OBJECTIVETo report clinical experience of percutaneous endoscopic gastrostomy, duodenostomy, jejunostomy in 120 patients, focusing on its technique and indications.

METHODSOne hundred and twenty patients received percutaneous endoscopic gastrostomy, duodenostomy, jejunostomy from May 2001 to April 2004, including 75 percutaneous endoscopic gastrostomy (PEG), 42 percutaneous endoscopic jejunostomy (PEJ), 2 percutaneous endoscopic duodenostomy (PED), 1 direct percutaneous endoscopic jejunostomy (DPEJ). All tubes established by traditional pull technique.

RESULTSThe average duration of PEG was (9 +/- 4) min, PEJ (17 +/- 6) min, DPEJ 20 min, and PED was 10 and 12 min for 2 patients, respectively. Success rate of the technique was 98.4% (120/122). Major complication rate was 0.8% (1/120), and minor complication rate was 7.5% (9/120). Clinical indications: PEG, PED and PEJ were applied for long-term enteral nutritional support in 88 patients, gastrointestinal decompression in 25 patients, and transfusing external drainage bile to gastrointestinal tract in 5 patients. Two radiation enteritis patients used PEG for gastrointestinal decompression preoperatively and long-term enteral nutritional support postoperatively.

CONCLUSIONPEG, PED PEJ and DPEJ are easily handled, effective and safe, and may be widely used in clinical practice.

Adult ; Aged ; Duodenostomy ; methods ; Endoscopy, Gastrointestinal ; Enteral Nutrition ; Female ; Gastrostomy ; methods ; Humans ; Jejunostomy ; methods ; Male ; Middle Aged

BACKGROUNDMost gastric cancer patients who undergo gastrectomy develop malnutrition. It is, therefore, crucial to establish an effective means to provide nutrition for these patients. To perform home enteral nutrition (EN) to ensure adequate nutritional intake in gastric cancer patients, we placed a jejunostomy catheter during gastric surgery. Most patients showed improved nutritional status.

METHODSTwenty-nine inpatients at our hospital underwent radical gastrectomy and jejunostomy from December 2002 to December 2007 and were designated as the jejunostomy group, and 32 matched patients without a jejunostomy tube were designated as the tube-free group. The jejunostomy group was treated with EN from 72 hours to 3 months postoperatively. The tube-free group did not receive EN. Data including preoperative and postoperative body weight, body mass index (BMI), nutrition risk screening (NRS) score, Karnofsky performance score (KPS), and laboratory biochemical indicators were documented respectively and compared.

RESULTSCompared with preoperative week 1, both groups showed decreased body weight and BMI at 3 months postoperatively. The weight loss in the jejunostomy group ((7.1 ± 3.3) kg) was significantly less than that in the tube-free group ((9.9 ± 3.1) kg). Similarly, BMI decreased by (2.4 ± 1.0) kg/m(2) in the jejunostomy group, which was significantly less than in the tube-free group ((3.2 ± 0.9) kg/m(2)). The number of patients with postoperative NRS ≥ 3 was decreased in the jejunostomy group, but was increased in the tube-free group, and this difference was significant. There were no significant differences between the two groups in total lymphocyte count, hemoglobin, albumin and prealbumin, and adverse drug effects.

CONCLUSIONSShort-term (3 months) EN supplementation via jejunostomy tube can reduce the risk of malnutrition and weight loss, and improve tolerance of chemotherapy. Tube feeding is reliable for achieving these goals because it is not important whether or not the patients have appetites.

Aged ; Body Weight ; Enteral Nutrition ; methods ; Female ; Gastrectomy ; methods ; Humans ; Intubation, Gastrointestinal ; methods ; Jejunostomy ; methods ; Male ; Postoperative Period ; Stomach Neoplasms ; surgery

Background:Laparoscopic total gastrectomy (LTG) is increasingly performed in patients with gastric cancer. However, the usage of intracorporeal esophagojejunostomy (IEJ) following LTG is limited, as the safety and efficacy remain unclear. The present meta-analysis aimed to evaluate the feasibility and safety of IEJ following LTG.

Methods:Studies published from January 1994 to January 2017 comparing the outcomes of IEJ and extracorporeal esophagojejunostomy (EEJ) following LTG were reviewed and collected from the PubMed, EBSCO, Cochrane Library, Embase, and China National Knowledge Internet (CNKI). Operative results, postoperative recovery, and postoperative complications were compared and analyzed. The weighted mean difference (WMD) and odds ratio (OR) with a 95% confidence interval (CI) were calculated using the Review Manager 5.3.

Results:Seven nonrandomized studies with 785 patients were included. Compared with EEJ, IEJ has less blood loss (WMD: -13.52 ml; 95% CI: -24.82--2.22; P = 0.02), earlier time to first oral intake (WMD: -0.49 day; 95% CI: -0.83--0.14; P < 0.01), and shorter length of hospitalization (WMD: -0.62 day; 95% CI: -1.08--0.16; P < 0.01). There was no significant difference between IEJ and EEJ regarding the operation time, anastomotic time, number of retrieved lymph nodes, time to first flatus, anastomosis leakage rate, anastomosis stenosis rate, and proximal resections (all P > 0.05).

ConclusionsCompared with EEJ, IEJ has better cosmesis, milder surgical trauma, and a faster postoperative recovery. IEJ can be performed as safely as EEJ. IEJ should be encouraged to surgeons with sufficient expertise.

Esophagostomy ; adverse effects ; methods ; Esophagus ; surgery ; Gastrectomy ; adverse effects ; methods ; Humans ; Jejunostomy ; adverse effects ; methods ; Laparoscopy ; adverse effects ; methods ; Stomach Neoplasms ; surgery ; Treatment Outcome

OBJECTIVETo investigate the feasibility and safety of percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic jejunostomy(PEJ).

METHODSFrom June 1996 to April 2005, clinical data of 121 patients treated with PEG or PEJ were analyzed retrospectively.

RESULTSA total of 121 patients experienced 134 times of PEG or PEG plus PEJ, including 90 cases (103 times) treated with PEG and 31 patients treated with PEG plus PEJ. Thirteen patients treated with PEG had fistula replacement 6-10 months after PEG. All patients had quick nutrition recovery after fistula tube insert,therefore parenteral nutrition was not required. No severe complications occurred in all patients after 10 months of following-up. Four patients had subcutaneous infection around fistula 4-10 days after PEG.

CONCLUSIONPEG and PEJ are safe and new methods for gastrointestinal decompression and enteral nutrition, which can be substitutes for nasogastric tube.

Adult ; Aged ; Aged, 80 and over ; Endoscopy, Gastrointestinal ; methods ; Female ; Follow-Up Studies ; Gastrostomy ; methods ; Humans ; Jejunostomy ; methods ; Male ; Middle Aged ; Retrospective Studies

BACKGROUND: Residual and recurrent bile duct stones after biliary surgery cause many difficult problems. and reoperation on biliary tract has limitation due to its high morbidity and mortality. In recent years, various non-operative modalities for management in residual and recurrent stone have been developed. METHODS: We analyzed 69 cases of residual and recurrent bile duct stones which were managed with non-operative modalities at the Department of surgery, Dae Dong Hospital from Jan. 1994 to Dec. 1997, and evaluated the efficacy of these modalities. RESULTS: Female exceeded male with a ratio 1.76:1. and the peak incidence of age group was 6th decade. The most common diagnostic procedure was T-tube cholangiography (53.6%). Interval between previous operation and second procedure for residual or recurrent stones was within 6 months in most cases (82%). Cholecystectomy with T-tube choledochostomy was performed most frequently in previous operation. Residual and recurrent stones were found only at common bile duct in 34 cases (49.3%) most commonly. Common bile duct stones were managed most frequently with endoscopic sphincterotomy (39.5%), but the complete removal rate was heighest in choledochoscopic stone removal (100%). Complete removal rate of intrahepatic duct stone was heighest with interventional radiologic stone removal as well as choledochoscopic stone removal (43.6%), but average number of session was smaller in choledochoscopic stone removal (2.5) than interventional radiologic stone removal (3.5). Associated complication with non-operative management modalities were very low, except three cases of hepaticocutaneous jejunostomy. The latter required reoperation due to continuous bile fistula in two cases, and long jejunal loop in one case. CONCLUSIONS: Choledochoscopic stone removal is most effective method in the management of residual and recurrent bile duct stones.
Bile Ducts* ; Bile* ; Biliary Tract ; Cholangiography ; Cholecystectomy ; Choledochostomy ; Common Bile Duct ; Female ; Fistula ; Humans ; Incidence ; Jejunostomy ; Male ; Methods ; Mortality ; Reoperation ; Sphincterotomy, Endoscopic

