title: The PEG-Pedi-PEG technique: a novel method for percutaneous endoscopic gastrojejunostomy tube placement (with video).
abstract: OBJECTIVE
  When PEG tube feeding is complicated by anatomic obstruction, dysmotility, or aspiration, a need arises for feeding beyond the pylorus. The currently available percutaneous gastrojejunostomy (PEG-J) kits have issues with the jejunal extension portion migrating back into the stomach. The aim of this study was to evaluate the feasibility and safety of a novel technique that creates PEG-J tubes by combining an adult percutaneous gastrostomy (PEG) tube with a pediatric PEG tube, the PEG-Pedi-PEG procedure.
  
  
  METHODS
  This was a retrospective study at a single tertiary care center. The main outcome measures were success of placement, rate of retrograde tube migration, early (<24 h after procedure was performed) and late (>24 h after procedure was performed) adverse events.
  
  
  RESULTS
  Seventeen patients underwent PEG-Pedi-PEG procedures during the study period. Technical success was achieved in all patients (100%). The retrograde migration rate of the jejunal extension tube was 0%. Early adverse events included peristomal pain in 1 patient. Late adverse events included inadvertent tube removal (3 patients), diarrhea (1 patient), prolonged ileus/gastroparesis (1 patient), and tube occlusion (1 patient). Mean follow-up was 290 days.
  
  
  CONCLUSIONS
  The PEG-Pedi-PEG procedure is a novel endoscopic technique to facilitate post-pyloric feeding because the pediatric PEG bumper may act like a sail in the small bowel, with peristalsis pushing the bumper distally and thus decreasing the possibility of migration back into the stomach. This study demonstrated excellent technical success, no retrograde migration, and a low rate of adverse events.
authors.affiliation: Division of Gastroenterology and Hepatology, University of California - Irvine, Orange, California, USA.
authors.forename: Jason B
authors.initials: JB
authors.lastname: Samarasena
authors.affiliation: Division of Gastroenterology and Hepatology, University of California - Irvine, Orange, California, USA.
authors.forename: Nathaniel H
authors.initials: NH
authors.lastname: Kwak
authors.affiliation: Division of Gastroenterology and Hepatology, University of California - Irvine, Orange, California, USA.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Chang
authors.affiliation: Division of Gastroenterology and Hepatology, University of California - Irvine, Orange, California, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003967:Diarrhea / Q000453:epidemiology; D016145:Endoscopy, Digestive System / Q000295:instrumentation* / Q000379:methods; D004750:Enteral Nutrition / Q000295:instrumentation* / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D015390:Gastric Bypass / Q000295:instrumentation* / Q000379:methods; D017219:Gastric Outlet Obstruction / Q000601:surgery; D018589:Gastroparesis / Q000601:surgery; D006801:Humans; D045823:Ileus / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D053120:Respiratory Aspiration / Q000517:prevention & control; D012189:Retrospective Studies; D013478:Superior Mesenteric Artery Syndrome / Q000601:surgery; D055815:Young Adult