title: Enteral access by double-balloon enteroscopy: an alternative method of direct percutaneous endoscopic jejunostomy placement.
abstract: BACKGROUND
  Although direct percutaneous endoscopic jejunal feeding tube placement is an increasingly accepted method of providing small-bowel access for long-term enteral nutrition, it is reliant on push enteroscopy and remains a technically challenging procedure with significant failure rates. Double-balloon enteroscopy, with its ability to provide controlled small-bowel intubation may facilitate direct percutaneous endoscopic jejunal tube placement.
  
  
  OBJECTIVE
  We report a prospective series of ten consecutive cases of double-balloon enteroscopy-assisted direct percutaneous endoscopic jejunal placement, accompanied by a step-by-step illustrated overview of the technique.
  
  
  RESULTS
  Direct percutaneous endoscopic jejunal tube placement by double-balloon enteroscopy was successful in nine of the ten attempted cases. In the first case, direct percutaneous endoscopic jejunal placement was abandoned due to inadequate transillumination; there were no procedure-related complications in any of our patients.
  
  
  CONCLUSIONS
  This first reported prospective case series of double-balloon enteroscopy-assisted direct percutaneous endoscopic jejunal placement shows a promisingly high success rate; larger comparative studies are required to clearly establish any advantages over the originally described push enteroscopy method.
authors.affiliation: St. Mark's Hospital and Academic Institute, Imperial College, London, UK.
authors.forename: E J
authors.initials: EJ
authors.lastname: Despott
authors.forename: S
authors.initials: S
authors.lastname: Gabe
authors.forename: E
authors.initials: E
authors.lastname: Tripoli
authors.forename: K
authors.initials: K
authors.lastname: Konieczko
authors.forename: C
authors.initials: C
authors.lastname: Fraser
mesh_terms: D000293:Adolescent; D000328:Adult; D058582:Double-Balloon Enteroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged