Percutaneous endoscopic gastrostomy with jejunal extension versus direct percutaneous endoscopic jejunostomy: patient-related outcomes and complications

BACKGROUND: Percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) and direct percutaneous endoscopic jejunostomy (D-PEJ) are used for jejunal feeding or administration of levodopa-carbidopa intestinal gel in patients with Parkinson's disease. PEG-J is currently preferred because it is technically less challenging to insert. However, comparative studies are scarce, and data on patient-reported outcomes (PROMs) are limited. METHODS: In this retrospective study conducted at a referral hospital, clinical experience, adverse events (AEs), and PROMs associated with both techniques were evaluated. RESULTS: Ninety-three patients underwent PEG-J and/or D-PEJ placement between January 1, 2010, and July 1, 2022. Patients with PEG-J required significantly more re-endoscopies per tube-year than those with D-PEJ (0.63 [standard deviation, SD, 0.72] vs. 0.27 [SD 0.50]). A total of 76.8% of PEG-J patients underwent at least one re-endoscopy (range, 0-3.85 per year), primarily due to dislocated jejunal extensions (77.4%). Tube-related AEs (including dislocation, occlusion, perforation, and ulceration) occurred significantly more often after PEG-J insertion (76.7% vs. 25.9%). Forty-five patients (48%) completed the PROM questionnaire. No statistically significant differences were found in quality of life. However, D-PEJ patients reported significantly more tube-related pain (44.4% vs. 15.9%). CONCLUSIONS: D-PEJ represents a viable alternative to PEG-J in experienced centers and should be considered when frequent complications with jejunal extensions occur.