1
|
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.
Collapse
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
| |
Collapse
|
2
|
Bourgeois A, Gkolfakis P, Fry L, Arvanitakis M. Jejunal access for enteral nutrition: A practical guide for percutaneous endoscopic gastrostomy with jejunal extension and direct percutaneous endoscopic jejunostomy. Best Pract Res Clin Gastroenterol 2023; 64-65:101849. [PMID: 37652649 DOI: 10.1016/j.bpg.2023.101849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/02/2023] [Indexed: 09/02/2023]
Abstract
For patients requiring long-term (>4 weeks) jejunal nutrition, jejunal medication delivery, or decompression, a percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) or a direct percutaneous endoscopic jejunostomy (DPEJ) may be indicated. PEG-J is the preferred option if a PEG tube is already in place or if simultaneous gastric decompression and jejunal nutrition are needed. DPEJ is recommended for patients with altered anatomy due to foregut surgery, high risk of jejunal extension migration, and whenever PEG-J fails. Successful placement rates are lower for DPEJ but recent publications have reported improvements, partly due to the use of balloon-assisted enteroscopy. Both techniques are contraindicated in cases of active peritonitis, uncorrectable coagulopathy, and ongoing bowel ischaemia, and relative contraindications include, among other, peptic ulcer disease and haemodynamic or respiratory instability. In this narrative review, we present the most recent evidence on indications, contraindications, technical considerations, adverse events, and outcomes of PEG-J and DPEJ.
Collapse
Affiliation(s)
- Amélie Bourgeois
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lucia Fry
- Internal Medicine, Gastroenterology and Geriatrics, Frankenwaldklinikum Kronach, Germany
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| |
Collapse
|
3
|
Aryan M, Colvin T, Mulki R, Daley L, Patel P, Locke J, Ahmed AM, Kyanam Kabir Baig KR, Mönkemüller K, Peter S. Direct percutaneous endoscopic jejunostomy tube placement in patients post Roux-en-Y gastric bypass, a single tertiary care center experience. Endosc Int Open 2022; 10:E1282-E1290. [PMID: 36118633 PMCID: PMC9473825 DOI: 10.1055/a-1905-0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background and study aims Obesity prevalence continues to rise in the United States with Roux-en-Y gastric bypass (RYGB) surgery being one of the most common bariatric procedures. With this trend, more patients with altered upper gastrointestinal (UGI) anatomy have required endoscopic intervention including direct percutaneous endoscopic jejunostomy (DPEJ) placement. We aimed to assess the safety and success rates of DPEJ in RYGB patients. Patients and methods All patients at a tertiary care referral center who underwent DPEJ during an 8-year period were queried from a prospectively maintained registry of all enteroscopy procedures. Duplicate cases and altered upper UGI anatomy subtypes other than RYGB were excluded. The final cohort consisted of two groups: RYGB vs native anatomy (NA). Demographic, procedural, readmission, follow-up, and complication data were recorded. Comparative analysis was performed. Results Seventy-two patients were included where 28 had RYGB and 44 had NA. Both groups had similar baseline and pre-procedure data. Procedure success rate was 89 % in RYGB patients and 98 % in NA patients ( P = 0.13). There were no intraprocedural complications. Early and late postprocedural complication rates were similar between the groups (both 4 % vs 7 %). Average follow-up times in the RYGB and NA groups were 12.97 ± 9.35 and 13.44 ± 9.21 months, respectively. Although readmission rates at 1 and 6 months were higher in the NA versus the RYGB group (21 % vs 7 % and 25 % vs 15 %), these differences were not significant. Conclusions DPEJ can be successful and safely placed in RYGB patients with no significant difference in procedure success, complication, or readmission rates when compared to control.
