OUTCOMES OF ENTEROSCOPY-ASSISTED DIRECT PERCUTANEOUS ENDOSCOPIC JEJUNOSTOMY (DPEJ) TUBE PLACEMENT - A SINGLE-CENTER EXPERIENCE

Aims Review our clinical experience of direct percutaneous endoscopic jejunostomy (DPEJ) in a tertiary care center.

Methods We performed a six year retrospective review of forty-eight patients with DPEJ tube placement. The main outcome measurements were technical success in native and altered anatomy. DPEJ was attempted in 48 patients - 63% females, age 52.5±15.4 years, BMI 21.1± 6.8 kg/m². Indications included gastroparesis (n=12), Parkinson’s disease (n=4), chronic pancreatitis (n=7), chronic malnutrition with multiple abdominal surgeries (n=12), intractable nausea and vomiting (n=8) and other (n=5).

Results DPEJ was successful in 42/48 (87.5%) patients. Placement involved double-balloon enteroscopy in 34 patients, single balloon enteroscopy in 1 patient, and push enteroscopy in 7 patients. Technical failures were due to lack of trans-illumination (n=4), ventral hernia (n=1) and previous adhesions (n=1). The most common thirty-day complications included site pain (4) and site infection (3). There was no difference in the complications between altered and native anatomy (29% vs 20%, p=0.32) or other outcomes such as failure rates, tube removal rates or PEJ duration.

DPEJ was a short term bridge for 14 patients with a mean time to removal being 8 ± 7 months. Only one patient requested the DPEJ to be removed due to discomfort. Expectedly, patients with significant improvement in albumin levels were able to achieve DPEJ removal (1±0.6 g/dL vs 0.4±0.5 g/dL, p=0.05). Removal of the tube was not dependent on the indication or anatomy. 61% of all patients did not have the DPEJ removed. The mean duration of follow up in those patients was 23±17 months with initial tube mean duration of 12±8 months.

Conclusions DPEJ is associated with a high technical success rate that is not influenced by altered anatomy and offers nutritional support with a low perioperative complication rate. It can often be used as a short term bridging therapy in some patients.