Del Piano, M., Ballarè, M., Carmagnola, S., Orsello, M., Garello, E., Pagliarulo, M., Sartori, M., & Montino, F. (2008). DPEJ placement in cases of PEG insertion failure. Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 40(2), 140-3.
Del Piano M, et al. DPEJ Placement in Cases of PEG Insertion Failure. Dig Liver Dis. 2008;40(2):140-3. PubMed PMID: 18160355.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - DPEJ placement in cases of PEG insertion failure. AU - Del Piano,M, AU - Ballarè,M, AU - Carmagnola,S, AU - Orsello,M, AU - Garello,E, AU - Pagliarulo,M, AU - Sartori,M, AU - Montino,F, Y1 - 2007/12/21/ PY - 2007/05/07/received PY - 2007/07/05/revised PY - 2007/09/27/accepted PY - 2007/12/28/pubmed PY - 2008/5/29/medline PY - 2007/12/28/entrez SP - 140 EP - 3 JF - Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver JO - Dig Liver Dis VL - 40 IS - 2 N2 - BACKGROUND AND STUDY AIMS: PEG placement is routinely used for enteral feeding; in some cases PEG is not feasible or indicated due to technical difficulties, such as gastric herniation, organ interposition, or presence of gastroparesis. In these cases, surgical gastrostomy or jejunostomy are possible alternatives; more recently, direct percutaneous jejunostomy (DPEJ) has been proposed to avoid surgical intervention. The aim of the study was to evaluate the necessity, technical feasibility and outcome of DPEJ in a group of patients consecutively proposed for PEG placement. PATIENTS AND METHODS: In each patient proposed for PEG placement, an upper gastrointestinal endoscopy was performed, and then a pull traction removal gastrostomy tube (18-20 F) was inserted. When PEG was not feasible or contraindicated, a variable stiffness pediatric videocolonscope was used to reach the jejunum: then DPEJ was performed with the same technique and materials as PEG. In both groups enteral feeding was started 24h after the endoscopic procedure, using an enteral feeding pump and the same nutritional schedules. RESULTS: In a 1-year period 90 patients were proposed for PEG placement; PEG could not be performed for technical reasons in 8 (gastric herniation in 1; organ interposition in 7) and gastroparesis in 1. In one patient both PEG and DPEJ were not feasible for organ interposition. The duration of the endoscopic procedure was slightly longer in DPEJ (mean 20 min versus 15 min). No complications related to the endoscopic procedure were observed in both DPEJ and PEG patients. No nutritional complication were observed in the DPEJ group. CONCLUSION: In our experience, PEG was not feasible or contraindicated in about 10% of patients proposed for. In these patients, DPEJ was placed: the procedure resulted to be feasible and safe with the use of a pediatric videocolonscope to easily reach the jejunum. The insertion of DPEJ did not change the nutritional management of enteral feeding. However, long-term effects or complications remain to be evaluated in larger studies. SN - 1590-8658 UR - https://www.unboundmedicine.com/medline/citation/18160355/DPEJ_placement_in_cases_of_PEG_insertion_failure_ DB - PRIME DP - Unbound Medicine ER -