Collapse
Affiliation(s)
- Mahmoud Aryan
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Tyler Colvin
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Ramzi Mulki
- Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, Alabama, United States
| | - Lauren Daley
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Parth Patel
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - John Locke
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Ali M. Ahmed
- Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, Alabama, United States
| | | | | | - Shajan Peter
- Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, Alabama, United States
| |
Collapse
|
4
|
Deliwala SS, Chandan S, Kumar A, Mohan B, Ponnapalli A, Hussain MS, Kaushal S, Novak J, Chawla S. Direct percutaneous endoscopic jejunostomy (DPEJ) and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) technical success and outcomes: Systematic review and meta-analysis. Endosc Int Open 2022; 10:E488-E520. [PMID: 35433212 PMCID: PMC9010104 DOI: 10.1055/a-1774-4736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background and study aims Endoscopic methods of delivering uninterrupted feeding to the jejunum include direct percutaneous endoscopic jejunostomy (DPEJ) or PEG with jejunal extension (PEG-J), validated from small individual studies. We aim to perform a meta-analysis to assess their effectiveness and safety in a variety of clinical scenarios. Methods Major databases were searched until June 2021. Efficacy outcomes included technical and clinical success, while safety outcomes included adverse events (AEs) and malfunction rates. We assessed heterogeneity using I 2 and classic fail-safe to assess bias. Results 29 studies included 1874 patients (983 males and 809 females); mean age of 60 ± 19 years. Pooled technical and clinical success rates with DPEJ were 86.6 % (CI, 82.1-90.1, I 2 73.1) and 96.9 % (CI, 95.0-98.0, I 2 12.7). The pooled incidence of malfunction, major and minor AEs with DPEJ were 11 %, 5 %, and 15 %. Pooled technical and clinical success for PEG-J were 94.4 % (CI, 85.5-97.9, I 2 33) and 98.7 % (CI, 95.5-99.6, I 2 < 0.001). The pooled incidence of malfunction, major and minor AEs with DPEJ were 24 %, 1 %, and 25 %. Device-assisted DPEJ performed better in altered gastrointestinal anatomy. First and second attempts were 87.6 % and 90.2 %. Conclusions DPEJ and PEG-J are safe and effective procedures placed with high fidelity with comparable outcomes. DPEJ was associated with fewer tube malfunction and failure rates; however, it is technically more complex and not standardized, while PEG-J had higher placement rates. The use of balloon enteroscopy was found to enhance DPEJ performance.
Collapse
Affiliation(s)
- Smit S. Deliwala
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, Michigan, United States
| | - Saurabh Chandan
- Gastroenterology and Hepatology, CHI Health Creighton University Medical Center, Omaha, Nebraska, United States
| | - Anand Kumar
- Gastroenterology & Hepatology, Lenox Hill Hospital, New York, New York, United States
| | - Babu Mohan
- Gastroenterology & Hepatology, University of Utah, Salt Lake City, Utah, United States
| | - Anoosha Ponnapalli
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, Michigan, United States
| | - Murtaza S. Hussain
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, Michigan, United States
| | - Sunil Kaushal
- Gastroenterology, Mclaren Health Corporation, Flint, Michigan, United States
| | - Joshua Novak
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Saurabh Chawla
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
| |
Collapse
|
5
|
Nishiwaki S, Kurobe T, Baba A, Nakamura H, Iwashita M, Adachi S, Hatakeyama H, Hayashi T, Maeda T. Prognostic outcomes after direct percutaneous endoscopic jejunostomy in elderly patients: comparison with percutaneous endoscopic gastrostomy. Gastrointest Endosc 2021; 94:48-56. [PMID: 33383037 DOI: 10.1016/j.gie.2020.12.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 12/18/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Direct percutaneous endoscopic jejunostomy (DPEJ) is an alternative method of enteral feeding to percutaneous endoscopic gastrostomy (PEG). Although long-term outcomes of PEG have been reported, little is known regarding the outcomes of DPEJ. METHODS A retrospective cohort study was conducted including 115 and 651 consecutive attempts of DPEJ and PEG, respectively, in a total of 766 elderly patients between April 2004 and March 2019. Patients' clinical background, procedural and long-term outcomes, survival analysis, and cause of death were analyzed. RESULTS Successful placement rates were 93.9% and 97.1% for DPEJ and PEG, respectively. There was no significant difference in procedure-related adverse events (AEs) between the DPEJ and PEG groups. Rates of pneumonia, vomiting, and upper GI bleeding were significantly lower, whereas those of fistula enlargement and ileus were significantly higher in the DPEJ group as long-term AEs. The median survival periods were 694 and 734 days for DPEJ and PEG, respectively, with no significant differences between the 2 groups. Multivariate analysis revealed that age 80 years old or older, C-reactive protein level of 1.0 mg/dL or higher, and the presence of diabetes were independent risk factors for mortality after DPEJ. Respiratory tract infection was the primary cause of death in both groups. CONCLUSIONS DPEJ is considered a safe and feasible method of access for enteral feeding as well as PEG. Although the survival period after DPEJ may be expected to be as long as that with PEG, DPEJ-specific AEs should be kept in mind on long-term feeding.
