Percutaneous Jejunostomy

Direct percutaneous jejunostomy placement is an often underutilized procedure that can allow for supplemental enteral nutrition in a certain subset of patients, in which percutaneous gastrostomy is not technically feasible, or in patients who require post-pyloric feeding. Percutaneous jejunostomy catheter placement was first described in the 1980s; since that time there have been minimal case series on the procedural technique and outcomes. At our institution, we perform percutaneous jejunostomy placement as a planned two-stage procedure. During the initial stage, direct jejunostomy is performed under a combination of fluoroscopic and ultrasound guidance, after distending the jejunum through a nasojejunal tube. After confirming intraluminal access, at least one Cope suture anchor is deployed, and guidewire access is maintained. Subsequently, the track is serially dilated, and a 14-Fr pigtail catheter is placed into the jejunum. Approximately 4 to 6 weeks later, the patient returns for conversion of the pigtail drain into a formal jejunostomy catheter with retention balloon, under fluoroscopic guidance. Several of the prior larger studies on the technique have noted major complications to occur in 12% of patients and minor complications to occur in 9.8% of patients. While percutaneous jejunostomy placement is not a frequently performed procedure, technical success and complication rates are comparable to that of surgical jejunostomy.