title: DPEJ placement in cases of PEG insertion failure.
abstract: OBJECTIVE
  PEG placement is routinely used for enteral feeding; in some cases PEG is not feasible or indicated due to technical difficulties, such as gastric herniation, organ interposition, or presence of gastroparesis. In these cases, surgical gastrostomy or jejunostomy are possible alternatives; more recently, direct percutaneous jejunostomy (DPEJ) has been proposed to avoid surgical intervention. The aim of the study was to evaluate the necessity, technical feasibility and outcome of DPEJ in a group of patients consecutively proposed for PEG placement.
  
  
  METHODS
  In each patient proposed for PEG placement, an upper gastrointestinal endoscopy was performed, and then a pull traction removal gastrostomy tube (18-20 F) was inserted. When PEG was not feasible or contraindicated, a variable stiffness pediatric videocolonscope was used to reach the jejunum: then DPEJ was performed with the same technique and materials as PEG. In both groups enteral feeding was started 24h after the endoscopic procedure, using an enteral feeding pump and the same nutritional schedules.
  
  
  RESULTS
  In a 1-year period 90 patients were proposed for PEG placement; PEG could not be performed for technical reasons in 8 (gastric herniation in 1; organ interposition in 7) and gastroparesis in 1. In one patient both PEG and DPEJ were not feasible for organ interposition. The duration of the endoscopic procedure was slightly longer in DPEJ (mean 20 min versus 15 min). No complications related to the endoscopic procedure were observed in both DPEJ and PEG patients. No nutritional complication were observed in the DPEJ group.
  
  
  CONCLUSIONS
  In our experience, PEG was not feasible or contraindicated in about 10% of patients proposed for. In these patients, DPEJ was placed: the procedure resulted to be feasible and safe with the use of a pediatric videocolonscope to easily reach the jejunum. The insertion of DPEJ did not change the nutritional management of enteral feeding. However, long-term effects or complications remain to be evaluated in larger studies.
authors.affiliation: Gastroenterology Unit, Azienda Ospedaliera Maggiore della Carità Corso Mazzini 18, 28100 Novara, Italy. mario.delpiano@alice.it <mario.delpiano@alice.it>
authors.forename: M
authors.initials: M
authors.lastname: Del Piano
authors.forename: M
authors.initials: M
authors.lastname: Ballarè
authors.forename: S
authors.initials: S
authors.lastname: Carmagnola
authors.forename: M
authors.initials: M
authors.lastname: Orsello
authors.forename: E
authors.initials: E
authors.lastname: Garello
authors.forename: M
authors.initials: M
authors.lastname: Pagliarulo
authors.forename: M
authors.initials: M
authors.lastname: Sartori
authors.forename: F
authors.initials: F
authors.lastname: Montino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000295:instrumentation; D005240:Feasibility Studies; D005773:Gastroscopy; D005774:Gastrostomy; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D007582:Jejunostomy; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome