What Is Percutaneous Endoscopic Jejunostomy (PEJ)?

When the body’s natural ability to eat and drink is compromised, such as with types of dysphagia (difficulty swallowing), measures must sometimes be taken in order to ensure that the body receives adequate nutrition. Your gastroenterologist may recommend placement of a feeding tube, with a procedure either known as a percutaneous endoscopic gastrostomy (PEG) or percutaneous endoscopic jejunostomy (PEJ). There are not many differences between the two procedures. PEG refers to feeding tube placement in the stomach, while PEJ refers to feeding tube placement in the jejunum. 

PEG is the most commonly used procedure, however, your doctor may determine that you require PEJ instead, depending on your individual case. PEJ can be difficult to maintain, but it is a better choice in certain circumstances, such as when a cancer patient has had a previous gastric resection. 

Who Can Benefit from Percutaneous Endoscopic Jejunostomy (PEJ)?

Anyone who has trouble swallowing or eating due to a condition or disease can benefit from a PEJ. Those with certain cancers, dysphagia, and any other complication that makes normal eating and drinking difficult are candidates for the procedure. Percutaneous endoscopic gastrostomy (PEG) is the procedure most often used for feeding tube placement, however, sometimes the feeding tube cannot be placed in the stomach. Instead, the feeding tube is placed in the jejunum, the second part of the small intestine. Prep, procedure, and methods are the same with both treatments; it is only the placement of the feeding tube that is different. 

How Should I Prepare for Percutaneous Endoscopic Jejunostomy (PEJ)?

If your gastroenterologist believes you are a good candidate for PEJ, you must prepare for your procedure beginning a week ahead of time. 

One week before your procedure, you will consult with your doctor and discuss any medications you are taking. Certain medications must be adapted or halted in order to perform a PEJ. Let your physician know if you take blood thinners, insulin, or other diabetes medications. Your diabetes medication dosages may need to be altered before feeding tube placement, and you will have to stop taking blood thinners, such as warfarin, prior to your procedure. Be sure to consult with both your prescribing doctor and your gastroenterologist, so you know exactly when to stop taking the medication.  

The day before your procedure, you will be asked to fast after midnight, with limited amounts of water. You are allowed 12 ounces of water from midnight until at least two hours before your procedure. The last two hours before your procedure, you cannot have anything to eat or drink. 

The day of your procedure, refrain from wearing makeup, cologne, powder, deodorant, or jewelry, including body piercings. If you typically wear contact lenses, wear your glasses instead. Bring a list of your medications with you to the appointment. 

How Is Percutaneous Endoscopic Jejunostomy (PEJ) Performed? 

After you arrive, you’ll be given a quick medical checkup before the procedure. The physician will go over all of the details of the procedure with you and answer any questions you may have. The team will check your heart rate, blood pressure, and oxygen before the procedure and attach equipment to you to carefully monitor your vital signs. 

When you are on the exam table, you will be given a mouth guard to protect your teeth, and tubes carrying oxygen are placed in your nose. The anesthesia team will also administer an anesthetic intravenously. 

Your doctor will evaluate your stomach and small intestine using an endoscope. An endoscope is a long, thin tube that is inserted in the mouth, down through the throat, and into the esophagus, stomach, and upper part of the small intestine, which under this procedure includes the duodenum and upper part of the jejunum. The tube has a camera on the end of it that allows your physician to see this part of the GI tract. 

After your provider ensures the safety of the procedure, they will make a small incision on the abdominal wall and will pass a feeding tube through the incision into the jejunum. The feeding tube will extend from 8 to 12 inches outside of the body and will be held in place with dressing. Once the feeding tube is inserted and in place, the doctor will remove the endoscope. 

What Happens After a PEJ?

After your procedure, you’ll go to a recovery room. As the anesthesia wears off, the medical team will monitor you. You must stay in the recovery unit until you are fully awake. When you are discharged, you will be given explicit instructions on possible complications after insertion, as well as instructions on how to care for and maintain your feeding tube. 

What Are Possible PEJ Complications?

PEJ is a relatively low-risk procedure, but there are complications in some cases. After your procedure is complete and you are home, call your physician immediately if you develop:

• Diarrhea
• Swelling, redness, or pus around the incision site
• Trouble flushing the tube itself
• A fever of 100.4° F or higher
• Severe abdominal pain
• Chest pain
• Shortness of breath
• Continual bleeding
• Dizziness or weakness
• Nausea and vomiting

In addition, maintenance of your PEJ is important, so ensure you leave with implicit instructions on how to take care of the feeding tube to help reduce the risk of infection or other complications.