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World J Gastrointest Endosc 2022 May;14(5):250-266

Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy.

Nutritional support is essential in patients who have a limited capability to maintain their body weight. Therefore, oral feeding is the main approach for such patients. When physiological nutrition is not possible, positioning of a nasogastric, nasojejunal tube, or other percutaneous devices may be feasible alternatives. Read More

Curr Opin Gastroenterol 2022 05 9;38(3):285-291. Epub 2022 Mar 9.

Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.

Purpose Of Review: The current review summarizes current evidence regarding the indications, contraindications, and technical aspects of placing a direct percutaneous endoscopic jejunostomy (DPEJ), as well as procedure-related and patient-related outcomes.

Recent Findings: DPEJ is indicated for patients who require long-term (>4 weeks) jejunal nutrition due to existing altered foregut anatomy (e.g. Read More

Endosc Int Open 2022 Apr 14;10(4):E488-E520. Epub 2022 Apr 14.

Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States.

Endoscopic methods of delivering uninterrupted feeding to the jejunum include direct percutaneous endoscopic jejunostomy (DPEJ) or PEG with jejunal extension (PEG-J), validated from small individual studies. We aim to perform a meta-analysis to assess their effectiveness and safety in a variety of clinical scenarios. Major databases were searched until June 2021. Read More

Cardiovasc Intervent Radiol 2022 Apr 8. Epub 2022 Apr 8.

Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.

Purpose: To evaluate the technical feasibility of percutaneous radiologic gastrostomy in patients after partial gastrectomy.

Materials And Methods: This retrospective study included 15 consecutive gastrectomized patients with attempted percutaneous radiologic gastrostomy at our institution between April 2014 and March 2021. When the stomach was sufficiently insufflated to distend below the left anterior subcostal margin, percutaneous radiologic gastrostomy with gastropexy was conventionally performed by the Seldinger technique. Read More

Rinsho Shinkeigaku 2022 Apr 29;62(4):298-300. Epub 2022 Mar 29.

Department of Surgery, Saiseikai Utsunomiya Hospital.

A 68-year-old woman with Parkinson's disease, who had previously undergone Roux-en-Y gastrojejunostomy for early gastric cancer, complained of wearing-off and troublesome dyskinesia that had progressed over 7-years. After the introduction of levodopa-carbidopa intestinal gel therapy (LCIG) by nasojejunal tube, she had a good clinical response. Percutaneous endoscopic gastrostomy with a jejunal extension tube was difficult in this case, due to lack of gastrostomy site and fibrous postoperative adhesion. Read More

J Laparoendosc Adv Surg Tech A 2021 Dec 5;31(12):1376-1383. Epub 2021 Nov 5.

Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.

There are few nationwide studies comparing outcomes of open, laparoscopic (LAP), and percutaneous endoscopic (PEG) gastrostomy tube (GT) placement in the pediatric population. The Nationwide Readmissions Database from 2010 to 2014 was used to identify patients ≤18 years (excluding newborns) who underwent GT placement. Demographics, hospital characteristics, and outcomes were compared by the GT approach. Read More

Surg Endosc 2022 Jun 12;36(6):4233-4238. Epub 2021 Oct 12.

Department of Internal Medicine, Division of Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52240, USA.

Introduction: Several techniques for PEG-J tube placement have been described, commonly requiring fluoroscopic guidance and/or fixation of the jejunostomy tube (J-tube) into the small intestine. We describe a modified technique for placing jejunostomy tubes under direct visualization through a PEG with the use of ultra-thin endoscopes and steel guidewire.

Methods: A retrospective study at a single tertiary academic center evaluating patients who underwent PEG-J placement between 2010 and 2020. Read More

Ann Surg Oncol 2022 Jan 21;29(1):262-271. Epub 2021 Sep 21.

Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA.

Background: In advanced malignant bowel obstruction, decompressive gastrostomy tubes (GTs) may not be feasible due to ascites, peritoneal carcinomatosis, and altered gastric anatomy. Whereas nasogastric tubes (NGTs) allow temporary decompression, percutaneous transesophageal gastrostomy tubes (PTEGs) are an alternative method for long-term palliative decompression. This study performed a scoping review to determine outcomes with PTEG in advanced malignancies. Read More

Clin Park Relat Disord 2020 17;3:100079. Epub 2020 Nov 17.

Department of Neurology, National Center Hospital, Parkinson's Disease & Movement Disorders Center, National Center of Neurology and Psychiatry, Japan.

