Background and Aims
When PEG tube feeding is complicated by anatomic obstruction, dysmotility, or aspiration,
a need arises for feeding beyond the pylorus. The currently available percutaneous
gastrojejunostomy (PEG-J) kits have issues with the jejunal extension portion migrating
back into the stomach. The aim of this study was to evaluate the feasibility and safety
of a novel technique that creates PEG-J tubes by combining an adult percutaneous gastrostomy
(PEG) tube with a pediatric PEG tube, the PEG-Pedi-PEG procedure.
Methods
This was a retrospective study at a single tertiary care center. The main outcome
measures were success of placement, rate of retrograde tube migration, early (<24
h after procedure was performed) and late (>24 h after procedure was performed) adverse
events.
Results
Seventeen patients underwent PEG-Pedi-PEG procedures during the study period. Technical
success was achieved in all patients (100%). The retrograde migration rate of the
jejunal extension tube was 0%. Early adverse events included peristomal pain in 1
patient. Late adverse events included inadvertent tube removal (3 patients), diarrhea
(1 patient), prolonged ileus/gastroparesis (1 patient), and tube occlusion (1 patient).
Mean follow-up was 290 days.
Conclusions
The PEG-Pedi-PEG procedure is a novel endoscopic technique to facilitate post-pyloric
feeding because the pediatric PEG bumper may act like a sail in the small bowel, with
peristalsis pushing the bumper distally and thus decreasing the possibility of migration
back into the stomach. This study demonstrated excellent technical success, no retrograde
migration, and a low rate of adverse events.
Abbreviations:
PEG (percutaneous gastrostomy), PEG-J (percutaneous gastrojejunostomy)To read this article in full you will need to make a payment
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References
- Percutaneous endoscopic jejunostomy and jejunal extension tube through percutaneous endoscopic gastrostomy: a retrospective analysis of success, complications and outcomes.Digestion. 2009; 79: 92-97
- Multidisciplinary practical guidelines for gastrointestinal access for enteral nutrition and decompression from the Society of Interventional Radiology and American Gastroenterological Association Institute, with endorsement by Canadian Interventional Radiological Association and Cardiovascular and Interventional Radiological Society of Europe.J Vasc Interv Radiol. 2011; 22: 1089-1106
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ASGE Technology Committee; Kwon RS, Banerjee S, Desilets D, et al. American Society for Gastrointestinal Endoscopy. Technology status evaluation report: enteral nutrition access devices. Gastrointest Endosc 2010;72:236-48.
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Article info
Publication history
Published online: June 18, 2016
Accepted:
June 2,
2016
Received:
September 16,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Samarasena at [email protected]
Identification
Copyright
Copyright © 2016 by the American Society for Gastrointestinal Endoscopy
