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 22 May 2018

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News

Percutaneous endoscopic jejunostomy removes need for surgery

Direct percutaneous endoscopic jejunostomy is associated with complications in 10% of cases, but is a useful technique to gain enteral access that obviates the need for surgery, finds this month's American Journal of Gastroenterology.

News image

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Clinical utilization of direct percutaneous endoscopic jejunostomy is increasing.

However, little data exist regarding important clinical outcomes with direct percutaneous endoscopic jejunostomy.

Dr Minnesota and colleagues describe the indications, success, and complications of direct percutaneous endoscopic jejunostomy.

The research team evaluated a large cohort of more than 300 consecutive attempted direct percutaneous endoscopic jejunostomy cases at their institution.

The team identified 316 consecutive attempted direct percutaneous endoscopic jejunostomy placements between 1996 and 2004 from institutional databases.

The medical records of consenting patients were abstracted for demographics, indication, success, complications, and follow-up.

A scheme for classifying complication severity was designed.

The team noted that 307 attempts were made at direct percutaneous endoscopic jejunostomy on 286 patients.

81 adverse events were associated with direct percutaneous endoscopic jejunostomy placement
American Journal of Gastroenterology

Of these, 209 succeeded.

The researchers found that the most common indications for direct percutaneous endoscopic jejunostomy included resectable distal esophageal cancer.

Other common indications were malignancies causing obstruction, gastroparesis, prior esophageal or gastric resection, and high aspiration risk.

Overall, the team noted that 81 adverse events were associated with direct percutaneous endoscopic jejunostomy placement.

The researchers observed that percutaneous endoscopic jejunostomy was associated with removal in l in 69 cases.

There were 14 serious adverse events, 20 moderate adverse events, and 47 mild adverse events.

Serious adverse events included 7 bowel perforations, 3 jejunal volvuli, 3 major bleeds, and 1 aspira adverse events tion.

The team noted that the only death was due to profound jejunal mesenteric bleeding after an unsuccessful trocar pass.

Moderate adverse events included 9 chronic enterocutaneous fistulae.

In addition, the team found that many of the 47 mild adverse events were site infections.

Of these, 23 required oral antibiotics and 14 required persistent site pain.

Dr Minnesota's team concluded, “Direct percutaneous endoscopic jejunostomy was associated with a moderate or severe complication in 10% of cases.”

“Direct percutaneous endoscopic jejunostomy is a useful technique to gain enteral access that obviates the need for surgery."

"It is more reliable than percutaneous gastrostomy with jejunal extension"

"However, patients and physicians should be aware of the risks involved.”

Am J Gastroenterol 2005: 100(12): 2681
12 December 2005

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