A New Technique For Jejunal Feeding Tube Placement - A Marriage Of Enteroscope And Laparoscope

The technique of percutaneous endoscopic gastrostomy (PEG) is successful in most patients and is usually not associated with significant morbidity. However, PEG provides minimal protection against episodes of recurrent aspiration, especially in those patients with a prior history of such. The incidence of recurrent aspiration among these patients is reported to be 30% to 70%. 1 Lewis BS. Perform PEJ, not PED. Gastrointest Endosc. 1990; 36: 311-312 Abstract Full Text PDF PubMed Scopus (55) Google Scholar Surgical jejunostomy has been shown in some series to minimize the likelihood of aspiration in such patients. 2 Matino J. Feeding jejunostomy in patients with neurologic disorders. Arch Surg. 1981; 116: 169-171 Crossref PubMed Scopus (23) Google Scholar , 3 Burtch GD Shatney CH. Feeding jejunostomy (versus gastrostomy) passes the test of time. Am Surg. 1987; 53: 54-57 PubMed Google Scholar , 4 McGonigel MD Lucas CE Ledgerwood AM. Feeding jejunostomy in patients who are critically ill. Surg Gynecol Obstet. 1989; 168: 275-277 PubMed Google Scholar , 5 Weltz CR Morris JB Mullen JL. Surgical jejunostomy in aspiration risk patients. Ann Surg. 1992; 215: 140-145 Crossref PubMed Scopus (66) Google Scholar This has led to various methods of small-bore feeding tube placement in the jejunum through a previously established PEG. 6 Ponsky JL Aszodi A. Percutaneous endoscopic jejunostomy. Am J Gastroenterol. 1984; 79: 113-116 PubMed Google Scholar , 7 Gottfried EB Plumser AB. Endoscopic gastrojejunostomy: a technique to establish small bowel feeding without laparotomy. Gastrointest Endosc. 1984; 30: 355-357 Abstract Full Text PDF PubMed Scopus (47) Google Scholar , 8 Alzate GD Coons HG Elliott J et al. Percutaneous gastrostomy for jejunal feeding: a new technique. AJR Am J Roentgenol. 1986; 147: 822-825 Crossref PubMed Scopus (35) Google Scholar , 9 Parasher UK Abramowicz CJ Bell C et al. Successful placement of percutaneous gastrojejunostomy using steerable glidewire: a modified controlled push technique. Gastrointest Endosc. 1995; 41: 52-55 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar , 10 Kaplan DS Murthy UK Linscheer WG. Percutaneous endoscopic jejunostomy: long-term follow-up of 23 patients. Gastrointest Endosc. 1989; 35: 403-406 Abstract Full Text PDF PubMed Scopus (64) Google Scholar , 11 MacFadyen Jr., BV Ghorbrial R Catalano M et al. Concomitant placement of percutaneous endoscopic gastrostomy and jejunostomy. Surg Endosc. 1992; 6: 289-293 Crossref PubMed Scopus (9) Google Scholar Placing a jejunal feeding tube through a pre-existing PEG (JET PEG) is now an established technique. Unfortunately, JET PEG may be associated with several problems such as leakage, extrusion, cracking, or rupture of the jejunal tube component. 12 DiSario JA Foutch PG Sanowski RA. Poor results with percutaneous endoscopic jejunostomy. Gastrointest Endosc. 1990; 36: 257-260 Abstract Full Text PDF PubMed Scopus (189) Google Scholar In addition, the technique of JET PEG may not protect the patient from developing aspiration pneumonia. 13 Wolfsen HC Kozarek RA Ball TJ et al. Tube dysfunction following percutaneous endoscopic gastrostomy and jejunostomy. Gastrointest Endosc. 1990; 36: 261-263 Abstract Full Text PDF PubMed Scopus (137) Google Scholar Attempts at percutaneous endoscopic placement of jejunal feeding tubes have been described. 14 Shike M Wallach C Likier H. Direct percutaneous endoscopic jejunostomies. Gastrointest Endosc. 1991; 37: 62-65 Abstract Full Text PDF PubMed Scopus (67) Google Scholar , 15 Lewis BS. Direct percutaneous endoscopic jejunostomy. Gastrointest Endosc. 1991; 37 ([Letter]): 493 Abstract Full Text PDF PubMed Scopus (3) Google Scholar This technique has inherent difficulties and is not widely used. Recently, with the evolution of laparoscopic surgery, several techniques of laparoscopic feeding tube placement with successful results have been described. 16 Morris JB Mullen JL Yu JC et al. Laparoscopic-guided jejunostomy. Surgery. 1992; 112: 96-99 PubMed Google Scholar , 17 Eltringham WK Roe AM Galloway SW et al. A laparoscopic technique for full thickness intestinal biopsy and feeding jejunostomy. Gut. 1993; 34: 122-124 Crossref PubMed Scopus (18) Google Scholar