Toh Yoon Ezekiel Wong, Yoneda Kaori, Nakamura Shinya, Nishihara Kazuki
Department of Internal Medicine , Hiroshima Kyoritsu Hospital , Hiroshima , Japan.
Endoscopy Center, Hiroshima Kyoritsu Hospital , Hiroshima , Japan.
BMJ Open Gastroenterol. 2016 Jun 27;3(1):e000098. doi: 10.1136/bmjgast-2016-000098. eCollection 2016.
BACKGROUND/AIMS: Although percutaneous endoscopic gastrostomy (PEG) is the method of choice for long-term enteral nutrition, feeding-related adverse events such as aspiration pneumonia and peristomal leakage can impede the use of PEG. Percutaneous endoscopic transgastric jejunostomy (PEG-J) using large-bore jejunal tubes may help by circumventing gastric passage during enteral nutrition and improving drainage of gastric secretions.
20 patients (12 males and 8 females) who received PEG-J after unsuccessful PEG feeding during a 6-year period in our institution were analysed retrospectively to evaluate the efficacy of large-bore jejunal feeding tubes in maintaining enteral nutrition.
The median age was 83.5 (71-96) years. The median period between PEG and PEG-J was 33 (14-280) days. Indications were aspiration due to gastro-oesophageal reflux in 18 patients and severe peristomal leakage in 2 patients. Tube placements were successful in all patients. There were 6 (30%) in-hospital mortalities, with 3 (15%) occurring within 30 days after procedure.
PEG-J can be performed safely in patients with PEG and may facilitate the maintenance of enteral nutrition in most of the patients. Patients with unsuccessful PEG feeding can be offered the option of jejunal feeding before considering termination of enteral nutrition.
背景/目的：尽管经皮内镜下胃造口术（PEG）是长期肠内营养的首选方法，但诸如吸入性肺炎和造口周围渗漏等与喂养相关的不良事件可能会妨碍PEG的使用。使用大口径空肠管的经皮内镜下经胃空肠造口术（PEG-J）可能有助于在肠内营养期间绕过胃通道并改善胃分泌物引流。
回顾性分析我院6年间20例在PEG喂养失败后接受PEG-J的患者（12例男性和8例女性），以评估大口径空肠喂养管在维持肠内营养方面的疗效。
中位年龄为83.5（71-96）岁。PEG与PEG-J之间的中位间隔时间为33（14-280）天。适应症为18例因胃食管反流引起的误吸和2例严重的造口周围渗漏。所有患者的置管均成功。有6例（30%）住院死亡，其中3例（15%）在术后30天内发生。
PEG-J可在PEG患者中安全进行，并且可能有助于大多数患者维持肠内营养。在考虑终止肠内营养之前，PEG喂养失败的患者可以选择空肠喂养。
