Transnasal stent-assisted targeting technique for percutaneous jejunostomy placement in patients with hiatal hernias

  • Jeffrey Forris Beecham ChickEmail author
  • Neil Jairath
  • Joseph J. Gemmete
  • Anthony N. Hage
  • Jacob J. Bundy
  • Nishant A. Patel
  • Evan J. Johnson
  • Mamdouh Khayat
  • Ravi N. Srinivasa
Interventional Radiology



To report the transnasal stent-assisted targeting technique for percutaneous jejunostomy placement in patients with hiatal hernias.

Materials and methods

Four patients, including three (75%) females and one (25%) male, with mean age of 77.5 years (range 73–78 years), and with a hiatal hernia and intrathoracic stomach precluding gastrostomy placement and loop snare placement into the mid-jejunum underwent the transnasal stent-assisted targeting technique for percutaneous jejunostomy placement. In all patients, a duodenal stent was inserted into the jejunum in a transnasal fashion. The stent was partially unsheathed in an anterior loop of jejunum and percutaneously targeted using an 18-gauge needle through which a guidewire was advanced, trapped within the stent, and removed through the nose. The tract was serially dilated and a jejunostomy was placed. Technical success, procedure time, fluoroscopy time, radiation exposure, complications, time to enteral feeding, and follow-up were recorded.


Technical success was 100% (4/4) with all four patients requiring only one needle pass before successful jejunal cannulation. Mean procedure time was 108 min. Mean fluoroscopy time was 44 min. Mean dose area product was 3969.3 μGym2. No minor or major complications occurred. All four patients received enteral feeding one day after the procedure. Mean follow-up was 366 days.


The transnasal stent-assisted targeting technique is a novel method for primary jejunostomy placement in patients with hiatal hernias.


Primary jejunostomy Percutaneous jejunostomy Transnasal stent-assisted targeting Wallflex targeting Hiatal hernias 



The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Author contributions

All authors have read and contributed to this manuscript.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jeffrey Forris Beecham Chick
    • 1
    Email author
  • Neil Jairath
    • 2
  • Joseph J. Gemmete
    • 2
  • Anthony N. Hage
    • 2
  • Jacob J. Bundy
    • 2
  • Nishant A. Patel
    • 2
  • Evan J. Johnson
    • 2
  • Mamdouh Khayat
    • 2
  • Ravi N. Srinivasa
    • 3
  1. 1.Cardiovascular and Interventional RadiologyInova Alexandria HospitalAlexandriaUSA
  2. 2.Division of Vascular and Interventional Radiology, Department of RadiologyUniversity of Michigan Health SystemsAnn ArborUSA
  3. 3.Division of Interventional Radiology, Department of RadiologyUniversity of California Los AngelesLos AngelesUSA

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