Percutaneous Endoscopic Jejunostomy Using Single-Balloon Enteroscopy: A Case Series

Aims This study aimed to evaluate the technical and clinical success rates of percutaneous endoscopic jejunostomy (PEJ) placement using single-balloon enteroscopy, as well as the occurrence of complications—immediate, early (within 30 days), and late (within 90 days). This approach addresses the challenges posed by complex gastrointestinal anatomy, where standard PEG or PEJ techniques may not be feasible.

Methods A retrospective cohort study was conducted at a tertiary care center in Mexico from August 2016 to March 2024. The analysis included 12 patients who underwent a total of 17 PEJ placement procedures using single-balloon enteroscopy. Patient demographics, primary indications for enteral access, comorbidities, procedure duration, and sedation methods were recorded. Technical success was defined as successful placement of the PEJ tube, and clinical success was defined as effective use of the tube for enteral nutrition or medication administration within 24 hours of the procedure. Patients were followed for 90 days to monitor complications, categorized as immediate, early, or late [1] [2].

Results A total of 17 PEJ procedures were performed in 12 patients (10 with one procedure, one with five procedures, and one with two procedures). Sixty-six percent of the patients were female, and the median age was 70 years. The primary indications for PEJ placement were and gastroparesis (50%) and swallowing disorders (33.3%). Modified anatomy was present in 41.7% of patients, including 3 patients with prior Whipple procedures and 2 with gastrojejunostomy. The average site of tube placement was 70 cm from the pylorus, and the mean procedure duration was 40 minutes. All procedures achieved 100% technical and clinical success rates. No immediate, early, or late complications were observed during the median follow-up of 89 days. Survival rates were 75% at 30 days and 38% at 90 days. Nutritional outcomes demonstrated modest improvements in serum albumin levels, while body mass index changes were minimal.

Conclusions This case series represents the first report in Mexico describing PEJ placement via single-balloon enteroscopy. The findings demonstrate that this technique is a safe and effective alternative for enteral nutrition in patients with complex or altered gastrointestinal anatomy, with high technical and clinical success rates and no complications. Further research involving larger cohorts is recommended to confirm these results and evaluate long-term outcomes.

Publication History

Article published online:
27 March 2025

• References

• 1 Maple JT, Petersen BT, Baron TH, Gostout CJ, Wong Kee Song LM, Buttar NS.. Direct percutaneous endoscopic jejunostomy: outcomes in 307 consecutive attempts. Am J Gastroenterol 2005; 100 (12): 2681-2688
• 2 Fugazza A, Capogreco A, Cappello A. et al. Percutaneous endoscopic gastrostomy and jejunostomy: Indications and techniques. World J Gastrointest Endosc 2022; 14 (5): 250-266