Poor results with percutaneous endoscopic jejunostomy

doi:10.1016/S0016-5107(90)71018-8

Gastrointestinal Endoscopy

Volume 36, Issue 3, May 1990, Pages 257-260

Presented in part at the American Society for Gastrointestinal Endoscopy Meeting, May 17, 1989, Washington, D.C.

https://doi.org/10.1016/S0016-5107(90)71018-8 Get rights and content

A percutaneous endoscopic gastrostomy was placed in 20 malnourished patients to serve as a conduit for passage of a percutaneous endoscopic jejunostomy (PEJ) catheter for delivery of alimentation directly into the small bowel. Serious complications occurred in 95% of the patients and 50% of the subjects died. Aspiration was the most common adverse event and accounted for all deaths. Ten of 15 subjects (67%) treated with a PEJ to prevent aspiration continued to aspirate after the catheter was placed. PEJ tube failures were documented in 14 subjects (70%) and occurred because of occlusion, leakage, malposition, extrusion, cracking, kinking, or rupture of the catheter. These problems rendered the PEJ nonfunctional 18% of the time. Large manpower and resource investments were required to manage the PEJ and its complications. Our results suggest that enteral feeding through a PEJ does not prevent aspiration. Serious PEJ-related morbidity (95%), mortality (50%), and catheter failures (70%) occur. Refinements in methodology and catheter design will be required before additional use of this technique can be recommended.

References (17)

J.L. Ponsky et al.
Percutaneous approaches to enteral alimentation.
Ann J Surg
(1985)
D.E. Larson et al.
Percutaneous endoscopie gastrostomy: indications, success, compli cations, and morality in 314 consecutive patients
Gastroenterology
(1987)
E.J. Huxley et al.
Pharyngeal aspiration in normal adults and patients with depressed conscious ness
Am J Med
(1978)
S.G.T. Jolley et al.
Lower esophageal pressure changes with tube gastrostomy: a causative factor of gastroesophageal reflux in children?
J Pediatr Surg
(1986)
J.G. Papaila et al.
The effect of various types of gastrostomy on the lower esophageal sphincter
J Pediatr Surg
(1987)
D.S. Kaplan et al.
Percutaneous endoscopic jejunostomy: long-term follow-up of 23 patients
Gastrointest Endosc
(1989)
P.G. Foutch et al.
Percutaneous endoscopie gastrostomy (PEG): a new procedure comes of age
J Clin Gastroenterol
(1986)
J.L. Ponsky et al.
Percutaneous endoscopic gastrostomy: indications, limitations, techniques and results
World J Surg
(1989)

There are more references available in the full text version of this article.

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View full text

Poor results with percutaneous endoscopic jejunostomy

Ann J Surg

Gastroenterology

Am J Med

J Pediatr Surg

J Pediatr Surg

Gastrointest Endosc

Percutaneous endoscopie gastrostomy (PEG): a new procedure comes of age

J Clin Gastroenterol

Percutaneous endoscopic gastrostomy: indications, limitations, techniques and results

World J Surg