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.

Bowel intussusception caused by a percutaneously placed endoscopic gastrojejunostomy catheter: A case report

BACKGROUND In adults,bowel intussusception is a rare diagnosis and is mostly due to an organic bowel disorder.In rare cases,this is a complication of a percutaneously placed endoscopic gastro(jejunostomy)catheter.CASE SUMMARY We describe a case of a 73-year-old patient with a history of myocardial infarction,chronic idiopathic constipation and Parkinson’s disease.For the admission of his Parkinson’s medication,a percutaneous endoscopic gastrostomy with jejunal extension(PEG-J)was placed.The patient presented three times at the emergency department of the hospital with intermittent abdominal pain with nausea and vomiting.There were no distinctive abnormalities from the physical and laboratory examinations.An abdominal computed tomography scan showed a small bowel intussusception.By push endoscopy,a jejunal bezoar at the tip of the PEG-J catheter was found to be the cause of small bowel intussusception.The intussusception was resolved after removing the bezoar during push enteroscopy.CONCLUSION Endoscopic treatment of bowel intussusception caused by PEG-J catheter bezoar.