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Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Tube Placement: A Single Institution Experience and Outcomes to 30 Days and Beyond

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

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.

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Author information

Author notes

  1. Michael Mulcahy

    Present address: US Army Tripler Army Medical Center, Honolulu, HI, USA

  2. Colin P. O’Rourke

    Present address: Statistical Center for HIV/AIDS Research and Prevention, Seattle, WA, USA

Authors and Affiliations

  1. Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA

    Andrew T. Strong

  2. Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA

    Gautam Sharma, Matthew Davis, Michael Mulcahy, Suriya Punchai, Colin P. O’Rourke, Stacy A. Brethauer, John Rodriguez, Jeffrey L. Ponsky & Matthew D. Kroh

  3. Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Colin P. O’Rourke

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  1. Andrew T. Strong
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Corresponding author

Correspondence to Andrew T. Strong.

Ethics declarations

This study was approved by the Institutional Review Board. Prior to the procedure, all patients or a surrogate decision maker had provided informed consent.

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Author Contributions

Andrew Strong: Study concept and design, data collection, statistical analysis, initial draft of abstract and manuscript, and final approval of manuscript

Gautam Sharma: Study concept and design, data collection and analysis, and final approval of manuscript

Matthew Davis: Data collection and final approval of manuscript

Michael Mulcahy: Data collection and final approval of manuscript

Suriya Punchai: Data collection and final approval of manuscript

Colin P. O’Rourke: Study concept and design, statistical analysis, and final approval of manuscript

Stacy A. Brethauer: Study concept and design and final approval of manuscript

John Rodriguez: Study concept and design and final approval of manuscript

Jeffrey L. Ponsky: Study concept and design, critical review of manuscript, and final approval of manuscript

Matthew D. Kroh: Study concept and design, critical review of manuscript, and final approval of manuscript

All authors agree to be accountable to the contents of the manuscript.

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Strong, A.T., Sharma, G., Davis, M. et al. Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Tube Placement: A Single Institution Experience and Outcomes to 30 Days and Beyond. J Gastrointest Surg 21, 446–452 (2017). https://doi.org/10.1007/s11605-016-3337-2

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  • DOI: https://doi.org/10.1007/s11605-016-3337-2

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