title: Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Tube Placement: A Single Institution Experience and Outcomes to 30 Days and Beyond.
abstract: Patients with prior foregut surgery requiring long-term enteral access typically undergo operative jejunostomy tube placement; however, direct percutaneous endoscopic jejunostomy (DPEJ) is a viable alternative.
  
  
  
  All de novo DPEJ procedures performed by surgical and advanced endoscopists from May 2003 to June 2015 were retrospectively reviewed following approval by the Institutional Review Board. There were 59 cases identified.
  
  
  
  Our cohort had a mean age of 50.3 ± 16.9 years and 35 (59.3%) were female. All but two patients previously had foregut surgery including 19 patients (34.5%) with prior bariatric surgery. The composite of malnutrition and dehydration was the indication for DPEJ in 29 patients (49.1%) and was the initial enteral access placed in 47 patients (79.7%). Moderate sedation was used in 32 cases (54.2%), and 29 procedures (49.2%) were performed in the operating room. Within 30 days, there were six complications in five patients, giving a peri-procedural complication rate of 12.5%. Beyond 30 days, the most common complications were peri-tube leakage and dislodgement (each 16.9%). The median time to complication was 197 days.
  
  
  
  In patients with surgically altered foregut anatomy, DPEJ offers a less invasive alternative to operative jejunostomy tube placement. DPEJ can be placed in the endoscopy suite or operating room with an acceptable risk of perioperative complications.
authors.affiliation: Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA. stronga@ccf.org.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Strong
authors.affiliation: Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Gautam
authors.initials: G
authors.lastname: Sharma
authors.affiliation: Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Davis
authors.affiliation: Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.|US Army Tripler Army Medical Center, Honolulu, HI, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mulcahy
authors.affiliation: Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Suriya
authors.initials: S
authors.lastname: Punchai
authors.affiliation: Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.|Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.|Statistical Center for HIV/AIDS Research and Prevention, Seattle, WA, USA.
authors.forename: Colin P
authors.initials: CP
authors.lastname: O'Rourke
authors.affiliation: Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
authors.affiliation: Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: John
authors.initials: J
authors.lastname: Rodriguez
authors.affiliation: Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Ponsky
authors.affiliation: Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Kroh
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D015331:Cohort Studies; D003681:Dehydration / Q000150:complications / Q000628:therapy; D016099:Endoscopy, Gastrointestinal; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D007582:Jejunostomy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000628:therapy; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Direct percutaneous endoscopic jejunostomy (DPEJ); Endoscopy; Enteral access; Feeding tube; Jejunostomy