Simulating physiological neuronal and hormonal conditions during digestive and interdigestive periods, the study identified the changes of the motility of biliary system including bile duct and sphincter of Oddi (SO) before and after cholecystojejunostomy. Thirty-five rabbits were divided into five groups randomly. The experimental groups received the venous injection of CCK 10 ng/kg, erythromycin 10 mg/kg, atropine 3 micrograms/kg and L-NAME 10 mg/kg respectively. Each rabbit underwent manometry through introducing a three-lumen catheter via the papilla retrogradely, using the low-compliance papillary infusion system. Then the gallbladder and the upper segment of the jejunum was anastomosed and the manometric procedures repeated after one week. SO basal pressure was increased, contraction amplitude decreased, contraction time shortened after cholecystojejunostomy. L-NAME, CCK and erythromycin could all excite SO. L-NAME could increase basal pressure and contraction amplitude, CCK increase basal pressure contraction amplitude and frequency, and erythromycin increase contraction amplitude, respectively. But comparing with that before cholecystojejunostomy, the increasing extent was decreased. The tensional and spontaneous contractions of the SO were under the control of the neural and hormonal mechanism. The anastomosis of gallbladder and jejunum and the drainage of bile made the tensional contraction stronger, but the spontaneous contraction weakened after the operation due to the decreases of the sensitivity of SO to hormonal factors. The clinical symptoms may not be relieved when the patients with SO dysfunction accepted cholecystojejunostomy.
Cholecystectomy/*adverse effects ; Common Bile Duct/*physiopathology ; Gallbladder Emptying/*physiology ; Jejunostomy/*adverse effects ; Manometry/methods ; Muscle Contraction ; Postoperative Period ; Random Allocation ; Sphincter of Oddi/*physiopathology

Simulating physiological neuronal and hormonal conditions during digestive and interdigestive periods, the study identified the changes of the motility of biliary system including bile duct and sphincter of Oddi (SO) before and after cholecystojejunostomy. Thirty-five rabbits were divided into five groups randomly. The experimental groups received the venous injection of CCK 10 ng/kg, erythromycin 10 mg/kg, atropine 3 micrograms/kg and L-NAME 10 mg/kg respectively. Each rabbit underwent manometry through introducing a three-lumen catheter via the papilla retrogradely, using the low-compliance papillary infusion system. Then the gallbladder and the upper segment of the jejunum was anastomosed and the manometric procedures repeated after one week. SO basal pressure was increased, contraction amplitude decreased, contraction time shortened after cholecystojejunostomy. L-NAME, CCK and erythromycin could all excite SO. L-NAME could increase basal pressure and contraction amplitude, CCK increase basal pressure contraction amplitude and frequency, and erythromycin increase contraction amplitude, respectively. But comparing with that before cholecystojejunostomy, the increasing extent was decreased. The tensional and spontaneous contractions of the SO were under the control of the neural and hormonal mechanism. The anastomosis of gallbladder and jejunum and the drainage of bile made the tensional contraction stronger, but the spontaneous contraction weakened after the operation due to the decreases of the sensitivity of SO to hormonal factors. The clinical symptoms may not be relieved when the patients with SO dysfunction accepted cholecystojejunostomy.
Animals ; Cholecystectomy ; adverse effects ; Common Bile Duct ; physiopathology ; Female ; Gallbladder Emptying ; physiology ; Jejunostomy ; adverse effects ; Male ; Manometry ; methods ; Muscle Contraction ; Postoperative Period ; Rabbits ; Random Allocation ; Sphincter of Oddi ; physiopathology

OBJECTIVETo evaluate influences on intestinal structure and myoelectric motility between modified uncut jejunal loop and Roux-en-Y procedures for biliodigestive anastomosis.

METHODSFifteen rabbits were randomized in modified uncut jejunal loop group, Roux-en-Y group and control group. Traced fasting slow-wave frequency (SWF) before biliodigestive diversion and 25 d postoperative (POD25) during laparotomy. Before the second laparotomy on POD21, the fasting SWF, percentage of abroad migrating myoelectric complex (MMC%), the postprandial spike potential frequency (SPF) and percentage of abroad propagation (SP%) were recorded in vivo. Compared myoelectric recordings according to parameters above. On POD90, harvested the stitched ligation of ascending loop and part of descending loop in uncut group, and biliary limb in R-Y animals, which assessed under HE, c-kit labeling immunohistochemical staining and transmission electron microscope(TEM).

