Direct percutaneous endoscopic jejunostomy with small bowel enteroscopy and fluoroscopy

Gastrointestinal Endoscopy
M A ShetzlineM J Workman

Abstract

Approaches to the creation of a percutaneous jejunostomy (PEJ) include enteroscopy with jejunal transillumination, fluoroscopy with small bowel distension and tract dilation, and jejunal enteral tube placement through a percutaneous endoscopic gastrostomy. Although all have been successful, the combination of enteroscopy and fluoroscopy may improve visualization and the success of PEJ placement. This is a description of such a technique and its successful use in 7 patients. The procedure was performed with the patient under conscious sedation in a manner similar to standard PEG placement. The proximal jejunum was visualized and a standard snare was passed though the enteroscope and was opened. A needle and guidewire were directed percutaneously though the snare by using fluoroscopic guidance. Under direct endoscopic visualization the snare was closed around the guidewire. A standard 20F push-type "gastrostomy" tube was passed over the guidewire and through the mouth and the dome seated in the jejunum. A bumper was passed externally over the tube and tightened at the skin. PEJ placement was successful in all 7 patients. The average length of the procedure was 40 minutes (range 22-64 minutes). There were no major complications. M...Continue Reading

Citations

Oct 11, 2005·Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition·Andrew D Guidroz, Ayaz J Chaudhary
Jan 6, 2006·The American Journal of Gastroenterology·John T MapleNavtej S Buttar
Jul 21, 2017·Revista Española De Enfermedades Digestivas : Organo Oficial De La Sociedad Española De Patología Digestiva·Carlos BernardesJoão Carvalho
Dec 18, 2007·Journal of the American Geriatrics Society·Masaki IshiiYasuyoshi Ouchi
Jan 1, 2008·Case Reports in Gastroenterology·Martin D Zielinski, Robert R Cima
Jun 30, 2005·The American Journal of Gastroenterology·Michael A ShetzlineNaurang Agrawal
Jan 27, 2006·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Dia T SimmonsTodd H Baron
Jun 20, 2006·Best Practice & Research. Clinical Gastroenterology·James A DiSario
Jun 15, 2010·Gastrointestinal Endoscopy·Richard S KwonWilliam M Tierney

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