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Hasan Y, Ali A, Sayed AE, Levin A, Gerke H, Jhun HY, Mokadem M, Abiad RE, Jesudoss R, Polyak S, Sahar N. Direct endoscopic placement of percutaneous endoscopic gastrostomies with jejunal extension tubes (PEG-J) using ultra-thin endoscopes - long-term outcomes from a U.S. tertiary referral center. Surg Endosc 2022; 36:4233-4238. [PMID: 34642797 DOI: 10.1007/s00464-021-08757-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/27/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Several techniques for PEG-J tube placement have been described, commonly requiring fluoroscopic guidance and/or fixation of the jejunostomy tube (J-tube) into the small intestine. We describe a modified technique for placing jejunostomy tubes under direct visualization through a PEG with the use of ultra-thin endoscopes and steel guidewire. METHODS A retrospective study at a single tertiary academic center evaluating patients who underwent PEG-J placement between 2010 and 2020. All PEG tubes were placed with a pull-through technique. The Olympus GIF-N180 endoscope was advanced through the PEG to the jejunum and a Savary-Gilliard guidewire was used for placement of the J-tube extension. RESULTS Fifty-eight patients underwent PEG-J placement (median age 61 years; women 52%). Surgically altered gastric anatomy was observed in 11 patients (19%). Median procedure time was 44 min for new PEG-J tube placement (range 26-103) and 20 min for placement of a J-tube extension through an existing PEG tube (range 9-86) or gastrostomy tract. Technical success rate was in 100%. Sixty-two repeat procedures were performed for J-tube exchange in 27 patients (46%, range 1-9 per patient), of which 51 procedures (82%) were done using the same technique. The most common indication for tube replacement was tube dysfunction (63%, n = 39). The median procedure time for tube exchange was 20 min (range 2-62). No major adverse events were encountered. CONCLUSION PEG-J tubes can be placed effectively, rapidly, and safely using an ultra-thin caliber endoscope and a stiff steel wire through the PEG tube or mature gastrostomy site, precluding the need for fluoroscopy or oral access. J-tubes can be easily replaced utilizing the same technique.
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Affiliation(s)
- Yazan Hasan
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52240, USA
| | - Asad Ali
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52240, USA
| | - Amer El Sayed
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52240, USA
| | - Avraham Levin
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52240, USA
| | - Henning Gerke
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52240, USA
| | - Hye Yeon Jhun
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52240, USA
| | - Mohamad Mokadem
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52240, USA
| | - Rami El Abiad
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52240, USA
| | - Randhir Jesudoss
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52240, USA
| | - Steven Polyak
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52240, USA
| | - Nadav Sahar
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52240, USA.
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