Endoscopy 2017; 49(12): 1251-1255
DOI: 10.1055/s-0043-118095
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Insertion of percutaneous endoscopic gastrostomy tubes with jejunal extensions using the “wedge” technique: a novel method to prevent retrograde tube migration into the stomach

Michael S. L. Sey1, Hannah Gregor2, Jamie Gregor1, Brian Yan1
  • 1Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
  • 2Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
Further Information

Publication History

submitted 01 April 2017

accepted after revision 30 June 2017

Publication Date:
12 September 2017 (eFirst)


Background and study aim In percutaneous endoscopic gastrostomy (PEG) with jejunal extension (PEGJ) procedures, retrograde migration of the jejunal extension tube into the stomach during endoscope withdrawal is a frustrating problem. We describe the novel “wedge” technique for inserting the jejunal extension tube, utilizing single-balloon enteroscopy to anchor it in place.

Patients and methods Prospective 1-year study of consecutive patients undergoing PEGJ insertion at a single tertiary care center. The primary outcome was number of pyloric intubations required to place the jejunal extension tube. Secondary outcomes included success rate, time, and complications related to jejunal extension tube insertion.

Results 17 patients underwent the procedure. The jejunal extension tube was inserted at the first attempt in 15 patients (88.2 %) and 2 required another pyloric intubation. Abdominal X-ray showed that all PEGJ tubes were successfully seated in the proximal jejunum. The mean (SD) time required for jejunal extension insertion was 16.9 (8.6) minutes. Two adverse events occurred due to PEG insertion although none were related to the jejunal extension insertion itself.

Conclusions: The “wedge” technique is an effective and easy method for inserting a jejunal extension tube after PEG insertion.