Direct percutaneous endoscopic jejunostomy: High completion rates with selective use of a long drainage access needle

Abstract

Background. Direct percutaneous endoscopic jejunostomy (DPEJ) insertion is a useful technique for artificial nutritional support in selected patients. However, it is technically difficult and most case series report significant procedural failure rates. Methods. We reviewed our case series of DPEJ insertions, done in a tertiary care referral centre from 2002 to 2008. Patients were selected for DPEJ if they required artificial enteric nutritional support but were unsuitable for endoscopic gastrostomy. Our technique includes selective usage of a long drainage access needle for gut luminal puncture, selective fluoroscopic guidance and selective usage of general anaesthesia. Results. Of 40 consecutive patients undergoing attempted DPEJ insertion, 39/40 (97.5) had a successful procedure. Sixteen cases (40) required the drainage access needle for completion, nineteen cases (47.5%) were done with fluoroscopy, and five cases (12.5) were done under general anaesthesia. There were no procedural complications. Conclusions. This technique led to a high completion rate and low complication rate. With appropriate care and expertise, DPEJ insertion is reliable and safe. © 2009 G.W. Moran and N. C. Fisher.