Krafft Matthew R, Maan Soban, Scott Adam, Shepherd Katherine, Karna Rahul, Clemetson Emily, Singh Shailendra, Thakkar Shyam, Amateau Stuart K
Department of Medicine, Division of Gastroenterology & Hepatology, West Virginia University School of Medicine, Morgantown, WV, USA.
Division of Gastroenterology, Hepatology, & Nutrition, University of Minnesota Medical Center, M Health Fairview, Minneapolis, MN, USA.
Dig Dis Sci. 2025 Jul 30. doi: 10.1007/s10620-025-09198-2.
Endoscopic procedures for post-pyloric feeding include percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) and direct percutaneous endoscopic jejunostomy (PEJ). We conducted the largest and only dual-center retrospective study comparing outcomes of patients receiving PEG-J vs. PEJ.
A dual-center retrospective study was conducted of patients who underwent either PEG-J or PEJ for post-pyloric feeding ± gastric decompression. Primary outcomes were technical success (TS) and reintervention for adverse event (rAE: ≥ 1 feeding tube exchange, conversion, and/or removal performed as needed for management of tube-related or stoma-related AE). Secondary outcomes were index procedure time, AE category (tube-related/stoma-related), and reintervention(s) prompted by each AE category.
TS was similar for both procedures (PEG-J: 71/75 [95%] vs. PEJ: 68/75 [91%], p = 0.533). The PEG-J cohort had more reinterventions for AEs (rAE: 33/75 [44%] vs. 20/75 [27%], p = 0.04) occurring closer to the index procedure (median time to rAE, 163 days vs. 307 days, log rank p = 0.018). Tube-related AEs (38/75 [51%] vs. 25/75 [33%], p = 0.047) and resultant reinterventions were more common after PEG-J, especially tube clog (p = 0.017) and retrograde J-tube migration (p = 0.0003). Stoma-related AEs (PEG-J: 3/75 [4%] vs. PEJ: 7/75 [9%], p = 0.327) and resultant reinterventions were similar in both cohorts.
Technical success was comparable between PEG-J and PEJ; however, PEJ recipients had fewer tube-related AEs and resultant reinterventions. These findings favor PEJ as first-line for patients requiring prolonged post-pyloric feeding, especially if concomitant gastric decompression is not required.
幽门后喂养的内镜手术包括带空肠延长的经皮内镜下胃造口术（PEG-J）和直接经皮内镜下空肠造口术（PEJ）。我们开展了规模最大且唯一的一项双中心回顾性研究，比较接受PEG-J与PEJ治疗的患者的结局。
对因幽门后喂养±胃减压而接受PEG-J或PEJ治疗的患者进行双中心回顾性研究。主要结局为技术成功（TS）和因不良事件进行的再次干预（rAE：为处理与导管相关或造口相关的不良事件而进行的≥1次喂养管更换、转换和/或移除）。次要结局为首次手术时间、不良事件类别（导管相关/造口相关）以及由各不良事件类别引发的再次干预。
两种手术的技术成功率相似（PEG-J组：71/75 [95%]，PEJ组：68/75 [91%]，p = 0.533）。PEG-J组因不良事件进行的再次干预更多（rAE：33/75 [44%] 对比20/75 [27%]，p = 0.04），且这些再次干预发生的时间更接近首次手术（rAE的中位时间，163天对比307天，对数秩检验p = 0.018）。PEG-J术后导管相关不良事件（38/75 [51%] 对比25/75 [33%]，p = 0.047）及由此导致的再次干预更为常见，尤其是导管堵塞（p = 0.017）和空肠管逆行移位（p = 0.0003）。造口相关不良事件（PEG-J组：3/75 [4%]，PEJ组：7/75 [9%]，p = 0.327）及由此导致的再次干预在两组中相似。
PEG-J和PEJ的技术成功率相当；然而，接受PEJ治疗的患者导管相关不良事件及由此导致的再次干预较少。这些结果表明，对于需要长期进行幽门后喂养的患者，尤其是不需要同时进行胃减压的患者，PEJ应作为一线治疗方法。
