Direct percutaneous endoscopic jejunostomy using transgastrostomic endoscopy

[Purpose] Direct percutaneous endoscopic jejunostomy (D-PEJ) was performed using transgastrostomic endoscopy (TGE) in patients with repeated reflux or aspiration of gastric contents infused through PEG. [Methods] TGE was performed with a small-caliber endoscope GIF-XP240 (Olympus, Tokyo). One-Step Button™ (Boston Scientific, Natick, MA) was placed with the pull method under the guidance of TGE and fluoroscopy. [Results] D-PEJ were able to be placed on the upper jejunum in 9 patients except one case of dislocation of the upper jejunum after test puncture. There was no important procedure-related morbidity. No radioactivity in the stomach was observed during 60 min. after infusion of liquid meal mixed with Tc-99m Sn-colloid through D-PEJ in all patients. [Conclusion] D-PEJ using TGE was a useful and safe method without using a small bowel endoscope or overtube.