title: New method of direct percutaneous endoscopic jejunostomy tube placement using balloon-assisted enteroscopy with fluoroscopy.
abstract: OBJECTIVE
  Direct percutaneous endoscopic jejunostomy (DPEJ) is a useful method to provide nutrition to patients with a variety of gastrointestinal (GI) problems. The present study describes a new method of DPEJ using balloon-assisted-enteroscopy.
  
  
  METHODS
  This observational, retrospective, single-arm case study conducted at a tertiary care hospital during a 15-month period included 25 patients (12 females, 13 males, mean age 54 years, age range 31-79 years) with necrotizing pancreatitis, n = 7; complex upper GI surgery, n = 6; complex fistula, n = 6; impossibility to place a gastrostomy tube, n = 5; and bowel obstruction, n = 1. The new DPEJ technique focused on three key components: (i) use of balloon-assisted overtube; (ii) use of fluoroscopy; (iii) leaving the overtube in place during the entire procedure (and also for DPEJ removal).
  
  
  RESULTS
  Technical success was 96%. Mean time of the procedure was 30.5 min (range 24 to 45 min). Clinical success was 100% (24/24); all DPEJ could be used for their intended purpose.
  
  
  CONCLUSIONS
  This new method of inserting a DPEJ using balloon enteroscopy and fluoroscopy was safe and successful. Future comparative studies are now warranted.
authors.affiliation: Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, USA.
authors.forename: Jacobo
authors.initials: J
authors.lastname: Velázquez-Aviña
authors.forename: Ryan
authors.initials: R
authors.lastname: Beyer
authors.forename: Claudia P
authors.initials: CP
authors.lastname: Díaz-Tobar
authors.forename: Shajan
authors.initials: S
authors.lastname: Peter
authors.forename: Kondal R
authors.initials: KR
authors.lastname: Kyanam Kabir Baig
authors.forename: C Mel
authors.initials: CM
authors.lastname: Wilcox
authors.forename: Klaus
authors.initials: K
authors.lastname: Mönkemüller
mesh_terms: D000328:Adult; D000368:Aged; D058582:Double-Balloon Enteroscopy / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007582:Jejunostomy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: balloon enteroscopy; direct jejunostomy; double-balloon enteroscopy; endoscopic jejunostomy; jejunostomy