非肿瘤患者手术与内镜下放置空肠造瘘管的耐久性-一项超过10年的单中心经验。

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-03-24 DOI:10.1016/j.clnesp.2025.03.048

Ahmad Nasasra , Richard J. Hackett , Priya Nandoskar , Frederick H. Koh , Simon Gabe , Suzanne Donnelly , Richard Holman , Carolynne J. Vaizey , Janindra H. Warusavitarne , Akash M. Mehta

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引用次数: 0

摘要

背景：空肠通路适用于需要肠内营养或给药的口服摄入受损或胃轻瘫患者。建立空肠通路的方法有很多；包括放射学、内窥镜和外科方法。本研究旨在评估内镜下空肠管置入术与手术置入术的并发症及再干预率。方法：我们回顾性收集了10年间（2011-2021年）在单一中心接受手术或内窥镜植入JT的患者的数据。我们分析了以下信息：年龄，性别，需要放置JT的潜在病理，重要的合并症以及以下结果数据：管闭塞，脱位和需要再次入院和再次干预的比率。结果：165例患者被纳入队列。其中96/165采用直接经皮内镜下空肠造口术（DPEJ）（14/96）或经皮内镜下空肠延伸胃造口术（PEG-J）（82/96），其余69/165通过外科翼缘（SF）管（45/69）或外科Witzel （SW）技术（18/69）进行手术放置。特发性胃轻瘫作为植入JT的指征（包括Ehlers-Danlos综合征患者）影响了63.8%的手术队列和42.7%的内镜队列。在平均近17个月的随访中，手术组再次干预、JT脱位和JT闭塞的总体需求分别为32.4%、8.8%和14.7%，而内镜组为62.8%、25.5%和27.7% （p值分别为0.0002、0.0075和0.057）。SW的个体再干预率为38.9%，SF为31.1%，PEG-J为61%，DPEJ为64.3%。结论：与内窥镜放置JT相比，手术放置JT可显著降低脱位率和长期再次干预的需要。

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Durability of surgically versus endoscopically placed jejunostomy tubes in non-oncology patients – A single centre experience over 10 years

Background

Jejunal access is indicated in patients with impaired oral intake or gastroparesis who require enteral nutrition or medication delivery. There are various approaches to establishing jejunal access; including radiological, endoscopic and surgical methods. This study aims to evaluate the complication and re-intervention rates between endoscopic and surgical placement of jejunal tubes (JT).

Method

We retrospectively collected data on patients undergoing surgical or endoscopic placement of JT at a single centre over a ten-year period (2011–2021). We analysed the following information: age, gender, underlying pathology necessitating the JT placement, significant co-morbidities as well as the following outcome data: rates of tube occlusion, dislodgement and need for re-admission and re-intervention.

Results

There were 165 patients included in the cohort. Of these, 96/165 underwent endoscopic placement either using Direct Percutaneous Endoscopic Jejunostomy (DPEJ) (14/96) or through Percutaneous Endoscopic Gastrostomy with Jejunal Extension (PEG-J) (82/96), and the remaining 69/165 underwent surgical placement either via a surgical flange (SF) tube (45/69) or the surgical Witzel (SW) technique (18/69). Idiopathic gastroparesis as an indication for JT placement (including Ehlers-Danlos Syndrome patients) affected 63.8 % of the surgical and 42.7 % of the endoscopic cohorts. At mean follow up of almost 17 months, the overall need for re-intervention, JT dislodgment and JT occlusion were 32.4 %, 8.8 % and 14.7 % in the surgical cohort, versus 62.8 %, 25.5 % and 27.7 % in the endoscopic cohort (p values of 0.0002, 0.0075 and 0.057, respectively). Individual re-intervention rates were 38.9 % for SW, 31.1 % for SF, 61 % for PEG-J and 64.3 % for DPEJ.

Conclusion

Surgical siting of JT demonstrates significantly reduced dislodgement rates, and requirement for re-intervention in the long-term as compared to endoscopic JT placement.

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.