Lim Amanda H, Schoeman Mark N, Nguyen Nam Q
Departments of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia.
Departments of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia ; University Department of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia.
Endosc Int Open. 2015 Dec;3(6):E610-4. doi: 10.1055/s-0034-1392806. Epub 2015 Sep 15.
To assess the clinical outcomes of patients who received direct percutaneous endoscopic jejunostomy (DPEJ) for enteral feeding.
This is a 10-year cohort study in a single tertiary center. Main outcome measurements were technical success, and short- and long-term outcomes. DPEJ was attempted in 83 patients (51 men; 55 ± 2 years) for dysphagia (n = 35), gastroparesis with recurrent aspiration (n = 30), and levodopa drug infusion for severe Parkinson's disease (n = 18).
DPEJ was successful in 75 (90 %) patients. All technical failures were related to the inability to find adequate trans-illumination, and were not influenced by BMI, age, gender, or indication. Peri-operative (30-day) adverse events occurred in 11 (13 %) patients, including wound infection (3), leakage around the stoma (4), minor bleeding requiring no intervention (2), and aspiration (1). There was one case (1.2 %) of gastric perforation after PEJ insertion for levodopa drug infusion trial. This 60-year-old woman required an emergency laparotomy with nil complications, and levodopa drug infusion recommenced successfully. One case of intestinal perforation (1.2 %) occurred after jejunostomy tube replacement at 6 months of insertion, which was successfully managed with surgery. There were no peri-operative deaths. Adequate delivery of enteral feeding or Duodopa drug was achieved in 66/73 (90 %) patients, with evidence of weight gain or improvement in Parkinson's disease. Seven (8 %) continued to have clinical regurgitation but not aspiration. After a median follow-up of 84 months, 27 (33 %) patients died of their underlying diseases. Seven (8 %) had marked improvement in their underlying disease and had PEJ removed after 5 months (range 1 - 8 months).
Single center study.
DPEJ is associated with a high technical success rate (90 %), a relatively low rate of peri-operative adverse events (13 %) and an improvement in long-term nutritional support in the majority of patients (90 %). DPEJ should be the procedure of choice to gain enteral access for feeding or drug delivery prior to considering surgery.
评估接受直接经皮内镜空肠造口术（DPEJ）进行肠内营养支持的患者的临床结局。
这是一项在单一三级中心开展的为期10年的队列研究。主要结局指标为技术成功率以及短期和长期结局。83例患者（51例男性；年龄55±2岁）接受了DPEJ，其中吞咽困难患者35例，反复误吸的胃轻瘫患者30例，严重帕金森病患者18例（接受左旋多巴药物输注）。
75例（90%）患者DPEJ成功。所有技术失败均与无法找到足够的透照有关，且不受体重指数、年龄、性别或适应证的影响。围手术期（30天）不良事件发生在11例（13%）患者中，包括伤口感染3例、造口周围渗漏4例、无需干预的少量出血2例、误吸1例。在左旋多巴药物输注试验的PEJ置入后发生1例胃穿孔（1.2%）。这名60岁女性需要进行急诊剖腹手术，无并发症发生，左旋多巴药物输注成功重新开始。1例肠穿孔（1.2%）发生在空肠造口管置入6个月后更换时，通过手术成功处理。无围手术期死亡病例。66/73例（90%）患者实现了充足的肠内营养或Duodopa药物输注，有体重增加或帕金森病改善的证据。7例（8%）患者持续存在临床反流但无误吸。中位随访8个月后，27例（33%）患者死于基础疾病。7例（8%）患者基础疾病明显改善，5个月（范围1 - 8个月）后拔除了PEJ。
单中心研究。
DPEJ技术成功率高（90%），围手术期不良事件发生率相对较低（13%），且大多数患者（90%）长期营养支持得到改善。在考虑手术之前，DPEJ应作为获取肠内营养通路进行喂养或给药的首选方法。
