DIRECT PERCUTANEOUS ENDOSCOPIC JEJUNOSTOMIES FOR ENTERAL FEEDING

Background: Enteral feeding through percutaneous endoscopic gastrostom y (PEG) is increasingly utilized in hospitals, homes, and institutions . However, PEGs have two major limitations: (1) risk for aspiration, w hich occurs in up to 30% of patients, and (2) it does not allow entera l feeding in patients with gastric outlet obstruction, gastroparesis, or gastric resection. Methods: A new endoscopic method for placement o f direct percutaneous endoscopic jejunostomy (DPEJ) was attempted in 1 50 patients with or without a history of major abdominal surgery. Pati ents were followed-up until tube utilization ceased because of death o r resumption of oral feeding. Results: There were 129 (86%) successful procedures and 21 (14%) unsuccessful attempts. Procedure-related comp lications included nine (6%) insional infections. Bleeding, abscess, a nd colonic perforation each occurred in one patient (.6%), and all req uired surgical intervention. On long-term follow-up (n = 97), tube mal function occurred in 3 patients (3%) and aspiration in 3 (3%). Duratio n of tube use in this population was 113 +/- 173 days. Conclusions: DP EJs can be performed successfully with a low complication rate. Entera l feeding through DPEJs drastically reduces aspiration, which commonly occurs with PEG feeding. DPEJs allow feeding and hydration of patient s with gastric outlet obstruction due to cancer who are not surgical c andidates, eliminate the need for intravenous hydration and feeding, a nd can cut costs of hospitalization and treatment.