Introduction: Tube-related adverse events (AEs) occur frequently in patients with Parkinson's disease (PD) receiving levodopa-carbidopa intestinal gel therapy. Endoscopy has become evasive since the beginning of the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to evaluate methods that use the percutaneous endoscopic gastrostomy-jejunostomy (PEG-J) tubes without endoscopy. Read More

J Neurogastroenterol Motil 2021 Jul;27(3):408-418

Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

Background/aims: Gastroparesis is a chronic gastrointestinal disorder that frequently presents with symptoms that are difficult to manage, necessitating frequent hospitalizations. We sought to determine the predictors of early readmission due to gastroparesis based on etiology.

Methods: We identified all adults discharged with a principal diagnosis of gastroparesis after hospitalization from the 2014 Nationwide Readmission Database. Read More

Gastrointest Endosc 2021 07;94(1):57-59

Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.

Chirurg 2022 Mar 17;93(3):310-322. Epub 2021 Jun 17.

Gastroenterologie, Hepatologie, Stoffwechsel, Nephrologie, Klinikum Garmisch-Partenkirchen GmbH, Garmisch-Partenkirchen, Deutschland.

Endoscopy is the leading method in the diagnostics of gastrointestinal malignancies. With the increasing incidences of various tumor entities, a palliative treatment situation is already present in many patients despite an increasing number of screening strategies. Palliative endoscopy can make an essential contribution to alleviation of tumor-related symptoms, such as dysphagia, malnutrition, cholestasis, ileus and pain. Read More

J Gastrointest Surg 2021 12 15;25(12):3130-3136. Epub 2021 Jun 15.

Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.

Background And Methods: Gastro- or duodenojejunostomy leaks after pancreatoduodenectomy is rare. This study aims to analyze the incidence, management, and outcome of gastro- or duodenojejunostomy leaks after pancreatoduodenectomy based on a single center experience from 2004 to 2020 with a narrative literature review.

Results: Of a total of 1494 pancreatoduodenectomies, eight patients with gastrojejunostomy (n=1) or duodenojejunostomy (n=7) leak were identified from the institutional pancreatic database. Read More

Endoscopy 2022 03 30;54(3):E96-E97. Epub 2021 Mar 30.

Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham (UAB), Alabama, USA.

Endoscopy 2022 03 15;54(3):E92-E93. Epub 2021 Mar 15.

Endoscopy Unit, Digestive Diseases Department, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Catalonia, Spain.

Nutr Clin Pract 2021 Jun 8;36(3):648-653. Epub 2020 Dec 8.

Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.

Enteral nutrition (EN) is a widely used therapeutic tool to provide nutrition support for patients with various clinical conditions, including different types of cancer. Head and neck cancers, often complicated by dysphagia, are among leading indications for enteral feeding. Percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic jejunostomy (PEJ) tubes are typically used to deliver EN. Read More

Gastrointest Endosc 2021 07 29;94(1):48-56. Epub 2020 Dec 29.

Department of Internal Medicine, Nishimino Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan.

Background And Aims: Direct percutaneous endoscopic jejunostomy (DPEJ) is an alternative method of enteral feeding to percutaneous endoscopic gastrostomy (PEG). Although long-term outcomes of PEG have been reported, little is known regarding the outcomes of DPEJ.

Methods: A retrospective cohort study was conducted including 115 and 651 consecutive attempts of DPEJ and PEG, respectively, in a total of 766 elderly patients between April 2004 and March 2019. Read More

Endoscopy 2021 Jan 1;53(1):81-92. Epub 2020 Dec 1.

Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.

ESGE recommends considering the following indications for enteral tube insertion: (i) clinical conditions that make oral intake impossible (neurological conditions, obstructive causes); (ii) acute and/or chronic diseases that result in a catabolic state where oral intake becomes insufficient; and (iii) chronic small-bowel obstruction requiring a decompression gastrostomy.Strong recommendation, low quality evidence.ESGE recommends the use of temporary feeding tubes placed through a natural orifice (either nostril) in patients expected to require enteral nutrition (EN) for less than 4 weeks. Read More

Surg Clin North Am 2020 Dec 10;100(6):1091-1113. Epub 2020 Oct 10.

General Surgery, Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Smith Tower 1661, Houston, TX 77030, USA.

Various approaches for enteral access exist, but because there is no single best approach it should be tailored to the needs of the patient. This article discusses the various enteral access techniques for nasoenteric tubes, gastrostomy, gastrojejunostomy, and direct jejunostomy as well as their indications, contraindications, and pitfalls. Also discussed is enteral access in altered anatomy. Read More

J Pediatr Surg 2021 Aug 14;56(8):1430-1435. Epub 2020 Aug 14.

Department of Paediatric Surgery, Royal London Hospital, Whitechapel, Whitechapel Road, London E1 1FR.

Background: We experienced a high incidence of jejunal tube (JEJ) displacement in children who underwent percutaneous endoscopic transgastric jejunostomy (PEGJ), ever since the introduction of ENFit connector (2017).

