Faigel D O, Kadish S L, Ginsberg G G
Division of Gastroenterology, University of Pennsylvania Medical Center, Philadelphia, USA.
JPEN J Parenter Enteral Nutr. 1996 Jul-Aug;20(4):306-8. doi: 10.1177/0148607196020004306.
Delivery of enteral feeding beyond the ligament of Treitz is often desirable, as it diminishes enterogastric reflux and potential for pulmonary aspiration of enteral feeding solution. However, standard or fluoroscopically guided techniques often fail. We describe three such cases in which enteral feeding tube placement was achieved endoscopically and secured using an endoscopic clip-fixing device.
A standard feeding tube attached to a mucosal clip by a silk suture was advanced endoscopically into the small intestine. Using a through-the-endoscope clip-fixing device, the tube was attached to the bowel wall.
Three patients underwent the above procedure: a postgastrectomy patient with a functionally obstructed jejunal pouch and a previously failed fluoroscopically guided placement had a nasojejunal feeding tube successfully placed beyond the obstruction: a cancer patient with duodenal obstruction due to SMA syndrome, a surgical gastrostomy, and a previously failed fluoroscopic attempt had a dual lumen pergastrostomy feeding tube placed beyond the obstruction; and a patient with a refractory benign esophageal stricture underwent esophageal dilation followed by successful feeding tube placement into the proximal jejunum. In all patients, the tube functioned well without subsequent occlusion or dislodgement.
Endoscopic placement of feeding tubes using a clip-fixing device is a useful technique in patients with normal and abnormal anatomy in whom reliable delivery of enteral feeding beyond the ligament of Treitz is desired.
经Treitz韧带进行肠内喂养通常是可取的，因为它可减少肠胃反流以及肠内喂养溶液发生肺误吸的可能性。然而，标准技术或在荧光镜引导下的技术常常失败。我们描述了三例通过内镜实现肠内喂养管放置并使用内镜夹固定装置进行固定的病例。
将一根通过丝线缝合与黏膜夹相连的标准喂养管经内镜推进至小肠。使用经内镜夹固定装置将喂养管固定于肠壁。
三名患者接受了上述操作：一名胃切除术后空肠袋功能障碍且先前荧光镜引导下放置失败的患者成功置入鼻空肠喂养管越过梗阻部位；一名因肠系膜上动脉综合征导致十二指肠梗阻、行手术胃造口术且先前荧光镜检查尝试失败的癌症患者成功置入双腔经胃造口喂养管越过梗阻部位；一名难治性良性食管狭窄患者先接受食管扩张，随后成功将喂养管置入近端空肠。所有患者的喂养管均功能良好，未出现后续堵塞或移位。
对于解剖结构正常或异常且期望经Treitz韧带可靠地进行肠内喂养的患者，使用夹固定装置进行内镜下喂养管放置是一种有用的技术。