Collapse
Affiliation(s)
- Shinji Nishiwaki
- Department of Internal Medicine, Nishimino Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan; Department of Internal Medicine, Ibi Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan
| | - Takuya Kurobe
- Department of Internal Medicine, Nishimino Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan
| | - Atsushi Baba
- Department of Internal Medicine, Nishimino Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan
| | - Hironori Nakamura
- Department of Internal Medicine, Ibi Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan
| | - Masahide Iwashita
- Department of Internal Medicine, Nishimino Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan
| | - Seiji Adachi
- Department of Gastroenterology, Gihoku Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan
| | - Hiroo Hatakeyama
- Department of Internal Medicine, Nishimino Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan; Department of Internal Medicine, Ibi Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan
| | - Takao Hayashi
- Department of Internal Medicine, Nishimino Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan
| | - Teruo Maeda
- Department of Internal Medicine, Nishimino Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan
| |
Collapse
|
6
|
Strong AT, Sharma G, Davis M, Mulcahy M, Punchai S, O'Rourke CP, Brethauer SA, Rodriguez J, Ponsky JL, Kroh MD. Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Tube Placement: A Single Institution Experience and Outcomes to 30 Days and Beyond. J Gastrointest Surg 2017; 21:446-452. [PMID: 27995433 DOI: 10.1007/s11605-016-3337-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/23/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Patients with prior foregut surgery requiring long-term enteral access typically undergo operative jejunostomy tube placement; however, direct percutaneous endoscopic jejunostomy (DPEJ) is a viable alternative. METHODS All de novo DPEJ procedures performed by surgical and advanced endoscopists from May 2003 to June 2015 were retrospectively reviewed following approval by the Institutional Review Board. There were 59 cases identified. RESULTS Our cohort had a mean age of 50.3 ± 16.9 years and 35 (59.3%) were female. All but two patients previously had foregut surgery including 19 patients (34.5%) with prior bariatric surgery. The composite of malnutrition and dehydration was the indication for DPEJ in 29 patients (49.1%) and was the initial enteral access placed in 47 patients (79.7%). Moderate sedation was used in 32 cases (54.2%), and 29 procedures (49.2%) were performed in the operating room. Within 30 days, there were six complications in five patients, giving a peri-procedural complication rate of 12.5%. Beyond 30 days, the most common complications were peri-tube leakage and dislodgement (each 16.9%). The median time to complication was 197 days. CONCLUSIONS In patients with surgically altered foregut anatomy, DPEJ offers a less invasive alternative to operative jejunostomy tube placement. DPEJ can be placed in the endoscopy suite or operating room with an acceptable risk of perioperative complications.
Collapse
Affiliation(s)
- Andrew T Strong
- Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA.
| | - Gautam Sharma
- Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Davis
- Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Michael Mulcahy
- Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
- US Army Tripler Army Medical Center, Honolulu, HI, USA
| | - Suriya Punchai
- Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Colin P O'Rourke
- Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
- Statistical Center for HIV/AIDS Research and Prevention, Seattle, WA, USA
| | - Stacy A Brethauer
- Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - John Rodriguez
- Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jeffrey L Ponsky
- Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew D Kroh
- Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
7
|
Lim AH, Schoeman MN, Nguyen NQ. Long-term outcomes of direct percutaneous endoscopic jejunostomy: a 10-year cohort. Endosc Int Open 2015; 3:E610-4. [PMID: 26716121 PMCID: PMC4683153 DOI: 10.1055/s-0034-1392806] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 07/13/2015] [Indexed: 01/24/2023] Open
Abstract
STUDY AIM To assess the clinical outcomes of patients who received direct percutaneous endoscopic jejunostomy (DPEJ) for enteral feeding. MATERIALS AND METHODS This is a 10-year cohort study in a single tertiary center. Main outcome measurements were technical success, and short- and long-term outcomes. DPEJ was attempted in 83 patients (51 men; 55 ± 2 years) for dysphagia (n = 35), gastroparesis with recurrent aspiration (n = 30), and levodopa drug infusion for severe Parkinson's disease (n = 18). RESULTS DPEJ was successful in 75 (90 %) patients. All technical failures were related to the inability to find adequate trans-illumination, and were not influenced by BMI, age, gender, or indication. Peri-operative (30-day) adverse events occurred in 11 (13 %) patients, including wound infection (3), leakage around the stoma (4), minor bleeding requiring no intervention (2), and aspiration (1). There was one case (1.2 %) of gastric perforation after PEJ insertion for levodopa drug infusion trial. This 60-year-old woman required an emergency laparotomy with nil complications, and levodopa drug infusion recommenced successfully. One case of intestinal perforation (1.2 %) occurred after jejunostomy tube replacement at 6 months of insertion, which was successfully managed with surgery. There were no peri-operative deaths. Adequate delivery of enteral feeding or Duodopa drug was achieved in 66/73 (90 %) patients, with evidence of weight gain or improvement in Parkinson's disease. Seven (8 %) continued to have clinical regurgitation but not aspiration. After a median follow-up of 84 months, 27 (33 %) patients died of their underlying diseases. Seven (8 %) had marked improvement in their underlying disease and had PEJ removed after 5 months (range 1 - 8 months). LIMITATIONS Single center study. CONCLUSIONS DPEJ is associated with a high technical success rate (90 %), a relatively low rate of peri-operative adverse events (13 %) and an improvement in long-term nutritional support in the majority of patients (90 %). DPEJ should be the procedure of choice to gain enteral access for feeding or drug delivery prior to considering surgery.
Collapse
Affiliation(s)
- Amanda H. Lim
- Departments of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Mark N. Schoeman
- Departments of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Nam Q. Nguyen
- Departments of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia,University Department of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia,Corresponding author Nam Q. Nguyen, PhD Department of Gastroenterology and HepatologyRoyal Adelaide HospitalNorth TerraceAdelaideSouth Australia 5000Australia+61-8-82235885
| |
Collapse
|
8
|
Velázquez-Aviña J, Beyer R, Díaz-Tobar CP, Peter S, Kyanam Kabir Baig KR, Wilcox CM, Mönkemüller K. New method of direct percutaneous endoscopic jejunostomy tube placement using balloon-assisted enteroscopy with fluoroscopy. Dig Endosc 2015; 27:317-22. [PMID: 25211635 DOI: 10.1111/den.12352] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/20/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIM Direct percutaneous endoscopic jejunostomy (DPEJ) is a useful method to provide nutrition to patients with a variety of gastrointestinal (GI) problems. The present study describes a new method of DPEJ using balloon-assisted-enteroscopy. METHODS This observational, retrospective, single-arm case study conducted at a tertiary care hospital during a 15-month period included 25 patients (12 females, 13 males, mean age 54 years, age range 31-79 years) with necrotizing pancreatitis, n = 7; complex upper GI surgery, n = 6; complex fistula, n = 6; impossibility to place a gastrostomy tube, n = 5; and bowel obstruction, n = 1. The new DPEJ technique focused on three key components: (i) use of balloon-assisted overtube; (ii) use of fluoroscopy; (iii) leaving the overtube in place during the entire procedure (and also for DPEJ removal). RESULTS Technical success was 96%. Mean time of the procedure was 30.5 min (range 24 to 45 min). Clinical success was 100% (24/24); all DPEJ could be used for their intended purpose. CONCLUSIONS This new method of inserting a DPEJ using balloon enteroscopy and fluoroscopy was safe and successful. Future comparative studies are now warranted.
Collapse
Affiliation(s)
- Jacobo Velázquez-Aviña
- Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, USA
| | | | | | | | | | | | | |
Collapse
|