Post written by Nicholas M. McDonald, MD, from the Division of Gastroenterology and Hepatology, University of Minnesota, Minneapolis, Minnesota.
A 23-year-old woman with a history of nausea, vomiting, and a 40-lb weight loss resulting in a BMI of 14.5 was referred for evaluation. Her symptoms were attributed to gastroparesis. Prior to referral, she had undergone surgical placement of a percutaneous gastrostomy with jejunostomy extension for enteral feeding. Since then she had experienced multiple episodes of coiling of the jejunostomy tube into her stomach resulting in vomiting and further weight loss.
We removed the jejunal extension and replaced it within the jejunum over a wire using a pediatric gastroscope and fluoroscopy. We then used endoscopic suturing to create 3 “struts” in the stomach to prevent migration of the tube back into the stomach, which worked very well for her.
In clinical practice, gastroenterologists commonly encounter issues with feeding tubes. Migration or dislodgement of a jejunal extension occurs in up to 10% of cases, and aside from replacement, therapeutic options are limited. In our practice, we offer endoscopic suturing as one option for prevention of recurrent gastric looping of these jejunal extensions.
Endoscopic suturing may be a good option for patients experiencing recurrent jejunal tube migration. After receiving appropriate training, available through the ASGE and other avenues, endoscopic suturing of stents and feeding tubes may be a great way to introduce endoscopic suturing into your endoscopy toolbox for more complex procedures including perforation management and bariatrics.
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