Case StudiesPercutaneous transgastric placement of jejunal feeding tubes with an ultrathin endoscope☆
Section snippets
Patients and methods
All consecutive patients who underwent conversion from PEG tube to transgastric jejunal feeding tube were identified by using an endoscopy database and medical records (Table 1).Indications for transgastric jejunal feeding tube placement included inability to deliver adequate nutrition and/or to deliver nutrition safely by means of a PEG tube, and specific clinical situations that required jejunal feeding. Institutional review board approval and patient consent under Minnesota state law were
Observations
Sixteen jejunal tube placements were performed in 13 patients between April 1999 and November 2000 (Table 1). Placement distal the ligament of Treitz was successful in each case.
Conscious sedation was required for 5 of the 16 procedures because of patient preference. In one case, in which the cause of PEG failure or dysfunction was unknown before procedure, conscious sedation was used because a standard endoscope was first passed orally to assess the gastrostomy site, PEG tube, gastric lumen,
Discussion
The most common type of gastrostomy jejunal feeding tube is the so-called “jejunal extension,” placed fluoroscopically with or without endoscopy through the lumen of an existing PEG tube. During fluoroscopic placement, a guidewire can be threaded through the PEG tube, across the pylorus, and into the jejunum. The jejunal feeding tube is advanced over the guidewire into the jejunum. This method can be technically difficult in patients with altered anatomy (e.g., gastric outlet obstruction
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Cited by (51)
Surgical management of gastroparesis
2020, Gastroparesis: Pathophysiology, Clinical Presentation, Diagnosis and TreatmentUpdate on endoscopic enteral access
2018, Techniques in Gastrointestinal EndoscopyCitation Excerpt :The guidewire is inserted through the endoscope and placed in the jejunum. The endoscope is then removed and the jejunal tube is passed over the guidewire [69]. Another technique places the PEG tube internal bumper over the pylorus and then the jejunal tube is passed through the PEG tube into the jejunum.
Enteral Access and Associated Complications
2018, Gastroenterology Clinics of North AmericaEnteral access and enteral nutrition in patients with short bowel syndrome
2018, Adult Short Bowel Syndrome: Nutritional, Medical, and Surgical ManagementAdvances in nutritional delivery interventions
2015, Techniques in Gastrointestinal Endoscopy
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