title: DPEJ tube placement prevents aspiration pneumonia in high-risk patients.
abstract: Percutaneous endoscopic gastrostomy (PEG) or PEG tube with transgastric jejunostomy tube (PEG-J) feeding has not been shown to decrease aspiration pneumonia. The aim of this study was to determine if direct percutaneous endoscopic jejunostomy (DPEJ) tube placement results in a decreased incidence of aspiration pneumonia in high-risk patients. The design was a retrospective review of all patients receiving DPEJ tube for aspiration pneumonia from 1999 to 2005. Demographics, incidence of aspiration pneumonia, and outcomes were collected and compared before and after the DPEJ placement. Eleven patients (4 women, 7 men) were identified; their mean age was 44.9 years (range, 18-94 years). The etiologies for recurrent aspiration pneumonia were neurologic disease (9), esophageal surgery (1), and severe debilitation (1). The mean follow-up was 20.9 months (range, 6-48 months). The patients' mean weight increased from 43.8 kg (range, 19-55 kg) to 48.3 kg (range, 30-65 kg) after placement (P < .001). The total number of documented aspiration pneumonia episodes for all patients decreased from 29 (mean, 3.64; range, 1-6) before DPEJ placement to 3 (mean, 0.27; range, 0-2) after DPEJ placement (P < .001). The mean number of aspiration pneumonia events per month prior to the DPEJ placement was 3.39 and postplacement was 0.42 (P < .001). DPEJ placement appears to decrease recurrent aspiration pneumonia in patients with history of aspiration pneumonia.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Utah, 4R118 School of Medicine, Salt Lake City, UT 84132, USA.
authors.forename: Panagiotis H
authors.initials: PH
authors.lastname: Panagiotakis
authors.forename: James A
authors.initials: JA
authors.lastname: DiSario
authors.forename: Kristen
authors.initials: K
authors.lastname: Hilden
authors.forename: Maydeen
authors.initials: M
authors.lastname: Ogara
authors.forename: John C
authors.initials: JC
authors.lastname: Fang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000295:instrumentation*; D005260:Female; D005773:Gastroscopy; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000453:epidemiology* / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome