Application of Percutaneous Endoscopic Gastrojejunostomy in Duodenal Crohn’s Disease-Associated Strictures

Background Duodenal Crohn’s disease(CD)-associated strictures are related to a high risk of malnutrition,and effective methods of enteral nutrition(EN)are needed to support these patients.The purpose of this study was to evaluate the efficacy and safety of percutaneous endoscopic gastrojejunostomy(PEG-J)for the treatment of duodenal CD-associated strictures.Methods Patients with strictures associated with duodenal CD were recruited.The clinical data,stricture characteristics,nutritional status,duration of PEG-J tube placement,complications,and follow up periods were recorded.Results A total of 24 patients with duodenal CD-associated strictures underwent PEG-J tube placement.The PEG-J tubes were successfully placed in 100%of the patients within an average of 19.04±2.94 minutes.There were no procedure-related complications.There were no major complications after PEG-J tube placement,and only two minor complications(8.33%)occurred.PEG-J was well tolerated in all patients.The mean Karnofsky score was 67.50±7.94 points and 83.33±7.02 points(P=0.000),the mean body mass index was 17.02±1.85 kg/m^(2)and 18.10±1.78 kg/m^(2)(P=0.045),and the mean Alb level was 35.28±5.35 g/dl and 38.68±5.10 g/dl(P=0.029)before PEG-J and 3 months after PEG-J,respectively.The median CD Activity Index(CDAI score)was 144(range 87-280)and the median C-reactive protein(CRP)was 1.90 mg/L(0.5-67.9 mg/L)after PEG-J,which were significantly lower than the respective 196 mg/L(range 114-331 mg/L)(P=0.044)and 3.75 mg/L(range 0.5-67 mg/L)(P=0.033)before PEG-J.Conclusion PEG-J was a safe,well-tolerated and effective method for the treatment of duodenal CD-associated strictures.PEG-J improved the patient’s nutritional status and reduced disease CD activity.These findings suggest that PEG-J is an option for EN in patients with duodenal CD-associated strictures.