Direct percutaneous endoscopic jejunostomy

Jejunal feeding often is preferable to gastric feeding, particularly in the following situations: high risk for aspiration; gastric resection (partial or total); gastric pull-up; gastric outlet obstruction; obstructed or nonfunctioning gastrojejunostomy; and gastric dysmotility. The technique of placing a thin tube through a gastrostomy tube and pulling it endoscopically into the proximal jejunum allows delivery of nutrients into the jejunum. The results of this technique, however, have been poor. The direct percutaneous endoscopic jejunostomy technique allows placement of tubes directly in the jejunum with a success rate of around 85% and a minimal complication rate which is comparable to that of PEGs.