O049 - SIMPLIFIED PLACEMENT OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY WITH JEJUNAL EXTENSION (PEG-J) USING ULTRA-THIN ENDOSCOPES THROUGH A MATURE GASTROSTOMY TRACT: A SINGLE CENTER EXPERIENCE

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O049

SIMPLIFIED PLACEMENT OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY WITH JEJUNAL EXTENSION (PEG-J) USING ULTRA-THIN ENDOSCOPES THROUGH A MATURE GASTROSTOMY TRACT: A SINGLE CENTER EXPERIENCE

O. Perzon1,2, N. E. E. Lourie1,2,*, Y. Ishai1,2, R. Alon1,2, E. Forkush1,2, S. Yaari1,2, M. Masarwa1,2, D. Hakimian1,2

1Gastroenterology and Hepatology, Hadassah medical center, 2Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel

 

Rationale: Post-pyloric feeding is often needed in percutaneous endoscopic gastrostomy (PEG) patients due to aspiration, gastroparesis, or gastric outlet obstruction. We evaluated the feasibility and safety of percutaneous gastrojejunostomy (PEG-J) tube placement using an ultra-thin endoscope via a mature gastrostomy tract in a tertiary center.

Methods: We retrospectively reviewed all PEG-J placements using the "through-the-gastrostomy" technique between 2019–2024. An Olympus GIF-XP190N ultra-thin endoscope was introduced through the gastrostomy into the jejunum. A soft-tipped guidewire was inserted, the endoscope withdrawn, and a PEG-J tube advanced over the wire.

Results: A total of 77 procedures were performed in 30 patients (mean age 56.2 ± 21.5 years; 39% female). Most patients (97%) had an ASA score ≥3. Technical success was 99% (76/77), with sedation used in only 21% of cases. No major adverse events occurred. Tube position was verified in 49% of cases (38/77) via X-ray or endoscopy, with accurate placement in nearly all (76/77). Among 33 cases with incidental imaging at a median of 51 days following PEG-J placement, the tube remained in place in 64% (21/33).

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Conclusion: PEG-J placement using an ultra-thin endoscope through a mature gastrostomy tract is a reliable, safe, effective, and durable technique. This approach may obviate the need for fluoroscopy or endoscopic confirmation of tube position when such resources are limited or inaccessible. Importantly, this technique presents a notable benefit for high-risk patients (ASA ≥3), as it minimizes the need for sedation or the involvement of an anesthesiologist during the procedure.

Disclosure of Interest: None declared