Long-term outcomes of direct percutaneous endoscopic jejunostomy: a 10-year cohort.

All direct percutaneous endoscopic jejunostomy (DPEJs) were performed by two experienced interventional endoscopists (MS and NN), using a paediatric colonoscope (Olympus, GHG180) and a standard Ponsky PEG kit. All subjects received prophylactic antibiotic 1 hour prior to the procedure (Cephazolin 1gm IV; or Vancomycin 1gm IV if known to have penicillin allergy). The scope was advanced into the jejunum as far as possible. With the room light dimmed, the abdomen was closely observed for the light trans-lumination from the scope tip as the scope slowly withdrew. Once good light trans-lumination was identified, the overlying skin was quickly cleansed with local anti-septic and a 22G needle was used to puncture into the lumen of the jejunal loop under direct endoscopic vision. This is to temporarily fix and secure the relevant jejunal loop to the abdomen wall, allowing time for injection of local anaesthesia (lignocaine 2%, 10ml), insertion of a larger bore trocar needle and a small skin incision. A plastic loop-wire was then feed through the trocar needle, which was grasped by a snare and pulled out of the mouth by removing the scope. The PEG tube was attached to the loop-wire, pulled through the mouth into the jejunum and out the abdominal wall at the DPEJ site. The inner bumper was retracted against the anterior abdominal wall and fixed by a plastic disc. The procedure lasts for up to an hour. The overall duration of observation for each patient was up to 10 years.