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• W1995955805 abstract "Introduction: Aspiration pneumonia is a major complication after PEG. Direct percutaneous endoscopic jejunostomy (D-PEJ) is one of the effective methods for preventing aspiration. While D-PEJ is a stable and safe access to maintain enteral feeding, it is not yet carried out globally because of the technical difficulty and the requirement of a long endoscope (160 cm long or longer). We developed a new technique for placement of a one-step button in the jejunum using transgastrostomic endoscopy (TGE). Methods: D-PEJ was attempted in 19 patients by the following procedures from May, 2004 to November, 2005. All patients were not able to maintain feeding through PEG because of repeated aspiration. The mean age was 83 years old and the male:female ratio was 7:11. TGE was carried out through the mature gastrocutaneous tract after removal of the PEG button (24 F), using a small-caliber endoscope, GIF XP-240 (Olympus Optical Co., Ltd, Tokyo, Japan). After inserting TGE into the jejunum, we determined the site of placement by transillumination and indentation of the jejunum under the guidance of fluoroscopy. Then a one-point suture was conducted with a double lumen gastropexy device (Create Medic Co., Ltd., Yokohama, Japan) to fix the jejunum to the abdominal wall. After puncturing a 16G needle into the jejunum, a loop wire was inserted through the outer sheath of the needle and was grasped by the snare and pulled out through the PEG or brought out from the mouth by TGE. One-Step Button (18 F, through PEG, or 24 F, through mouth, Boston Scientific, Natick, MA) was placed by the conventional pull technique. The length of the button for D-PEJ was selected as the same length of PEG button in all cases. Placement of inner bumper in the jejunum was observed by reinsertion of TGE, and PEG button was replaced after TGE was removed. Results: D-PEJ was successfully placed in 17 patients (89%). The average length of the procedure was 28 min. The reasons of failure in two patients were translocation of the jejunum during puncture and lack of transillumination. There were two procedure related complications (11%); one was penetration through the transverse colon which could be successfully revised by D-PEJ on different sites of the jejunum, and the other was pneumoperitoneum which recovered conservatively. Minor complications included peristomal leakage in 4 patients (24%) and diarrhea in 3 patients (18%). No aspiration pneumonia was observed after D-PEJ during the mean observation period of 205 days. Conclusion: D-PEJ using TGE was a useful and safe technique which needs no long endoscope." @default.
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• W1995955805 date "2006-04-01" @default.
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• W1995955805 title "One Step Button Placement of Direct Percutaneous Endoscopic Jejunostomy Using Transgastrostomic Endoscopy" @default.
• W1995955805 doi "https://doi.org/10.1016/j.gie.2006.03.361" @default.
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