DIRECT ENDOSCOPIC PERCUTANEOUS JEJUNOSTOMY (EPJ) - CLINICAL-RESULTS

Direct puncture of the small bowel under endoscopic guidance (direct E PJ) is possible in patients whose stomach has been removed or whose sm all bowel cannot be punctured by other methods. From January 1990 to J une 1992 a total of 39 patients underwent successful direct EPJ at our institution. The indications were malnutrition after partial or total gastrectomy (n = 19), insufficient anastomosis or a stenosis after es ophageal resection and esophagojejunostomy (n = 13), esophageal perfor ation (n = 3), fistulas (n = 2), or severe trauma (n = 2). The tubes w ere inserted at the bedside under local anesthesia using the string pu ll-through technique. The procedure was attempted in five other patien ts but it was technically impossible to insert the tubes in these pati ents. Postoperative enteral feeding was possible in all 39 patients wh ose direct EPJ was successful. Complications included tube dysfunction due to plugging and fracture in five patients, pressure-induced enter ic ulcers in two, and local infections in three patients. The ulcers a nd infections were managed conservatively. We conclude that direct EPJ is a safe, effective alternative to surgical catheter-jejunostomy.