Safety and durability of PEG-J: a single-centre experience

Abstract

Introduction

Although percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) is currently indicated in a variety of conditions, limited data are available regarding its safety and the best timing for its replacement. We herein describe a single-centre cohort of patients who underwent PEG-J placement or replacement to assess the short- and long-term safety of the procedure.

Methods

Demographic and procedure-related data regarding all patients undergoing a PEG-J procedure between March 2010 and 2020, either first placement or any replacement, at the Endoscopy Unit of a University Hospital in Northern Italy (IRCCS Policlinico San Matteo, Pavia, Italy), were retrospectively collected. Data were collected until last available follow-up.

Results

We included 73 patients (mean age 70 ± 9.7, 60.3% female) who underwent a PEG-J procedure. Data on a total of 215 procedures were gathered with a median follow up time of 21 months (IQR 9.3–39.5). No immediate adverse events (AEs) were reported. Short-term (within 30 days) AEs, including jejunal extension dislocations, accidental removal, obstruction and kinking occurred in 12 patients (5.6% of the total procedures), whilst long-term AEs (obstruction, tube malfunctions, inner tube dislocation, pyloric ulcer, hypergranulation tissue, wear, buried bumper syndrome and accidental removal) were reported in 40 patients. The risk of developing an AE was not reduced if tube replacement was performed electively. The median duration of the PEG-J before replacement was 12 months (IQR 6–16 months).

Conclusion

PEG-J placement and replacement are safe procedures. Although PEG-J durability is variable an elective procedure might be indicated to reduce urgent replacements.

Keywords:

• PEG-J
• safety
• jejunal extension
• adverse event
• tube damage

Acknowledgements

The authors thank the Endoscopy Unit staff of IRCCS Policlinico San Matteo for the time put into this project.

Ethics approval

This study was conducted as a service improvement clinical AUDIT and, as such, is exempt from ethical approval.

Author contributions

All authors significantly participated in the drafting of the manuscript or critical revision of the manuscript for important intellectual content and provided approval of the final submitted version. Individual contributions are as follow: SC and LR designed and coordinated the study, enrolled patients, interpreted data and wrote the manuscript. ADS, FDG, and MVL supervised SC, reviewed the paper and made final critical revision for important intellectual contents.

Disclosure statement

No potential conflict of interest was reported by the author(s).