肠内营养的空肠通路:经皮内镜下空肠延伸胃造口术和直接经皮内镜下空肠造口术的实用指南

IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Best Practice & Research Clinical Gastroenterology Pub Date : 2023-06-01 DOI:10.1016/j.bpg.2023.101849
Amélie Bourgeois , Paraskevas Gkolfakis , Lucia Fry , Marianna Arvanitakis
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引用次数: 0

摘要

对于需要长期(>;4周)空肠营养、空肠药物输送或减压的患者,可能需要经皮内镜下空肠扩张胃造口术(PEG-J)或直接经皮内镜空肠造口术(DPEJ)。如果PEG管已经就位,或者如果需要同时进行胃减压和空肠营养,则PEG-J是优选的选择。DPEJ推荐用于前肠手术导致解剖结构改变、空肠延伸迁移风险高以及PEG-J失败的患者。DPEJ的成功放置率较低,但最近的出版物报道有所改善,部分原因是使用了球囊辅助肠镜。这两种技术在活动性腹膜炎、无法纠正的凝血病和持续性肠缺血的情况下都是禁忌症,相对禁忌症包括消化性溃疡和血液动力学或呼吸不稳定。在这篇叙述性综述中,我们介绍了关于PEG-J和DPEJ的适应症、禁忌症、技术考虑、不良事件和结果的最新证据。
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Jejunal access for enteral nutrition: A practical guide for percutaneous endoscopic gastrostomy with jejunal extension and direct percutaneous endoscopic jejunostomy

For patients requiring long-term (>4 weeks) jejunal nutrition, jejunal medication delivery, or decompression, a percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) or a direct percutaneous endoscopic jejunostomy (DPEJ) may be indicated. PEG-J is the preferred option if a PEG tube is already in place or if simultaneous gastric decompression and jejunal nutrition are needed. DPEJ is recommended for patients with altered anatomy due to foregut surgery, high risk of jejunal extension migration, and whenever PEG-J fails. Successful placement rates are lower for DPEJ but recent publications have reported improvements, partly due to the use of balloon-assisted enteroscopy. Both techniques are contraindicated in cases of active peritonitis, uncorrectable coagulopathy, and ongoing bowel ischaemia, and relative contraindications include, among other, peptic ulcer disease and haemodynamic or respiratory instability. In this narrative review, we present the most recent evidence on indications, contraindications, technical considerations, adverse events, and outcomes of PEG-J and DPEJ.

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来源期刊
CiteScore
5.50
自引率
0.00%
发文量
23
审稿时长
69 days
期刊介绍: Each topic-based issue of Best Practice & Research Clinical Gastroenterology will provide a comprehensive review of current clinical practice and thinking within the specialty of gastroenterology.
期刊最新文献
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