BACKGROUND: Direct percutaneous endoscopic jejunostomy (DPEJ) placement succeeds in 72% to 86% of attempts. Failure is most often because of inadequate transillumination or gastroduodenal obstruction. Even in failed cases, patients are exposed to the risks of anesthesia, exploratory percutaneous needle punctures, and the cost burden of suboptimal resource utilization. Hence, a preprocedure predictor of outcome would be useful. OBJECTIVE: To evaluate whether review of clinically available abdominal CTs can predict the outcome of subsequent DPEJ attempts. DESIGN: Retrospectively conducted blinded review of abdominal CTs performed within 30 days before attempted DPEJ. Objective anatomic features potentially pertinent to DPEJ success were scored, and a prediction of the anticipated procedural outcome was made. SETTING: A large tertiary referral center. PATIENTS: A total of 115 patients who underwent attempted DPEJ and who also had an abdominal CT in the preceding 30 days. MAIN OUTCOME MEASUREMENTS: Reviewer's overall prediction of success, 3 objective anatomic measurements. RESULTS: For the overall prediction of success, a CT performed poorly, with a sensitivity of 60%, a specificity of 53%, a positive predictive value of 71%, and a negative predictive value of 40%. Mean abdominal-wall thickness was significantly greater in the failures than the successes (27 vs 21 mm, P = .02), and just 39% of the procedures in patients with an abdominal-wall thickness >3 cm were successful. LIMITATIONS: Retrospective. CONCLUSIONS: Failed DPEJ attempts were associated with greater patient abdominal-wall thickness, and this should be taken into consideration before attempted DPEJ. Otherwise, review of existing abdominal CTs appears to have limited utility in predicting DPEJ outcome.
BACKGROUND: Direct percutaneous endoscopic jejunostomy (DPEJ) placement succeeds in 72% to 86% of attempts. Failure is most often because of inadequate transillumination or gastroduodenal obstruction. Even in failed cases, patients are exposed to the risks of anesthesia, exploratory percutaneous needle punctures, and the cost burden of suboptimal resource utilization. Hence, a preprocedure predictor of outcome would be useful. OBJECTIVE: To evaluate whether review of clinically available abdominal CTs can predict the outcome of subsequent DPEJ attempts. DESIGN: Retrospectively conducted blinded review of abdominal CTs performed within 30 days before attempted DPEJ. Objective anatomic features potentially pertinent to DPEJ success were scored, and a prediction of the anticipated procedural outcome was made. SETTING: A large tertiary referral center. PATIENTS: A total of 115 patients who underwent attempted DPEJ and who also had an abdominal CT in the preceding 30 days. MAIN OUTCOME MEASUREMENTS: Reviewer's overall prediction of success, 3 objective anatomic measurements. RESULTS: For the overall prediction of success, a CT performed poorly, with a sensitivity of 60%, a specificity of 53%, a positive predictive value of 71%, and a negative predictive value of 40%. Mean abdominal-wall thickness was significantly greater in the failures than the successes (27 vs 21 mm, P = .02), and just 39% of the procedures in patients with an abdominal-wall thickness >3 cm were successful. LIMITATIONS: Retrospective. CONCLUSIONS: Failed DPEJ attempts were associated with greater patient abdominal-wall thickness, and this should be taken into consideration before attempted DPEJ. Otherwise, review of existing abdominal CTs appears to have limited utility in predicting DPEJ outcome.
Authors: Andrew T Strong; Gautam Sharma; Matthew Davis; Michael Mulcahy; Suriya Punchai; Colin P O'Rourke; Stacy A Brethauer; John Rodriguez; Jeffrey L Ponsky; Matthew D Kroh Journal: J Gastrointest Surg Date: 2016-12-19 Impact factor: 3.452