Percutaneous endoscopic gastrojejunostomy with a tapered tip, nonweighted jejunal feeding tube: improved placement success.

Abstract

Gaining enteral access to the small bowel for patients unable to tolerate gastric feedings is a difficult challenge for today's endoscopist. A new over-the-guidewire method for placement of a percutaneous endoscopic gastrojejunostomy (PEG/J) is prospectively studied using a nonweighted, tapered tip, distal feed through jejunal tube (J-tube). Twenty five hospitalized patients were referred to the nutrition service for enteral access. A Wilson-Cook 24/12-French PEG/J system was placed and followed until removal or patient death. The PEG/J system was placed in 25/25 patients in an average of 26 min and 45 s. The tip of the J-tube was in the distal duodenum in 52% of patients and in the jejunum in 48% of patients. J-tube complications occurred in 20% of patients and included one incidence of clogging (4%) and four cases of inadvertent removal (16%). Average longevity of the J-tube was 63.9 days, with most patients converted to either oral or gastric feedings. The use of an nonweighted, tapered tip J-tube and the over-the-guidewire placement technique has resulted in a reliable method of accessing the small bowel for enteral nutrition.