PERCUTANEOUS ENDOSCOPIC GASTROJEJUNOSTOMY - A DUAL CENTER SAFETY AND EFFICACY TRIAL

Although jejunal tube placement through a percutaneous endoscopic gast rostomy (PEG) has not been proven to be preferable to PEG feeding, it would be theoretically advantageous for those patients prone to gastro intestinal aspiration. However, reliable placement of a small bowel fe eding tube through a PEG has been technically difficult. We have previ ously reported successful placement of a percutaneous endoscopic gastr ojejunostomy (PEG/J) with minimal complications. These results are in contrast to other series that report technical difficulty, frequent tu be dysfunction and gastric aspiration. We describe an over-the-wire PE G/J technique performed by multiple operators at two medical centers. Gastrostomy tube placement was successful in 94% of patients. Initial placement of the jejunal tube was successful in 88% of patients. Secon d attempts were 100% successful. The average procedure time was 36 min utes. The distal duodenal and jejunal placement of the jejunal tube re sulted in no episodes of gastroduodenal reflux. Complications included jejunal tube migration (6%), clogging (18%), and unintentional remova l (11%). The majority of patients were ultimately converted to either oral or intragastric feedings. We conclude that the PEG/J system is a reliable, reproducible method of small bowel feeding and is associated with no episodes of tube feeding reflux when the jejunal tube is posi tioned in the distal duodenum or beyond. Furthermore, it provides a te mporary nutritional bridge for those patients who are later transition ed to either PEG or oral feeding.