Percutaneous endoscopic jejunostomy (PEJ) in patients with dumping syndrome: Evaluation of our center on a series of clinical cases

Abstract

Summary: Background: The Dumping syndrome occurs in a variable percentage of subjects undergoing surgery involving the esophageal and gastric district. The treatment makes use of the introduction of dietary measures and artificial nutrition, especially the internal one. This study evaluates the experience of a single center regarding the use of percutaneous endoscopic jejunostomy (PEJ) in patients developing the dumping syndrome. Methods: We evaluated the case history of our department, of all patients operated on at the level of the upper gastrointestinal tract, who had manifested symptoms referable to the Dumping syndrome in the postoperative period. We have identified 3, which we have carried out further investigations to confirm the presence of an accelerated gastric emptying, and given the poor results obtained with dietary modifications and drug therapy, we have implemented a feeding through enteral nutrition, through a jejunal probe. PEG/J positioned by Pull technique, and subsequently replaced after 8 months. Results: Clinically, patients did not develop short- or long-term complications, symptoms were significantly reduced, and they gained weight. Psychologically, the anxiety disorders related to nutrition have improved. Conclusions: By means of percutaneous endoscopic jejunostomy, the symptoms related to hypoglycemic crises following the hyperinsulinemic response to the ingestion of carbohydrates in patients with Dumping were attenuated and the anxiety of eating was lessened. Although limited to a few cases, we believe this form of nutrition is the best for patients with dumping.

Keywords

• Dumping syndrome
• Nissen fundoplication
• Heller myotomy
• Percutaneous endoscopic gastrostomy (PEG)
• Percutaneous endoscopic jejunostomy (PEJ)