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Short- and long-term outcomes from percutaneous endoscopic gastrostomy with jejunal extension

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Abstract

Background

There is a paucity of data regarding the safety and efficacy of percutaneous endoscopic gastrostomy with jejunal extension (PEG-J). We evaluated adverse events related to PEG-J and determined the clinical impact of PEG-J in those with chronic pancreatitis (CP).

Methods

This cohort study included all patients who underwent PEG-J placement in a tertiary-care academic medical center between 2010 and 2012. Main outcome measurements were (1) short- and long-term complications related to PEG-J and (2) changes in weight and hospitalizations during the 12-month period before and after PEG-J in the CP subgroup.

Results

Of 102 patients undergoing PEG-J placement, the overall technical success rate was 97 %. During a median follow-up period of 22 months (1–46 months, n = 90), at least one tube malfunction occurred in 52/90 (58 %; 177 episodes) after a median of 53 days (3–350 days), requiring a median of two tube replacements. Short-term (<30 days) tube malfunction occurred in 28/90 (31 %) and delayed in 24/90 (27 %); these included dislodgement (29 %), clogging (26 %) and kinking (14 %). In the CP subgroup (n = 58), mean body weight (kg) (70 vs. 71, p = 0.06) and body mass index (kg/m2, 26 vs. 27, p = 0.05) increased post-PEG-J. Mean number of hospitalizations (5 vs. 2, p < 0.0001) and inpatient days per 12 months (22 vs. 12, p = 0.005) decreased.

Conclusions

While we observed no major complications related to PEG-J, half of patients had at least one episode of tube malfunction. In the CP subgroup, jejunal feeding via PEG-J significantly reduced the number of hospitalizations and inpatients days, while improving nutritional parameters.

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Abbreviations

ASGE:

American Society for Gastrointestinal Endoscopy

PEG-J:

Percutaneous endoscopic gastrostomy with jejunal extension

D-PEJ:

Direct percutaneous endoscopic jejunostomy

CP:

Chronic pancreatitis

NJ:

Nasojejunal

GI:

Gastrointestinal

BW:

Body weight

BMI:

Body mass index

RAP:

Recurrent acute pancreatitis

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Authors’ contributions

GAC and WR contributed to the conception and design. WR helped in data collection. GAC and WR were involved in data analysis and interpretation. GAC and WR helped in manuscript drafting. GAC, GAL and SS contributed to critical revision of the article for important intellectual content. GAC, GAL, JLW, ELF, LMH and SS were involved in final approval of the article.

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Authors and Affiliations

  1. Indiana University School of Medicine, Indianapolis, IN, USA

    Wiriyaporn Ridtitid, Glen A. Lehman, James L. Watkins, Lee McHenry, Evan L. Fogel, Stuart Sherman & Gregory A. Coté

  2. King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Chulalongkorn University, Bangkok, Thailand

    Wiriyaporn Ridtitid

  3. Medical University of South Carolina, 114 Doughty Street, MSC 702, Room 249, Charleston, SC, 29425, USA

    Gregory A. Coté

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  1. Wiriyaporn Ridtitid
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  2. Glen A. Lehman
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Correspondence to Gregory A. Coté.

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Disclosure

An earlier version of these data was presented at the annual meeting of Digestive Diseases Week, 2014, Chicago, Illinois. Drs. Wiriyaporn Ridtitid, Glen A. Lehman, James L. Watkins, Lee McHenry, Evan L. Fogel, Stuart Sherman and Gregory A. Coté have no conflicts of interest or financial ties to disclose.

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Ridtitid, W., Lehman, G.A., Watkins, J.L. et al. Short- and long-term outcomes from percutaneous endoscopic gastrostomy with jejunal extension. Surg Endosc 31, 2901–2909 (2017). https://doi.org/10.1007/s00464-016-5301-3

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  • DOI: https://doi.org/10.1007/s00464-016-5301-3

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