Percutaneous transgastric placement of jejunal feeding tubes with an ultrathin endoscope

Background: Placement of jejunal feeding tubes in patients with PEG tubes by conventional techniques is often difficult. This is a description of a simple method for placement of jejunal tubes by using an ultrathin endoscope. This method does not always require conscious sedation. Methods: An ultrathin endoscope is passed through a mature gastrostomy tract to the proximal jejunum. A guidewire passed through the endoscope and placed beyond the ligament of Treitz is then used under fluoroscopy to place a transgastric jejunal feeding tube. Observations: Sixteen jejunal feeding tube placements were performed in 13 patients over a period of 20 months. Six patients required conscious sedation. Jejunal tubes had feeding channels of 10 to 12F. There were no complications. Feedings began on the day of placement. Conclusions: Ultrathin endoscopes can be used to place jejunal feeding tubes by means of the transgastric route. The procedure is simple, quick, and safe. In some patients, the use of conscious sedation can be avoided.