Endoscopic enteral nutritional access devices (original) (raw)
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Percutaneous transgastric placement of jejunal feeding tubes with an ultrathin endoscope
Gastrointestinal Endoscopy, 2002
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.
Gastrointestinal Endoscopy, 1999
Background: Percutaneous endoscopic gastrostomy (PEG) is a generally accepted procedure, but the appropriateness of patient selection and the justification of jejunal feeding have not been systematically investigated. Also, a critical appraisal of the applicability and tolerance of nutritional support in the immediate postinsertion period and during prolonged outpatient care is lacking. Methods: Prospectively collected data in adult and pediatric patients during a period of 7 years were analyzed. Follow-up data were available at days 1, 7 and 28 and thereafter every 6 to 12 weeks until gastrostomy removal, death or the conclusion of the study. Results: A PEG was successfully positioned in 268 of the 286 referred patients (94%). A jejunal tube through the PEG (JETPEG) was placed beyond the duodenojejunal ligament in 38 patients. Procedure-related mortality was 1%, 30-day outpatient mortality 6.7%. Total follow-up was 295 patient-years with an overall mortality of 53% (PEG 53%; JETPEG 50%). Both major (8.4%) and minor (24.0%) procedure-related complications in the first 28 days consisted merely of (infectious) wound problems. In prolonged follow-up, the complications were more tube-related. The durability of the tube in surviving patients with a PEG or JETPEG in situ was a median of 495 days (range 162 to 1732 days). Tube dysfunction because of clogging, porosity and fracture occurred after a median of 347 days (range 9 to 1123 days). Nausea, vomiting, bloating and dumping interfered with feeding during the first week and during extended follow-up. Intrajejunal feeding was associated with dumping and diarrhea. In retrospect, the anticipated need of 4 weeks of enteral nutrition was not met in 9.0%. The extension of a PEG into a JETPEG was thought inappropriate in 23.7%. In the remainder, a 91% reduction in aspiration justified its use. The tube life span was equal to or greater than that of a PEG, despite tube dysfunction in 26.8%. Conclusions: Proper selection of patients for a PEG, i.e., those with an anticipated need of greater than 4 weeks of enteral nutrition, is a challenge. Notwithstanding an increased rate of tube dysfunction, well-selected patients may benefit from a JETPEG. Follow-up is mandatory because many patients might have become malnourished or underfed while on tube feeding, mainly because of GI intolerance.
Journal of Wound, Ostomy and Continence Nursing
Enteral nutrition (EN) is the introduction of nutrients into the gastrointestinal tract through a tube placed in a natural or artifi cial stoma. Tubes may be passed into the stomach (gastrostomy) or the jejunum (jejunostomy) in patients who cannot obtain adequate nourishing via oral feeding. Following placement, nurses are typically responsible for management of gastrostomy or other enteral tube devices in both the acute and home care settings. This article summarizes guidelines developed for nursing management of percutaneous endoscopic gastrostomy or jejunostomy (PEG/PEJ) and gastrojejunostomy (PEGJ) tubes, developed by the Italian Association of Stoma care Nurses (AIOSS-Associazione Italiana Operatori Sanitari di Stomaterapia) in collaboration with the Italian Association of Endoscopic Operators (ANOTE-Associazione Nazionale Operatori Tecniche Endoscopiche) and the Italian Association of Gastroenterology Nurses and Associates (ANIGEA-Associazione Nazionale Infermieri di Gastroenterologia e Associati). The guidelines do not contain recommendations about EN through nasogastric tubes, indications for PEG/PEJ/ PEGJ positioning, composition of EN, selection of patients, type of tube, modality of administration of the EN,
2015
Background: Protein-calorie malnutrition is a common problem that develops in patients requiring management in the surgical intensive care unit (SICU). The use of durable enteral feeding tubes to help meet their nutritional needs has grown dramatically over that past three decades. However, prepyloric enteral feeding has been associated with increased aspiration risks. Hypothesis: We hypothesize that the percutaneous endoscopic gastrojejunostomy (PEGJ) tubes decrease the risk of aspiration compared to PEG in critically ill SICU patients. Materials and Methods: We retrospectively reviewed the medical records of 106 ICU patients who underwent PEG/PEGJ tube placement at an urban teaching hospital between September 2009 and May 2013. We evaluated the records for aspiration events, aspiration pneumonia, tube dislodgement, intra-abdominal sepsis, reoperation, pre-albumin, hospital and ICU length of stay, and outcome, including mortality. This study was approved by the MSM Institutional Re...
Short- and long-term outcomes from percutaneous endoscopic gastrostomy with jejunal extension
Surgical Endoscopy, 2016
Background-There is a paucity of data regarding the safety and efficacy of PEG-J. We evaluated adverse events related to percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) and determined the clinical impact of PEG-J in those with chronic pancreatitis (CP). Methods-This cohort study included all patients who underwent PEG-J placement in a tertiarycare academic medical center between 2010-2012. Main outcome measurements were 1) shortand long-term complications related to PEG-J; 2) changes in weight and hospitalizations during the 12-month period before and after PEG-J in the CP subgroup. Results-Of 102 patients undergoing PEG-J placement, the overall technical success rate was 97%. During a median follow-up period of 22 months (1-46 months, n=90), at least one tube malfunction occurred in 52/90 (58%; 177 episodes) after a median of 53 days (3-350 days), requiring a median of 2 tube replacements. Short-term (<30 days) tube malfunction occurred in 28/90 (31%) and delayed in 24/90 (27%); these included dislodgement (29%), clogging (26%) and kinking (14%). In the CP subgroup (n=58), mean body weight (kg) (70 vs. 71, p=0.06) and body mass index (kg/m 2 , 26 vs. 27, p=0.05) increased post-PEG-J. Mean number of hospitalizations (5 vs. 2, p<0.0001) and inpatient days per 12 months (22 vs. 12, p=0.005) decreased. Conclusions-While we observed no major complications related to PEG-J, half of patients had at least one episode of tube malfunction. In the CP subgroup, jejunal feeding via PEG-J significantly reduced the number of hospitalizations and inpatients days, while improving nutritional parameters.
Risks of Endoscopic Enteral Access
Techniques in Gastrointestinal Endoscopy, 2008
Enteral nutrition therapy can improve outcomes in many disease states such as pancreatitis and inflammatory bowel disease, and in critically ill patients. Obtaining enteral access is fundamental in order to provide enteral nutrition. The endoscopist plays an important role in placing enteral access systems. The endoscopist should be familiar with the techniques to perform percutaneous endoscopic gastrojejunostomy (PEG/J), direct percutaneous jejunostomy (DPEJ) and bedside nasoenteric tube placement as well as the management of complications that can result from their placement.
Surgical endoscopy, 2017
Enteral access through the jejunum is indicated when patients cannot tolerate oral intake or gastric feeding. While multiple approaches for feeding jejunal access exist, few studies have compared the efficacy of these techniques. The purpose of this study was to investigate the long-term durability, re-intervention rates, and nutritional outcomes following percutaneous endoscopic gastrostomy tubes with jejunal extension tubes (PEG-JET) versus laparoscopic jejunostomy tubes (j-tubes). Retrospective chart review was performed on all patients who underwent PEG-JET or laparoscopic jejunostomy tube placement from January 2005 through December 2015 at our institution. Thirty-day and long-term outcomes were compared between the two groups. A total of 105 patients underwent PEG-JET and 307 patients underwent laparoscopic j-tube placement during the defined study period. In terms of 30-day outcomes, patients who underwent PEG-JET placement were significantly more likely to experience a tube ...