Freeman Cecilia, Delegge Mark H
Digestive Disease Center, Medical University of South Carolina, Charleston, SC 29425, USA.
Curr Opin Gastroenterol. 2009 Mar;25(2):155-9. doi: 10.1097/MOG.0b013e328324f86b.
Small bowel endoscopic enteral access is perceived as difficult. However, small bowel access is necessary for patients who are unable to tolerate gastric feedings. This review discusses the successes and challenges involved with endoscopic small bowel tube placement in various populations using a variety of placement techniques.
In general, direct percutaneous endoscopic jejunostomy (DPEJ) is becoming a more common procedure performed to obtain small bowel enteral access. BMI may be a useful predictor of DPEJ tube placement success and complication rates. A retrospective review determined that DPEJ tube placement significantly decreased the incidence of aspiration pneumonia in patients with previous recurrent aspiration pneumonia episodes. DPEJ is an effective method of providing enteral nutrition for patients when percutaneous endoscopic gastrostomy is not indicated because of anatomical or gastric function abnormalities. However, there are known complications of DPEJ, including small bowel volvulus. Nasojejunal tubes also can provide enteral access to the small intestine. Endoscopic insertion of nasojejunal tubes promotes decreased length of hospital stay and early initiation of enteral feedings as compared with bedside self-migrating jejunal tubes in patients with severe acute pancreatitis. Endoscopically placed small bowel feeding tubes can safely deliver enteral nutrition to patients when gastric feedings are not indicated.
Continued evaluation of endoscopic jejunal tube placement methods and associated clinical outcomes in assorted populations is necessary to determine the safest and most effective technique.
小肠内镜肠内通路被认为具有挑战性。然而，对于无法耐受胃内喂养的患者而言，小肠通路是必要的。本综述讨论了使用各种放置技术在内镜下为不同人群放置小肠管的成功经验和面临的挑战。
一般来说，直接经皮内镜空肠造口术（DPEJ）正成为一种更常用的获得小肠肠内通路的手术。体重指数（BMI）可能是DPEJ管放置成功及并发症发生率的一个有用预测指标。一项回顾性研究确定，DPEJ管放置显著降低了既往有反复吸入性肺炎发作患者的吸入性肺炎发生率。当因解剖结构或胃功能异常而不适合行经皮内镜胃造口术时，DPEJ是为患者提供肠内营养的一种有效方法。然而，DPEJ存在一些已知并发症，包括小肠扭转。鼻空肠管也可为小肠提供肠内通路。与在重症急性胰腺炎患者床边自行置入空肠管相比，内镜下置入鼻空肠管可缩短住院时间并更早开始肠内喂养。当不适合胃内喂养时，内镜放置的小肠喂养管可为患者安全地提供肠内营养。
有必要持续评估内镜空肠管放置方法及在不同人群中的相关临床结果，以确定最安全、最有效的技术。