RESULTSOn POD25, SWF declined mildly in uncut group (8.4%) and markedly in R-Y group (23.8%) respectively. The difference was significant (P<0.05). Before laparotomy on POD21 when abdomen closed, between uncut and control animals, there were statistical difference in fasting SWF and postprandial SPF (P<0.05), while no significance in MMC% and SP% (P>0.05). Moreover, differences of each parameters between R-Y group and control or uncut group were markedly statistical (P<0.01). Abroad myoelectric propagation through the ligated segment can be observed in uncut animals. Meanwhile, ectopic pacemaker was detected locating in the proximal segment of the Roux limb and triggering retrograde propagation in R-Y animals. On POD90, no recanalization were observed In uncut animals. Furthermore, occluded lumen with mild atrophic mucosa under microscope and c-kit labeling cells located in the inner circular muscle layer were observed, which proven to be Interstitial cells of Cajal (ICCs) by TEM. In R-Y animals, lumen of the Roux limb dilated. There's no significant difference in c-kit labeling area between R-Y and uncut animals by image analysis system. Reductions of processes and intercellular gap junction in ICCs, and loose interconnections between ICCs and SMCS or nerve endings were observed in R-Y animals.

CONCLUSIONSImpaired gastrointestinal motility after the Roux-en-Y procedure may due to the aberrant interstitial cells of Cajal. Modified uncut technique reveals a reliable and effective alternative for biliodigestive reconstruction.

Anastomosis, Roux-en-Y ; Animals ; Electrophysiology ; Female ; Intestines ; metabolism ; physiology ; surgery ; ultrastructure ; Jejunostomy ; methods ; Peristalsis ; physiology ; Postoperative Period ; Proto-Oncogene Proteins c-kit ; metabolism ; Rabbits ; Random Allocation

OBJECTIVE: The purpose of our study was to assess the feasibility of performing percutaneous radiologic gastrostomy (PRG) in patients who had undergone partial gastrectomy and to evaluate factors associated with technical success. MATERIALS AND METHODS: Nineteen patients after partial gastrectomy, who were referred for PRG between April 2006 and April 2012, were retrospectively analyzed. The remnant stomach was punctured using a 21-gauge Chiba-needle. A single anchor was used for the gastropexy and a 12-Fr or 14-Fr gastrostomy tube was inserted. Data were collected regarding the technical success, procedure time, and presence of any complications. Univariable analyses were performed to determine the factors related to the technical success. RESULTS: Percutaneous radiologic gastrostomy was technically successful in 10 patients (53%), while a failed attempt and failure without an attempt were observed in 5 (26%) and 4 (21%) patients, respectively. Percutaneous radiologic jejunostomy was successfully performed in 9 patients who experienced technical failure. In the 10 successful PRG cases, the mean procedure time was 6.35 minutes. Major complications occurred in 2 patients, tube passage through the liver and pneumoperitonum in one and severe hemorrhage in the other. The technical success rate was higher in patients with Billroth I gastrectomy (100%, 6/6) than in patients with Billroth II gastrectomy (31%, 4/13) (p = 0.011). CONCLUSION: Percutaneous radiologic gastrostomy can be successfully performed using the one-anchor technique in approximately half of the patients after partial gastrectomy.
Aged ; Aged, 80 and over ; Analysis of Variance ; Feasibility Studies ; Female ; Gastrectomy/*methods ; Gastric Stump ; Gastrostomy/instrumentation/*methods ; Humans ; Jejunostomy/methods ; Male ; Middle Aged ; Operative Time ; Punctures/methods ; Radiography, Interventional ; Retrospective Studies ; Suture Anchors ; Treatment Outcome

OBJECTIVETo explore the clinical value of percutaneous endoscopic gastrostomy/jejunostomy (PEG/J) in critically ill patients.

METHODSWe retrospectively analysed the clinical data of 30 critically ill patients who received PEG/J in our hospital. The indications, key operation procedures, peri-operative preparation, complications, and efficacy were recorded.

RESULTSTwenty-nine critically ill patients successfully received PEG/J. The mean operation time of PEG and PEJ were (7.5 +/- 2.5) min and (12.5 +/- 8.2) min, respectively, and the duration of tube functioning was (230 +/- 159) d; no procedure-related complications and serious complications were observed. Complications included local soft tissue infection (n = 1), J-tube dislodgment (n = 1), and obstruction of jejunal tube (n = 2). The serum levels of albumin and pre-albumin increased 4 weeks after operation; however, no significant difference was observed.

CONCLUSIONPEG/J is an effective, micro-invasive, safe, and convenient approach to establish a long-term gastrointestinal nutrition route for critically ill patients.

Aged ; Aged, 80 and over ; Critical Illness ; Enteral Nutrition ; methods ; Female ; Gastroscopy ; adverse effects ; methods ; Gastrostomy ; adverse effects ; methods ; Humans ; Jejunostomy ; adverse effects ; methods ; Male ; Middle Aged ; Retrospective Studies ; Serum Albumin ; metabolism