Del Piano M, Ballarè M, Carmagnola S, Orsello M, Garello E, Pagliarulo M, Sartori M, Montino F
Gastroenterology Unit, Azienda Ospedaliera Maggiore della Carità Corso Mazzini 18, 28100 Novara, Italy.
Dig Liver Dis. 2008 Feb;40(2):140-3. doi: 10.1016/j.dld.2007.09.012. Epub 2007 Dec 21.
PEG placement is routinely used for enteral feeding; in some cases PEG is not feasible or indicated due to technical difficulties, such as gastric herniation, organ interposition, or presence of gastroparesis. In these cases, surgical gastrostomy or jejunostomy are possible alternatives; more recently, direct percutaneous jejunostomy (DPEJ) has been proposed to avoid surgical intervention. The aim of the study was to evaluate the necessity, technical feasibility and outcome of DPEJ in a group of patients consecutively proposed for PEG placement.
In each patient proposed for PEG placement, an upper gastrointestinal endoscopy was performed, and then a pull traction removal gastrostomy tube (18-20 F) was inserted. When PEG was not feasible or contraindicated, a variable stiffness pediatric videocolonscope was used to reach the jejunum: then DPEJ was performed with the same technique and materials as PEG. In both groups enteral feeding was started 24h after the endoscopic procedure, using an enteral feeding pump and the same nutritional schedules.
In a 1-year period 90 patients were proposed for PEG placement; PEG could not be performed for technical reasons in 8 (gastric herniation in 1; organ interposition in 7) and gastroparesis in 1. In one patient both PEG and DPEJ were not feasible for organ interposition. The duration of the endoscopic procedure was slightly longer in DPEJ (mean 20 min versus 15 min). No complications related to the endoscopic procedure were observed in both DPEJ and PEG patients. No nutritional complication were observed in the DPEJ group.
In our experience, PEG was not feasible or contraindicated in about 10% of patients proposed for. In these patients, DPEJ was placed: the procedure resulted to be feasible and safe with the use of a pediatric videocolonscope to easily reach the jejunum. The insertion of DPEJ did not change the nutritional management of enteral feeding. However, long-term effects or complications remain to be evaluated in larger studies.
经皮内镜下胃造口术（PEG）常用于肠内营养支持；但在某些情况下，由于技术困难，如胃疝、器官移位或胃轻瘫，PEG不可行或不适用。在这些情况下，手术胃造口术或空肠造口术是可行的替代方案；最近，有人提出直接经皮空肠造口术（DPEJ）以避免手术干预。本研究旨在评估在一组连续拟行PEG置入的患者中DPEJ的必要性、技术可行性及效果。
对每例拟行PEG置入的患者进行上消化道内镜检查，然后插入一根拔拉式胃造瘘管（18 - 20F）。当PEG不可行或禁忌时，使用可变硬度的小儿电子结肠镜到达空肠：然后采用与PEG相同的技术和材料进行DPEJ。两组患者在内镜检查后24小时开始肠内营养支持，使用肠内营养泵并采用相同的营养方案。
在1年期间，90例患者拟行PEG置入；8例因技术原因无法进行PEG（1例为胃疝，7例为器官移位），1例因胃轻瘫无法进行。1例患者因器官移位，PEG和DPEJ均不可行。DPEJ的内镜操作时间稍长（平均20分钟对15分钟）。DPEJ组和PEG组均未观察到与内镜操作相关的并发症。DPEJ组未观察到营养相关并发症。
根据我们的经验，约10%拟行PEG置入的患者中，PEG不可行或禁忌。在这些患者中，进行了DPEJ：使用小儿电子结肠镜轻松到达空肠，该操作可行且安全。DPEJ的置入未改变肠内营养支持的管理。然而，长期影响或并发症仍有待在更大规模的研究中评估。
