Gastroenterology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Division of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
JPEN J Parenter Enteral Nutr. 2018 Jul;42(5):898-906. doi: 10.1002/jpen.1023. Epub 2017 Dec 27.
Direct percutaneous endoscopic jejunostomy (DPEJ) is used for enteral nutrition (EN) in patients with postoperative anastomotic leaks after esophagectomy/gastrectomy and at high risk for aspiration. We characterized the indications, technical success, procedural/nutrition outcomes, and adverse events in a large cohort of patients undergoing DPEJ insertion.
Patients undergoing DPEJ insertion between January 2009 and March 2015 were identified from an institutional endoscopy database. Demographic, procedural, and nutrition outcome data were collected from electronic medical records. Regression analyses were used to identify predictors of adverse events and procedural success.
A total of 452 patients underwent 480 attempts at DPEJ insertion. Indications included preoperative or postoperative weight loss (64%), postoperative upper gastrointestinal (UGI) anastomotic leak (13%), aspiration prevention (10%), and other (13%). Of attempted procedures, 398 (83%) were successful. Feeding was initiated in 389 (98%) of patients; a median of 1775 calories was delivered daily. Median body mass index (BMI) at baseline was 22.9 (11.4-44.7) and did not change over follow-up. Median change in BMI after DPEJ was similar in groups that received EN with palliative and curative intent. Adverse events following 480 attempted DPEJ insertions included 13 (3%) immediate and 74 (15%) delayed, 13 (3%) of which were serious. Patients with head and neck cancer had more adverse events than those with esophageal cancer (P = .020).
DPEJ is a successful and safe procedure that effectively provides access for EN support in malnourished patients and patients with postoperative UGI cancer.
直接经皮内镜空肠造口术（DPEJ）用于食管/胃切除术后吻合口漏且有较高误吸风险的患者的肠内营养（EN）。我们对一组接受 DPEJ 置管术的患者进行了特征描述，包括适应证、技术成功率、程序/营养结局和不良事件。
从机构内镜数据库中确定了 2009 年 1 月至 2015 年 3 月间接受 DPEJ 置管术的患者。从电子病历中收集人口统计学、程序和营养结局数据。回归分析用于识别不良事件和程序成功的预测因素。
共有 452 例患者进行了 480 次 DPEJ 置管术尝试。适应证包括术前或术后体重减轻（64%）、术后上消化道（UGI）吻合口漏（13%）、预防误吸（10%）和其他（13%）。尝试的手术中，398 例（83%）成功。389 例（98%）患者开始喂养，每天平均输送 1775 卡路里。基线时的平均体重指数（BMI）为 22.9（11.4-44.7），随访期间未发生变化。接受姑息性和根治性 EN 的患者 DPEJ 后 BMI 变化中位数相似。480 次 DPEJ 尝试后的不良事件包括 13 例（3%）即刻不良事件和 74 例（15%）延迟不良事件，其中 13 例（3%）为严重不良事件。头颈部癌症患者的不良事件发生率高于食管癌患者（P =.020）。
DPEJ 是一种成功且安全的手术，可为营养不良患者和 UGI 癌症术后患者提供有效的 EN 支持。
