Abstract
Background
Although direct percutaneous endoscopic jejunal feeding tube placement is an increasingly accepted method of providing small-bowel access for long-term enteral nutrition, it is reliant on push enteroscopy and remains a technically challenging procedure with significant failure rates. Double-balloon enteroscopy, with its ability to provide controlled small-bowel intubation may facilitate direct percutaneous endoscopic jejunal tube placement.
Aims and Methods
We report a prospective series of ten consecutive cases of double-balloon enteroscopy-assisted direct percutaneous endoscopic jejunal placement, accompanied by a step-by-step illustrated overview of the technique.
Results
Direct percutaneous endoscopic jejunal tube placement by double-balloon enteroscopy was successful in nine of the ten attempted cases. In the first case, direct percutaneous endoscopic jejunal placement was abandoned due to inadequate transillumination; there were no procedure-related complications in any of our patients.
Conclusions
This first reported prospective case series of double-balloon enteroscopy-assisted direct percutaneous endoscopic jejunal placement shows a promisingly high success rate; larger comparative studies are required to clearly establish any advantages over the originally described push enteroscopy method.
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References
DiSario JA, Baskin WN, Brown RD, et al. Endoscopic approaches to enteral nutritional support. Gastrointest Endosc. 2002;55:901–908.
Pearce CB, Duncan HD. Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: its indications and limitations. Postgrad Med J. 2002;78:198–204.
Delegge MH. Small bowel endoscopic enteral access. Gastrointest Endosc Clin N Am. 2007;17:663–686.
McClave SA, DeMeo MT, Delegge MH, et al. North American summit on aspiration in the critically ill patient: consensus statement. JPEN J Parenter Enteral Nutr. 2002;26:S80–S85.
Fan AC, Baron TH, Rumalla A, Harewood GC. Comparison of direct percutaneous endoscopic jejunostomy and PEG with jejunal extension. Gastrointest Endosc. 2002;56:890–894.
Rumalla A, Baron TH. Results of direct percutaneous endoscopic jejunostomy, an alternative method for providing jejunal feeding. Mayo Clin Proc. 2000;75:807–810.
Shike M, Schroy P, Ritchie MA, Lightdale CJ, Morse R. Percutaneous endoscopic jejunostomy in cancer patients with previous gastric resection. Gastrointest Endosc. 1987;33:372–374.
Baskin W, Johanson JF. Trans-PEG ultra thin endoscopy for PEG/J Placement. Gastrointest Endosc. 2003;57:146–147.
Delegge MH, Duckworth PF Jr, McHenry L Jr, Foxx-Orenstein A, Craig RM, Kirby DF. Percutaneous endoscopic gastrojejunostomy: a dual center safety and efficacy trial. JPEN J Parenter Enteral Nutr. 1995;19:239–243.
Delegge MH, Patrick P, Gibbs R. Percutaneous endoscopic gastrojejunostomy with a tapered tip, nonweighted jejunal feeding tube: improved placement success. Am J Gastroenterol. 1996;91:1130–1134.
Floch MH. Indications for percutaneous gastrostomy (jejunostomy) (PEG/J). Am J Gastroenterol. 1990;85:1074–1075.
Oksuzoglu G, Kav T, Ates Y, Bagci S. A trick for performing PEG-J more quickly. Endoscopy. 2008;40(Suppl 2):E184.
Ott L, Annis K, Hatton J, McClain M, Young B. Postpyloric enteral feeding costs for patients with severe head injury: blind placement, endoscopy, and PEG/J versus TPN. J Neurotrauma. 1999;16:233–242.
DiSario JA, Foutch PG, Sanowski RA. Poor results with percutaneous endoscopic jejunostomy. Gastrointest Endosc. 1990;36:257–260.
Wolfsen HC, Kozarek RA, Ball TJ, Patterson DJ, Botoman VA. Tube dysfunction following percutaneous endoscopic gastrostomy and jejunostomy. Gastrointest Endosc. 1990;36:261–263.
Baron TH. Direct percutaneous endoscopic jejunostomy. Am J Gastroenterol. 2006;101:1407–1409.
Maple JT, Petersen BT, Baron TH, Gostout CJ, Wong Kee Song LM, Buttar NS. Direct percutaneous endoscopic jejunostomy: outcomes in 307 consecutive attempts. Am J Gastroenterol. 2005;100:2681–2688.
Panagiotakis PH, DiSario JA, Hilden K, Ogara M, Fang JC. DPEJ tube placement prevents aspiration pneumonia in high-risk patients. Nutr Clin Pract. 2008;23:172–175.
Yamamoto H, Yano T, Kita H, Sunada K, Ido K, Sugano K. New system of double-balloon enteroscopy for diagnosis and treatment of small intestinal disorders. Gastroenterology. 2003;125:1556–1557.
Yamamoto H, Sugano K. A new method of enteroscopy—the double-balloon method. Can J Gastroenterol. 2003;17:273–274.
Orlando-Lopez R, Ross AS, Dye CE, Semrad CE. Double-balloon enteroscopy facilitates direct percutaneous endoscopic jejunostomy placement. Gastrointest Endosc. 2008;67:AB266.
Mehdizadeh S, Ross A, Gerson L, et al. What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers. Gastrointest Endosc. 2006;64(5):740–750.
Banerjee S, Shen B, Baron TH, et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc. 2008;67:791–798.
May A, Nachbar L, Schneider M, Neumann M, Ell C. Push-and-pull enteroscopy using the double-balloon technique: method of assessing depth of insertion and training of the enteroscopy technique using the Erlangen Endo-Trainer. Endoscopy. 2005;37:66–70.
Ponsky JL, Gauderer MW. Percutaneous endoscopic gastrostomy: a nonoperative technique for feeding gastrostomy. Gastrointest Endosc. 1981;27:9–11.
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Edward J. Despott: Research and Education Grant from Endoscopy UK (EUK).
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Despott, E.J., Gabe, S., Tripoli, E. et al. Enteral Access by Double-Balloon Enteroscopy: An Alternative Method of Direct Percutaneous Endoscopic Jejunostomy Placement. Dig Dis Sci 56, 494–498 (2011). https://doi.org/10.1007/s10620-010-1306-2
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DOI: https://doi.org/10.1007/s10620-010-1306-2