Methods: Two interventions were introduced in 2018 - fixative suture to PEGJ ENFit connector, and conversion to balloon transgastric-jejunal feeding device (Balloon GJ) whenever possible. Children receiving PEGJ and Balloon GJ in 2. Read More

Adv Surg 2020 09 17;54:231-249. Epub 2020 Jun 17.

Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA. Electronic address:

Surg Endosc 2021 06 24;35(6):2976-2980. Epub 2020 Jun 24.

Gastroenterology, Hepatology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.

Introduction: Bevacizumab is a humanized anti-vascular endothelial growth factor monoclonal antibody used in the treatment of cervical cancer, ovarian cancer, colorectal cancer, lung cancer, renal cell cancer, and recurrent glioblastomas. Its approval by US FDA was issued with a black box warning that its use has been associated with a risk of gastrointestinal (GI) tract perforation and that it should be discontinued in patients who have experienced such. The reported incidence of GI perforation in those receiving bevacizumab is as high as 3%. Read More

GE Port J Gastroenterol 2020 Apr 7;27(3):172-184. Epub 2019 Oct 7.

Gastroenterology Department, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal.

Background: Digestive tumours are among the leading causes of morbidity and mortality. Many cancer patients cannot maintain oral feeding and develop malnutrition. The authors aim to: review the endoscopic, radiologic and surgical techniques for nutritional support in cancer patients; address the strategies for nutritional intervention according to the selected technique; and establish a decision-making algorithm to define the best approach in a specific tumour setting. Read More

Dig Endosc 2020 Sep 27;32(6):984-988. Epub 2020 May 27.

Endoscopy Unit, Department of Gastroenterology, Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Hospital General Universitario de Alicante, Alicante, Spain.

Percutaneous endoscopic gastrostomy (PEG) is the method of choice for feeding and nutritional support in patients with a normal gastrointestinal function who require long-term enteral nutrition. We report our experience regarding an alternative endoscopic ultrasound (EUS)-guided PEG technique. A retrospective clinical experience case series study was conducted from January 2019 to November 2019 at a tertiary center. Read More

Anticancer Res 2020 Feb;40(2):1167-1173

Department of Otolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany

Background: A gastrostomy feeding tube is one method for long-term feeding support in patients undergoing radio(chemo)therapy for head and neck cancer (HNC). The aim of this study was to analyze the safety of prophylactic gastrostomy tube placement and usage in HNSCC patients.

Patients And Methods: HNC patients undergoing percutaneous endoscopic gastrostomy (PEG) or radiological percutaneous gastrostomy (RPG) tube placement prior to radio(chemo)therapy from 2010-2014 were retrospectively reviewed regarding procedural and long-term gastrostomy tube-related complications, usage of PEG/RPG, weight profile, pretreatment and posttreatment body mass index. Read More

Clin J Gastroenterol 2020 Aug 24;13(4):501-505. Epub 2020 Jan 24.

Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.

Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure providing nutritional benefits to malnourished patients. Although a past history of celiotomy is not a contradiction for PEG construction, this procedure is rarely undertaken in post-esophagectomy patients, for two reasons: anatomically limited gastric spaces and high susceptibility to pulmonary aspiration. To overcome these limitations, we developed an original method of introducing PEG with jejunal extension for esophagectomized patients with retrosternal gastric pull-up reconstruction. Read More

Asian J Endosc Surg 2020 Jul 9;13(3):410-414. Epub 2019 Dec 9.

Department of Surgery, Keio University, School of Medicine, Tokyo, Japan.

We report the case of a 70-year-old woman with synchronous advanced esophageal cancer and pancreatic head cancer. To reduce the surgical invasiveness, we performed a two-stage operation that included percutaneous endoscopic gastrostomy and minimally invasive esophagectomy. In the first stage, we performed a percutaneous endoscopic gastrostomy, a thoracoscopic esophagectomy with cervical and mediastinal lymph node dissection, and an esophagostomy without a laparotomy. Read More

J Formos Med Assoc 2020 Aug 21;119(8):1320-1324. Epub 2019 Nov 21.

Department of Medical Imaging, National Taiwan University Cancer Center, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address:

Background/purpose: Enteral feeding, mainly by using a nasogastric tube (NGT), is generally favored over parenteral supplementation in head and neck cancer (HNC) patients with dysphagia. However, the placement of a NGT, either blindly or by endoscopy, is technically challenging in these patients due to the obstructive mass and the altered regional anatomy. The aim of this retrospective study was to estimate the clinical feasibility and safety of fluoroscopic-guided NGT placement in patients with advanced HNC. Read More