Direct Percutaneous Endoscopic Jejunostomy: High Completion Rates with Selective Use of a Long Drainage Access Needle
Table 2
Case summaries of three examples of DPEJ insertion where particular procedural difficulties were encountered, and where the drainage access needle was helpful in ensuring a successful outcome. No case developed any complication.
Case
Procedural challenge
Technique
Male, 25. Severe cerebral palsy with dysphagia and recurrent aspiration pneumonia
Large paraoesophageal hernia with proximal jejunum in thorax
Enteroscope with overtube used. Jejunum punctured within thorax (via diaphragmatic hiatus from abdominal wall approach) with fluoroscopic guidance
Female, 53. Pancreatic cancer with partial duodenal obstruction and peritoneal metastases
Large volume of omental malignancy and moderate amount of ascites
Enteroscope used. Deep loop of jejunum punctured with fluoroscopic guidance
Female, 65. Gastric linitis plastica with peritoneal metastases
Overweight patient with mobile jejunum
Enteroscope used. Jejunum punctured with fluoroscopic guidance