Preemptive fixation of a jejunal enteral tube extension via novel anchoring system

We present a case of a 76-year-old man with a pertinent past medical history of severe pharyngeal dysphagia status post percutaneous endoscopic gastrostomy (PEG) tube who presented for nasojejunal (NJ) to PEG-jejunostomy (PEG-J) conversion. Two prior attempts at jejunal-arm extension failed secondary to initial proximal positioning of the PEG tube and its consequent migration peri-procedurally. Initial scout films demonstrated the PEG tube bumper and the NJ tip in the proximal jejunum, respectively ([Fig. 1]). A guidewire was positioned in the jejunum with subsequent NJ tube removal. The jejunal-arm was then extended, over the wire, into the proximal jejunum past the ligament of Treitz ([Fig. 2]). Once in position, the X-Tack Endoscopic HeliX Tacking System (Boston Scientific; Marlborough, MA, USA) was utilized to secure the jejunal-arm to the proximal aspect of the gastric body ([Fig. 3], [Fig. 4], [Fig. 5]) for the prevention of jejunal-arm coiling. Thereafter, he tolerated PEG-J feeds with minimal reflux into the venting gastrostomy-arm and was subsequently discharged.

Fig. 1 A fluoroscopic image depicting scout imaging of the previously placed percutaneous endoscopic gastrostomy (PEG) tube bumper and a nasojejunal (NJ) tube with its tip in the proximal jejunum, respectively.

Fig. 2 A fluoroscopic image demonstrating successful over the wire jejunal arm extension into the proximal jejunum past the ligament of Treitz.

Fig. 3 An endoscopic image of HeliX Tack placement, superior to the PEG-jejunum (PEG-J) tube, along the anterior aspect of the proximal gastric body.

Fig. 4 An endoscopic image of HeliX Tack placement, inferior to the PEG-J tube, along the anterior aspect of the proximal gastric body.

Fig. 5 An endoscopic image exhibiting complete PEG-J arm fixation to the proximal aspect of the gastric body via the X-Tack anchoring system.

Download Video

Prophylactic fixation of percutaneous endoscopic gastrostomy jejunal arm extension to the proximal aspect of the gastric body via the X-Tack Endoscopic HeliX Tacking System (Boston Scientific; Marlborough, MA, USA) for the prevention of gastric coiling.Video 1

PEG tubes routinely serve as a first-line medium to deliver enteral nutrition for a prolonged period; however, associated dysfunctions/complications are not uncommon [1]. PEG tube dislodgement has been reported to occur in 0.6–4.0% of cases within 7–10 days of initial placement, and up to 12.8% long-term [2]. Literature studies regarding endoscopic intervention in PEG tube dislodgement mainly consist of case reports/series for the management of recurrent dislodgment(s) [1] [2] [3] [4] [5]. Of these, the OverStitch device (Boston Scientific; Marlborough, MA, USA) has been predominantly utilized [1] [2] [3] [4] with a recent case incorporating the X-Tack system [5]. Given the scarce literature pertaining to this topic, both the role of pre-emptive endoscopic suturing in jejunal-arm extension(s) as well as the efficacy of the X-Tack system in such cases is unclear. As such, this case illustrates the successful NJ to PEG-J conversion with precautionary jejunal-arm fixation via the X-Tack Endoscopic HeliX Tacking System ([Video 1]).

Endoscopy_UCTN_Code_TTT_1AO_2AK

Contributorsʼ Statement

Jonathan Rozenberg: Visualization, Writing – original draft, Writing – review & editing. Rami J. K. Musallam: Visualization, Writing - review & editing. William F. Abel: Visualization, Writing – review & editing. Vivek Kesar: Visualization, Writing – review & editing. Patrick I. Okolo: Visualization, Writing – review & editing. Varun Kesar: Conceptualization, Data curation, Supervision, Validation, Writing – review & editing.

Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 McDonald NM, Storm AC. Endoscopic suturing of a jejunal feeding tube extension to prevent recurrent gastric coiling. VideoGIE 2020; 6: 122-123
• 2 Barola S, Chen YI, Ngamruengphong S. et al. Technique of endoscopic suturing of an enteral feeding tube to manage recurrent dislodgement. VideoGIE 2017; 2: 64-65
• 3 Agnihotri A, Barola S, Flickinger J. Novel technique to manage recurrent PEG-J tube dislodgement with full-thickness endoscopic suturing. Am J Gastroenterol 2017; 112: 815-816
• 4 Agnihotri A, Barola S, Hill C. et al. Endoscopic suturing for the management of recurrent dislodgment of percutaneous endoscopic gastrostomy-jejunostomy tube. J Dig Dis 2018; 19: 170-176
• 5 Nasir A, Bouvette C, El Haj Chehade A. et al. S3333 Apollo Endosurgery X-Tack Device in Securing Jejunal Extensions. Am J Gastroenterol 2023; 118: S2208

Publication History

Article published online:
20 January 2026