DiSario J A, Foutch P G, Sanowski R A
Gastroenterology Division, Carl T. Hayden Veterans Administration Medical Center, Phoenix, Arizona 85012.
Gastrointest Endosc. 1990 May-Jun;36(3):257-60. doi: 10.1016/s0016-5107(90)71018-8.
A percutaneous endoscopic gastrostomy was placed in 20 malnourished patients to serve as a conduit for passage of a percutaneous endoscopic jejunostomy (PEJ) catheter for delivery of alimentation directly into the small bowel. Serious complications occurred in 95% of the patients and 50% of the subjects died. Aspiration was the most common adverse event and accounted for all deaths. Ten of 15 subjects (67%) treated with a PEJ to prevent aspiration continued to aspirate after the catheter was placed. PEJ tube failures were documented in 14 subjects (70%) and occurred because of occlusion, leakage, malposition, extrusion, cracking, kinking, or rupture of the catheter. These problems rendered the PEJ nonfunctional 18% of the time. Large manpower and resource investments were required to manage the PEJ and its complications. Our results suggest that enteral feeding through a PEJ does not prevent aspiration. Serious PEJ-related morbidity (95%), mortality (50%), and catheter failures (70%) occur. Refinements in methodology and catheter design will be required before additional use of this technique can be recommended.
对20名营养不良患者进行了经皮内镜下胃造口术，作为经皮内镜下空肠造口术（PEJ）导管通过的通道，以便将营养物质直接输送到小肠。95%的患者出现了严重并发症，50%的受试者死亡。误吸是最常见的不良事件，也是所有死亡的原因。15名接受PEJ治疗以预防误吸的受试者中有10名（67%）在放置导管后仍继续发生误吸。14名受试者（70%）记录了PEJ管故障，其发生原因包括导管堵塞、渗漏、位置不当、挤出、破裂、扭结或断裂。这些问题导致PEJ在18%的时间内无法正常工作。管理PEJ及其并发症需要大量的人力和资源投入。我们的结果表明，通过PEJ进行肠内喂养并不能预防误吸。会出现严重的与PEJ相关的发病率（95%）、死亡率（50%）和导管故障（70%）。在推荐进一步使用该技术之前，需要对方法和导管设计进行改进。
