Tips and Tricks for Deep Jejunal Enteral Access: Modifying Techniques to Maximize Success


Endoscopic insertion of enteral feeding tubes is a major advance in the delivery of nutrition therapy. Since the first report of percutaneous endoscopic gastrostomy (PEG) in 1980 (Gauderer et al. J Pediatr Surg. 15:872–5, 1980), insertion techniques and equipment have been refined and improved. Despite this progress, deep jejunal enteral access remains a difficult procedure, and many endoscopists do not have experience with the techniques of nasojejunal (NJ) placement, percutaneous endoscopic gastrojejunostomy (PEGJ), or direct percutaneous endoscopic jejunostomy (DPEJ) (Shike and Latkany, Gastrointest Endosc Clin N Am. 8:569–80, 1998). The difference between an exasperating experience and a rewarding procedure lies in mastering the “tips and tricks” that make insertion easy. While the basic techniques are described elsewhere (McClave and Chang 2011), we review several universal basic principles to enhance deep jejunal access, which should promote a more efficient and successful procedure.

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Conflict of Interest

Matthew Bechtold, Robert Martindale, Douglas Nguyen, and David C. Evans have nothing to disclose.

Steven A. McClave is a consultant for Covidien and has received research grants from Abbot and Nestle.

Lena B. Palmer has received travel and compensation for participation in the Regional Advisory Board from NPS Pharmaceuticals.

Human and Animal Rights and Informed Consent

This article does not contain any studies with animal subjects performed by any of the authors. With regard to the authors’ research cited in this paper, all procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.

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Correspondence to Lena B. Palmer.

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This article is part of the Topical Collection on Nutrition and Obesity

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Palmer, L.B., McClave, S.A., Bechtold, M.L. et al. Tips and Tricks for Deep Jejunal Enteral Access: Modifying Techniques to Maximize Success. Curr Gastroenterol Rep 16, 409 (2014).

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  • Jejunal access
  • Enteral feeding
  • Post-pyloric placement