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Locke J, Norwood DA, Forrister N, Ahmed AM, Aryan M, Oster R, Reddy S, Kabir Baig KK, Peter S. Safety and efficacy of direct percutaneous endoscopic jejunostomy tube placement compared with surgical jejunostomy: a tertiary care analysis. Gastrointest Endosc 2024; 99:981-988.e5. [PMID: 38103750 DOI: 10.1016/j.gie.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND AIMS Jejunostomy tube placements provides enteral access for feeding in eligible patients who cannot meet their nutritional needs by mouth. They can be surgically placed laparoscopically (lap-J) or with the use of a conventional open laparotomy approach (open-J). Recently, direct percutaneous endoscopic jejunostomy (DPEJ) has emerged as an alternative owing to its low cost and shorter recovery times. We sought to retrospectively compare the procedural success rates and adverse events of these methods. METHODS Patients were identified by querying our health system patient database and the departmental database of patients who underwent DPEJ. The patients were divided into 3 cohorts based on the procedure: DPEJ, lap-J, or open-J. Patient age and body mass index, procedural success rate, and adverse event rate were compared among the 3 groups. RESULTS A total of 201 patients met inclusion criteria (65 DPEJ, 111 lap-J, and 25 open-J). Procedural success rates were similar among the 3 groups (DPEJ 96.9%, lap-J 99.1%, open-J 100%; P = .702). Rates of infection and bleeding were also similar among the 3 groups. There were no cases of GI perforation. Tube dysfunction for any reason that required complete removal or replacement within 90 days occurred more often in the surgical groups than in the DPEJ group (DPEJ 0%, lap-J 35.1%, open-J 40.0%; P < .001). This was driven largely by increased rates of tube clogging and tube dislodgement in the surgical groups. CONCLUSIONS DPEJ is a safe and effective alternative to surgical jejunostomy in eligible patients and may be associated with decreased adverse event rates at 90 days.
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Affiliation(s)
- John Locke
- Division of Internal Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Dalton A Norwood
- Division of Preventive Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Nicholas Forrister
- Division of Internal Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Ali M Ahmed
- Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, Alabama, USA
| | - Mahmoud Aryan
- Division of Internal Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Robert Oster
- Division of Preventive Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Sushanth Reddy
- Division of Surgical Oncology, University of Alabama, Birmingham, Alabama, USA
| | | | - Shajan Peter
- Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, Alabama, USA
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Ramai D, Heaton J, Fang J. Safety of Percutaneous Endoscopic Jejunostomy Placement Compared With Surgical and Radiologic Jejunostomy Placement: A Nationwide Inpatient Assessment. J Clin Gastroenterol 2023:00004836-990000000-00235. [PMID: 38019077 DOI: 10.1097/mcg.0000000000001948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/27/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND AND AIMS We compared the safety and outcomes of percutaneous jejunostomy tubes placed endoscopically (PEJ), fluoroscopically by interventional radiology (IR-jejunostomy), and open jejunostomy placed surgically (surgical jejunostomy). METHODS Using the Nationwide Readmissions Database, we identified hospitalized patients who underwent a jejunostomy from 2016 to 2019. Selected patients were divided into 3 cohorts: PEJ, IR-jejunostomy, and surgical jejunostomy. Adjusted odds ratios (OR) for adverse events were calculated using multivariable logistic regression analysis. RESULTS A total of 6022 (65.2±9.8 y) surgical jejunostomy patients, 3715 (63.6±11.0 y) endoscopic jejunostomy patients, and 14,912 (64.8±11.6 y) IR-jejunostomy patients were identified. Compared with surgery, PEJ patients were 32% less likely to experience postprocedure complications (OR: 0.68; 95% CI: 0.58-0.79, P<0.001) while IR-jejunostomy patients were 17% less likely to experience complications (OR: 0.83; 95% CI: 0.73-0.94, P<0.001); test of proportion showed that endoscopy had significantly fewer total adverse events compared with IR (P<0.001). For individual complications, compared with surgery, the odds of intestinal perforation using PEJ and IR, respectively, were 0.26 (95% CI: 0.14-0.49, P<0.001) and 0.31 (95% CI: 0.21-0.47, P<0.001), for postprocedure infection 0.32 (95% CI: 0.20-0.50; P<0.001) and 0.61 (95% CI: 0.45-0.83; P=0.001); and for hemorrhage requiring blood transfusion 0.71 (95% CI: 0.56-0.91; P=0.005) and 0.75 (95% CI: 0.61-0.91; P=0.003). CONCLUSIONS Endoscopic placement of percutaneous jejunostomy tubes (PEJ) in inpatients is associated with significantly lower risks of adverse events and mortality compared with IR and surgical jejunostomy.
