Direct percutaneous endoscopic jejunostomy with small bowel enteroscopy and fluoroscopy.

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Surgical Techniques

Background:

• Percutaneous jejunostomy (PEJ) creation involves various methods, including enteroscopy, fluoroscopy, and transgastric approaches.
• Combining enteroscopy with fluoroscopy may enhance visualization and success rates for PEJ placement.

Purpose of the Study:

• To describe a novel technique for percutaneous endoscopic jejunostomy (PEJ) placement utilizing enteroscopy and fluoroscopy.
• To report the successful application of this technique in a series of patients.

Main Methods:

• The procedure involved conscious sedation and was similar to standard percutaneous endoscopic gastrostomy (PEG) placement.
• Enteroscopy visualized the proximal jejunum, with a snare used to guide a percutaneous needle and guidewire under fluoroscopic guidance.
• A jejunal feeding tube was then advanced over the guidewire, with the dome positioned in the jejunum.

Main Results:

• PEJ placement was successful in all 7 patients.
• The average procedure time was 40 minutes, with no major complications reported.
• Feeding tubes remained functional throughout the follow-up period.

Conclusions:

• Percutaneous endoscopic jejunostomy placement using enteroscopy and fluoroscopy is a safe and effective technique.
• This method offers a viable option for distal enteral nutritional support when PEG is not feasible.