The PEG-pedi-PEG technique is a promising method for jejunal feeding in adults.

Introduction: Intragastric feeding via percutaneous gastrostomy (PEG) is unsuitable for many patients, and jejunal feeding is required. A PEG tube with a jejunostomy extension tube (PEG+J) is commonly used but is frequently complicated by retrograde migration of the jejunostomy extension tube into the stomach, requiring endoscopic replacement. The PEG-pedi-PEG procedure is a new method aimed at reducing this complication. In this procedure, a pediatric PEG tube acts as a jejunostomy extension and is inserted through an adult PEG tube. The pediatric bumper provides an anchor in the small bowel and remains in position by peristalsis. Method(s): We performed a single-center retrospective study looking at patients undergoing PEG-pedi-PEG insertion after a previous PEG+J insertion. The PEG+J insertion was taken as the initial time point for all calculations. The main outcome recorded was number of endoscopic replacements, as well as time between these replacements, before and after PEG-pedi-PEG insertions. If the PEG-pedi-PEG was not replaced after initial insertion, then the time until last follow-up was recorded. Additionally, we observed early and late complication rates after PEG-pedi-PEG insertions. Result(s): Six patients were identified who had undergone both procedures. Indications for jejunal feeding included gastroparesis (three patients), duodenal stricture (one), narcotic bowel syndrome (one), and Parkinson's disease (one). Mean time from PEG+J to PEG-pedi-PEG insertion was 19 months (range, 2-41 months). Mean time of follow-up after PEG-pedi-PEG insertion was 10 months (range, 7-13 months). The number of endoscopic replacements per patient after PEG+J insertion, before PEG-pedi-PEG insertion, ranged from zero to 11. The most common indication was migration of the jejunostomy extension tube into the stomach, followed by an occluded jejunostomy extension. The number of endo-scopic replacements per patient after PEG-pedi-PEG insertion ranged from zero to one. T