Novel Modified Seldinger Technique for Gastrojejunal Feeding Tube Placement

BACKGROUND: Temporary or long-term nutritional support through gastrojejunal (GJ) feeding tubes is a safe and common means of enteral feeding in adults and children. It is indicated in patients with severe gastroesophageal reflux disease, gastric outlet obstruction, or severe gastric dysfunction or gastroparesis. Several techniques for GJ feeding tube placement have been reported. The most technically challenging part of GJ tube placement is the advancement and optimal positioning of the jejunal extension into the proximal jejunum. METHODS: A novel modified Seldinger technique was used for endoscopic placement of a percutaneous low-profile GJ tube (14 French). After gastric access was established, a dilator was advanced under endoscopic vision into the pylorus. Under fluoroscopy, a guidewire was threaded through the dilator into the duodenum. The dilator was then removed, and the GJ tube advanced over the guidewire. RESULTS: A total of 12 patients including 9 pediatric and 3 adult underwent the procedure with no complications. The main indication was gastroparesis with oral intolerance of food. The median operative time was 41.5 minutes. All patients tolerated jejunal tube feeding after surgery. CONCLUSION: The modified Seldinger technique for percutaneous endoscopic GJ tube placement is a safe and efficient procedure in both children and adults. Further studies are necessary to prove its reproducibility in other centers and to compare it to other methods of PEGJ tube placement.