DeLegge M H, Duckworth P F, McHenry L, Foxx-Orenstein A, Craig R M, Kirby D F
Section of Nutrition, Virginia Commonwealth University, Medical College of Virginia Hospitals, Richmond 23298-0711, USA.
JPEN J Parenter Enteral Nutr. 1995 May-Jun;19(3):239-43. doi: 10.1177/0148607195019003239.
Although jejunal tube placement through a percutaneous endoscopic gastrostomy (PEG) has not been proven to be preferable to PEG feeding, it would be theoretically advantageous for those patients prone to gastrointestinal aspiration. However, reliable placement of a small bowel feeding tube through a PEG has been technically difficult. We have previously reported successful placement of a percutaneous endoscopic gastrojejunostomy (PEG/J) with minimal complications. These results are in contrast to other series that report technical difficulty, frequent tube dysfunction and gastric aspiration. We describe an over-the-wire PEG/J technique performed by multiple operators at two medical centers. Gastrostomy tube placement was successful in 94% of patients. Initial placement of the jejunal tube was successful in 88% of patients. Second attempts were 100% successful. The average procedure time was 36 minutes. The distal duodenal and jejunal placement of the jejunal tube resulted in no episodes of gastroduodenal reflux. Complications included jejunal tube migration (6%), clogging (18%), and unintentional removal (11%). The majority of patients were ultimately converted to either oral or intragastric feedings. We conclude that the PEG/J system is a reliable, reproducible method of small bowel feeding and is associated with no episodes of tube feeding reflux when the jejunal tube is positioned in the distal duodenum or beyond. Furthermore, it provides a temporary nutritional bridge for those patients who are later transitioned to either PEG or oral feeding.
尽管经皮内镜下胃造口术（PEG）置入空肠管尚未被证明比PEG喂养更具优势，但对于那些容易发生胃肠道误吸的患者来说，理论上是有利的。然而，通过PEG可靠地放置小肠喂养管在技术上一直很困难。我们之前报道了经皮内镜下胃空肠造口术（PEG/J）的成功放置，并发症极少。这些结果与其他系列报道的技术困难、频繁的管道功能障碍和胃内容物误吸形成对比。我们描述了一种由两个医疗中心的多名操作人员实施的导丝引导下PEG/J技术。胃造口管放置在94%的患者中成功。空肠管的初次放置在88%的患者中成功。二次尝试的成功率为100%。平均手术时间为36分钟。空肠管放置在十二指肠远端和空肠，未发生胃十二指肠反流。并发症包括空肠管移位（6%）、堵塞（18%）和意外拔除（11%）。大多数患者最终转为口服或胃内喂养。我们得出结论，PEG/J系统是一种可靠、可重复的小肠喂养方法，当空肠管放置在十二指肠远端或更远部位时，不会发生管饲反流。此外，它为那些后来转为PEG或口服喂养的患者提供了一个临时的营养桥梁。
