title: Assessment of the safety and efficacy of percutaneous laparoscopic endoscopic jejunostomy (PLEJ).
abstract: OBJECTIVE
  Gastric feeding may not be possible in the neurologically impaired child with foregut dysmotility. Post-duodenal feeding can be crucial, thereby avoiding the need for parenteral nutrition. The aim of this study is to evaluate the technical success, complication and clinical outcome of our institution's technique in creating a jejunostomy using the percutaneous laparoscopic-endoscopic jejunostomy (PLEJ) technique.
  
  
  METHODS
  Retrospective review of all paediatric patients (<18) with PLEJ between January 2008 and April 2015 was conducted. Patients were identified using the electronic procedure code and clinic letters. Data were collected in regard to the procedure technical success, short and long-term complications and clinical outcomes.
  
  
  RESULTS
  Sixteen patients (age range, 2-17years) were identified. The procedure was successful in all cases. At a median follow up of 25months, eleven patients (68%) had significant improvement of their symptoms of feeding intolerance/aspirations and are permanently PLEJ fed and two (13%) were regraded to gastric feeds. Two patients moved from total parenteral nutrition to partial parenteral nutrition while on PLEJ feeds. All patients had experienced weight gain and either went up or maintained their weight centile. The only major complication was small bowel volvulus encountered in two patients with abnormal gastrointestinal anatomy requiring surgical intervention.
  
  
  CONCLUSIONS
  In our small case series, PLEJ placement was safe as it provides valuable visualization of the bowel loops intraabdominally. It is a technically feasible and successful approach for children requiring long-term jejunal feeding especially those with foregut dysmotility.
authors.affiliation: Centre of Paediatric Gastroenterology, Sheffield Children Hospital.
authors.forename: Dalis
authors.initials: D
authors.lastname: Belsha
authors.affiliation: Centre of Paediatric Gastroenterology, Sheffield Children Hospital. Electronic address: mike.thomson@sch.nhs.uk.
authors.forename: Mike
authors.initials: M
authors.lastname: Thomson
authors.affiliation: Paediatric Surgical Unit, Sheffield Children Hospital.
authors.forename: Dipankar R
authors.initials: DR
authors.lastname: Dass
authors.affiliation: Paediatric Surgical Unit, Sheffield Children Hospital.
authors.forename: Richard
authors.initials: R
authors.lastname: Lindley
authors.affiliation: Paediatric Surgical Unit, Sheffield Children Hospital.
authors.forename: Sean
authors.initials: S
authors.lastname: Marven
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D015430:Weight Gain
keywords: Children; Endoscopy; Enteral feeding; Gastrostomy; Jejunostomy; Percutaneous