Case Studies
Percutaneous transgastric placement of jejunal feeding tubes with an ultrathin endoscope

https://doi.org/10.1067/mge.2002.119257Get rights and content

Abstract

Background: Placement of jejunal feeding tubes in patients with PEG tubes by conventional techniques is often difficult. This is a description of a simple method for placement of jejunal tubes by using an ultrathin endoscope. This method does not always require conscious sedation. Methods: An ultrathin endoscope is passed through a mature gastrostomy tract to the proximal jejunum. A guidewire passed through the endoscope and placed beyond the ligament of Treitz is then used under fluoroscopy to place a transgastric jejunal feeding tube. Observations: Sixteen jejunal feeding tube placements were performed in 13 patients over a period of 20 months. Six patients required conscious sedation. Jejunal tubes had feeding channels of 10 to 12F. There were no complications. Feedings began on the day of placement. Conclusions: Ultrathin endoscopes can be used to place jejunal feeding tubes by means of the transgastric route. The procedure is simple, quick, and safe. In some patients, the use of conscious sedation can be avoided.

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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