Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Tube Placement

A Single Institution Experience and Outcomes to 30 Days and Beyond

Andrew T. Strong, Gautam Sharma, Matthew Davis, Michael Mulcahy, Suriya Punchai, Colin P. O’Rourke, Stacy A. Brethauer, John Rodriguez, Jeffrey L. Ponsky, Matthew D. Kroh

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)446-452
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume21
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

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Jejunostomy
Operating Rooms
Small Intestine
Conscious Sedation
Bariatric Surgery
Research Ethics Committees
Dehydration
Malnutrition
Endoscopy
Anatomy

All Science Journal Classification (ASJC) codes

  • Surgery
  • Gastroenterology

Cite this

Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Tube Placement : A Single Institution Experience and Outcomes to 30 Days and Beyond. / Strong, Andrew T.; Sharma, Gautam; Davis, Matthew; Mulcahy, Michael; Punchai, Suriya; O’Rourke, Colin P.; Brethauer, Stacy A.; Rodriguez, John; Ponsky, Jeffrey L.; Kroh, Matthew D.

In: Journal of Gastrointestinal Surgery, Vol. 21, No. 3, 01.03.2017, p. 446-452.

Research output: Contribution to journalArticle

Strong, AT, Sharma, G, Davis, M, Mulcahy, M, Punchai, S, O’Rourke, CP, Brethauer, SA, Rodriguez, J, Ponsky, JL & Kroh, MD 2017, 'Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Tube Placement: A Single Institution Experience and Outcomes to 30 Days and Beyond', Journal of Gastrointestinal Surgery, vol. 21, no. 3, pp. 446-452. https://doi.org/10.1007/s11605-016-3337-2
Strong, Andrew T. ; Sharma, Gautam ; Davis, Matthew ; Mulcahy, Michael ; Punchai, Suriya ; O’Rourke, Colin P. ; Brethauer, Stacy A. ; Rodriguez, John ; Ponsky, Jeffrey L. ; Kroh, Matthew D. / Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Tube Placement : A Single Institution Experience and Outcomes to 30 Days and Beyond. In: Journal of Gastrointestinal Surgery. 2017 ; Vol. 21, No. 3. pp. 446-452.
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abstract = "Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.",
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