P1708 - Efficacy and Safety of Direct Percutaneous Endoscopic Jejunostomy (DPEJ) and Percutaneous Endoscopic Gastrostomy With Jejunal Extension (PEG-J): A Systematic Review and Meta-Analysis

Smit S. Deliwala, MD¹, Saurabh Chandan, MD², Anand Kumar, MD³, Babu Mohan, MD⁴, Anoosha Ponnapalli, MD¹, Murtaza S. Hussain, MD¹, Sunil Kaushal, MD⁵, Joshua Novak, MD⁶, Saurabh Chawla, MD, FACG^6
1Michigan State University at Hurley Medical Center, Flint, MI; ²Creighton University School of Medicine, Omaha, NE; ³Lenox Hill Hospital, New York, NY; ⁴University of Utah School of Medicine, Salt Lake City, UT; ⁵McLaren Regional Medical Center, Flint, MI; ⁶Emory University School of Medicine, Atlanta, GA

Introduction: Endoscopic methods of accessing and delivering nutrition to the jejunum include direct percutaneous endoscopic jejunostomy (DPEJ) and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J). Conditions requiring jejunal feeding may include gastric outlet obstruction, acute pancreatitis, refractory gastroparesis, chronic dysmotility, and short bowel syndrome. Despite this, evidence regarding the technical and clinical aspects of DPEJ and PEG-J is limited. We conducted a systematic review and meta-analysis to assess the efficacy and safety of these methods.

Methods: Major databases including Medline, Embase, Web of Science, and Scopus were systematically searched until June 2021. A random-effects model was used to calculate the pooled rates and 95% confidence intervals (CI). Efficacy outcomes included technical and clinical success, while safety outcomes included adverse events (AEs) and malfunction rates. I-square (I²) was used to quantify heterogeneity.

Results: 29 studies with 1874 patients (mean age 60 ± 19 years) were included in the final analysis. Pooled rates of technical and clinical success with DPEJ were 86.6% (CI, 82.1 - 90.1, I2 73.1%) and 96.9% (CI, 95.0 – 98.0, I² 12.7%), respectively. The pooled incidence of malfunction, major and minor AEs with DPEJ were 11%, 5%, and 15%. Pooled rates of technical and clinical success for PEG-J were 94.4% (CI, 85.5 - 97.9, I2 33.0%) and 98.7% (CI, 95.5 – 99.6, I2 < 0.001%), respectively. The pooled incidence of malfunction, major and minor AEs with PEG-J were 24%, 1%, and 25%. TS & CS forest plots are detailed in figure 1.

Discussion: Our analysis shows that jejunal feeding by DPEJ or PEG-J can be performed with technical ease, has high clinical success and an acceptable safety profile in patients requiring enteral feeding. DPEJ was found to have lower rates of malfunction but is technically more complex with higher rates of major adverse events. Future studies exploring DPEJ & PEG-J success predictors may help in improving jejunal feeding outcomes.


Figure: Figure 1 - Technical and Clinical Success of DPEJ & PEG-J


Disclosures:
Smit Deliwala indicated no relevant financial relationships.
Saurabh Chandan indicated no relevant financial relationships.
Anand Kumar indicated no relevant financial relationships.
Babu Mohan indicated no relevant financial relationships.
Anoosha Ponnapalli indicated no relevant financial relationships.
Murtaza Hussain indicated no relevant financial relationships.
Sunil Kaushal indicated no relevant financial relationships.
Joshua Novak indicated no relevant financial relationships.
Saurabh Chawla indicated no relevant financial relationships.


Smit S. Deliwala, MD¹, Saurabh Chandan, MD², Anand Kumar, MD³, Babu Mohan, MD⁴, Anoosha Ponnapalli, MD¹, Murtaza S. Hussain, MD¹, Sunil Kaushal, MD⁵, Joshua Novak, MD⁶, Saurabh Chawla, MD, FACG⁶. P1708 - Efficacy and Safety of Direct Percutaneous Endoscopic Jejunostomy (DPEJ) and Percutaneous Endoscopic Gastrostomy With Jejunal Extension (PEG-J): A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.