Moran G W, Fisher N C
Gastroenterology Department, Russells Hall Hospital, Dudley, West Midlands DY1 2HQ, UK.
Diagn Ther Endosc. 2009;2009:520879. doi: 10.1155/2009/520879. Epub 2009 Jun 16.
Background. Direct percutaneous endoscopic jejunostomy (DPEJ) insertion is a useful technique for artificial nutritional support in selected patients. However, it is technically difficult and most case series report significant procedural failure rates. Methods. We reviewed our case series of DPEJ insertions, done in a tertiary care referral centre from 2002 to 2008. Patients were selected for DPEJ if they required artificial enteric nutritional support but were unsuitable for endoscopic gastrostomy. Our technique includes selective usage of a long drainage access needle for gut luminal puncture, selective fluoroscopic guidance and selective usage of general anaesthesia. Results. Of 40 consecutive patients undergoing attempted DPEJ insertion, 39/40 (97.5%) had a successful procedure. Sixteen cases (40%) required the drainage access needle for completion, nineteen cases (47.5%) were done with fluoroscopy, and five cases (12.5%) were done under general anaesthesia. There were no procedural complications. Conclusions. This technique led to a high completion rate and low complication rate. With appropriate care and expertise, DPEJ insertion is reliable and safe.
背景。直接经皮内镜空肠造口术（DPEJ）置入是为特定患者提供人工营养支持的一项有用技术。然而，该技术操作难度大，大多数病例系列报道显示手术失败率较高。方法。我们回顾了2002年至2008年在一家三级医疗转诊中心进行的DPEJ置入病例系列。如果患者需要人工肠内营养支持但不适合内镜胃造口术，则选择进行DPEJ。我们的技术包括选择性使用长引流穿刺针进行肠腔穿刺、选择性荧光透视引导以及选择性使用全身麻醉。结果。在连续40例尝试进行DPEJ置入的患者中，39/40（97.5%）手术成功。16例（40%）需要使用引流穿刺针完成手术，19例（47.5%）在荧光透视下完成，5例（12.5%）在全身麻醉下完成。无手术并发症。结论。该技术导致了高完成率和低并发症率。通过适当的护理和专业技能，DPEJ置入是可靠且安全的。
