Fan Andy C, Baron Todd H, Rumalla Ashwin, Harewood Gavin C
Division of Gastroenterology and Hepatology, Mayo Medical Center, Rochester, Minnesota, USA.
Gastrointest Endosc. 2002 Dec;56(6):890-4. doi: 10.1067/mge.2002.129607.
Jejunostomy tubes can be placed endoscopically by means of percutaneous gastrostomy with jejunal extension (PEG-J) or by direct percutaneous jejunostomy. These 2 techniques were retrospectively compared in patients requiring long-term jejunal feeding.
An endoscopy database was used to identify all patients who underwent endoscopic jejunal feeding tube placement from January 1996 to May 2001. Patients with a history of upper GI surgery were excluded. There were 56 patients with a direct percutaneous jejunostomy and 49 with a percutaneous gastrostomy with jejunal extension. Patients in the direct percutaneous jejunostomy group received a 20F direct jejunostomy tube; a 20F PEG tube with a 9F jejunal extension was used in the percutaneous gastrostomy with jejunal extension group. Medical records for the period of 6 months after establishment of jejunal access were reviewed. Complications and need for further endoscopic intervention within this time frame were recorded. The duration of feeding tube patency (number of days from established jejunal access to first endoscopic reintervention) was compared for both groups.
Feeding tube patency was significantly longer in patients who had a direct percutaneous jejunostomy compared with those with a percutaneous gastrostomy with jejunal extension. Within the 6-month period, 5 patients with a direct percutaneous jejunostomy required endoscopic reintervention for tube dysfunction compared with 19 patients who had a percutaneous gastrostomy with jejunal extension (p < 0.0001).
For patients who require long-term jejunal feeding, a direct percutaneous jejunostomy with a 20F tube provides more stable jejunal access compared with a percutaneous gastrostomy with jejunal extension with a 9F extension and has a lower associated rate of endoscopic reintervention.
空肠造口管可通过经皮胃造口术并带有空肠延长管（PEG-J）在内镜下放置，或通过直接经皮空肠造口术放置。对需要长期空肠喂养的患者，对这两种技术进行了回顾性比较。
使用一个内镜数据库来识别1996年1月至2001年5月期间所有接受内镜下空肠喂养管放置的患者。排除有上消化道手术史的患者。有56例患者接受了直接经皮空肠造口术，49例接受了经皮胃造口术并带有空肠延长管。直接经皮空肠造口术组的患者接受了一根20F的直接空肠造口管；经皮胃造口术并带有空肠延长管组使用了一根带有9F空肠延长管的20F胃造口管。回顾了建立空肠通路后6个月期间的病历。记录了在此时间段内的并发症以及进一步内镜干预的需求。比较了两组喂养管通畅的持续时间（从建立空肠通路到首次内镜再次干预的天数）。
与经皮胃造口术并带有空肠延长管的患者相比，直接经皮空肠造口术患者的喂养管通畅时间显著更长。在6个月期间，5例接受直接经皮空肠造口术的患者因管功能障碍需要内镜再次干预，而接受经皮胃造口术并带有空肠延长管的患者有19例（p<0.0001）。
对于需要长期空肠喂养的患者，与带有9F延长管的经皮胃造口术并带有空肠延长管相比，使用20F管的直接经皮空肠造口术能提供更稳定的空肠通路，且内镜再次干预的相关发生率更低。