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Affiliation(s)
- Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT
| | - Joseph Heaton
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ
| | - John Fang
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT
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Chen Y, Wu G, Qu C, Ye Z, Kang Y, Tian X. A multifaceted comparative analysis of image and video technologies in gastrointestinal endoscope and their clinical applications. Front Med (Lausanne) 2023; 10:1226748. [PMID: 37881626 PMCID: PMC10595015 DOI: 10.3389/fmed.2023.1226748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023] Open
Abstract
This paper presents a comprehensive exploration of endoscopic technologies in clinical applications across seven tables, each focusing on a unique facet of the medical field. The discourse begins with a detailed analysis of pediatric endoscopes, highlighting their diagnostic capabilities in various conditions. It then delves into the specifications and applications of globally recognized capsule endoscopy devices. Additionally, the paper incorporates an analysis of advanced imaging techniques, such as Narrow Band Imaging (NBI), Flexible Spectral Imaging Color Enhancement (FICE), and i-scan, which are increasingly being integrated into ultrathin gastrointestinal (GI) endoscopes. Factors like technological capabilities, light source, camera technology, and computational constraints are evaluated to understand their compatibility with these advanced imaging techniques, each offering unique advantages and challenges in clinical settings. NBI, for instance, is lauded for its user-friendly, real-time enhanced imaging capabilities, making it effective for early detection of conditions like colorectal cancer and Barrett's esophagus. Conversely, FICE and i-scan offer high customizability and are compatible with a broader range of endoscope models. The paper further delves into innovative advances in movement control for Nasojejunal (NJ) feeding tube endoscopy, elucidating the potential of AI and other novel strategies. A review of the technologies and methodologies enhancing endoscopic procedure control and diagnostic precision follows, emphasizing image and video technologies in pediatric endoscopy, capsule endoscopes, ultrathin endoscopes, and their clinical applications. Finally, a comparative analysis of leading real-time video monitoring endoscopes in clinical practices underscores the continuous advancements in the field of endoscopy, ensuring improved diagnostics and precision in surgical procedures. Collectively, the comparative analysis presented in this paper highlights the remarkable diversity and continuous evolution of endoscopic technologies, underlining their crucial role in diagnosing and treating an array of medical conditions, thereby fostering advancements in patient care and clinical outcomes.
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Affiliation(s)
| | | | | | | | | | - Xin Tian
- Department of Intensive Care Unit, Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
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Hsiung T, Chao WP, Chai SW, Chou TC, Wang CY, Huang TS. Laparoscopic vs. open feeding jejunostomy: a systemic review and meta-analysis. Surg Endosc 2022; 37:2485-2495. [PMID: 36513780 DOI: 10.1007/s00464-022-09782-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Feeding jejunostomy is a solid way for patients to maintain enteral nutrition. However, debate over the superiority of the laparoscopic vs. laparotomic method has raised concerns in recent years. This systemic review and meta-analysis aimed to compare the postoperative outcomes between these two approaches. METHODS We searched PubMed, Embase, and Scopus from the date of inception to April 2022 for studies comparing laparoscopic and open feeding jejunostomy. Study characteristics and outcomes were extracted from the included articles. The primary outcome was the relative risk (RR) of postoperative complications in each group. We also analyzed the major/minor complication rates and operations, excluding major concomitant procedures. The risk of bias of included studies were assessed using the ROBINS-I tool. The certainty of evidence was rated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS A total of seven retrospective studies with 1195 patients in total were included in this systemic review and meta-analysis. Laparoscopic feeding jejunostomy carried a significantly lower postoperative complication rate (RR: 0.62; 95% CI, 0.42-0.91, p = 0.02, low certainty of evidence) compared with laparotomy, and the heterogeneity was moderate (I2 = 34%, p = 0.18). After excluding major concomitant procedures, the RR between the laparoscopic and open group was 0.48 (95% CI, 0.33-0.70, p < 0.001, low certainty of evidence), suggesting that the laparoscopic approach was superior in terms of postoperative complications. CONCLUSIONS Our results indicate that laparoscopic feeding jejunostomy might reduce the postoperative overall complication rate compared with open feeding jejunostomy.
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Affiliation(s)
- Ted Hsiung
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Wu-Po Chao
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Shion Wei Chai
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Ta-Chun Chou
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Chih-Yuan Wang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Ting-Shuo Huang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan. .,Department of Chinese Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, 259, Taiwan. .,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, 20401, Taiwan.
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Haga K, Shibuya T, Nomura K, Haraikawa M, Nomura O, Nagahara A. Jejunostomy tube removed after pancreaticoduodenectomy using single-balloon endoscopy. Endoscopy 2022; 54:E478-E479. [PMID: 34598284 DOI: 10.1055/a-1630-6122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Keiichi Haga
- Department of Gastroenterology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Tomoyoshi Shibuya
- Department of Gastroenterology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kei Nomura
- Department of Gastroenterology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Mayuko Haraikawa
- Department of Gastroenterology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Osamu Nomura
- Department of Gastroenterology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
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