Current considerations of direct percutaneous endoscopic jejunostomy.
BACKGROUOND: Direct percutaneous endoscopic jejunostomy (DPEJ) is a well-known approach to deliver postpyloric enteral nutritional support to individuals who cannot tolerate gastric feeding. However, it is technically difficult, and some case series have reported significant procedural failure rates. The present article describes current indications, successes and complications of DPEJ placement.


METHODS
A MEDLINE database search was performed to identify relevant articles using the key words "direct percutaneous endoscopic jejunostomy", "percutaneous endoscopic gastrostomy", and "percutaneous endoscopic gastrostomy with a jejunal extension tube". Additional articles were identified by a manual search of the references cited in the key articles obtained in the primary search.


RESULTS
DPEJ is gradually becoming more common in the treatment of patients who cannot tolerate gastric feeding. Differences in patient selection and technique modifications may contribute to the various success rates reported. Failure is most often due to inadequate transillumination or gastroduodenal obstruction. Currently, there are limited data to evaluate the safety and effectiveness of DPEJ.


CONCLUSIONS
The clinical use of DPEJ is increasing. With appropriate care and expertise, DPEJ may prove to be reliable and safe.
Department of General Surgery, Nanjing Medical University, Jiangsu, China. zhuyanfei_2002@163.com
Yanfei
Y
Zhu
Liping
L
Shi
Hao
H
Tang
Guoqing
G
Tao
D016638:Critical Illness / Q000628:therapy; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D007582:Jejunostomy / Q000295:instrumentation / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome