Double percutaneous endoscopic gastrojejunostomy tubes for decompression and refeeding together with enteral nutrients: three case reports and a review of the literature

Superior Mesenteric Artery Syndrome Treated with Percutaneous Radiologic Gastrojejunostomy

Superior mesenteric artery (SMA) syndrome is a rare condition that must be differentiated from other gastrointestinal diseases manifesting as upper abdominal pain, nausea, or vomiting. The description of SMA syndrome is compression of the third portion of the duodenum by the SMA and the abdominal aorta. SMA syndrome is managed with nasoenteral nutrition or surgical strategies such as laparoscopic duodenojejunostomy. However, SMA syndrome treated using enteral nutrition by percuta-neous radiologic gastrojejunostomy has not been reported. Here, we report our experience of successfully managing a case of SMA syndrome with percutaneous radiologic gastrojejunostomy.

Gastroduodenal stents are associated with more durable patency as compared to percutaneous endoscopic gastrojejunostomy in the palliation of malignant gastric outlet obstruction

BACKGROUND

Gastroduodenal outlet obstruction (GOO) is a critical complication of cancers localized within and adjacent to the upper gastrointestinal tract. Approaches to the relief of GOO include surgical bypass with gastrojejunostomy (GJ), endoluminal placement of a self-expandable metallic stent (SEMS), and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J). To date no studies have compared the outcome of utilizing PEG-J with other modalities of therapy.

OBJECTIVES

To determine if there is a difference in complications or effectiveness when survival and/or device patency of PEG-J is compared to that of gastroduodenal SEMS in patients with malignant GOO.

METHODS

Patients who underwent placement of either PEG-J or gastroduodenal SEMS for unresectable malignant GOO were included in a retrospective cohort study.

RESULTS

24 patients (12 men) with a median age of 68.5 years underwent either PEG-J (n=12) or gastroduodenal SEMS (n=12) placement. Patients undergoing SEMS placement experienced longer overall device patency and/or survival as compared to those undergoing PEG-J (median 70 versus 35 days). Complications, including the need for re-intervention, were similar among both groups. Patients who underwent PEG-J as compared to those that had SEMS placement had a hazard ratio of 3.85 (CI 1.28-11.11) for decreased overall survival.

CONCLUSION

In patients with malignant GOO, placement of a palliative SEMS for gastric decompression and nutrition was associated with longer aggregate device patency and survival as compared to PEG-J. Both modalities were similar with respect to complications and the need for re-intervention.