Document Detail

Abdominal CT as a predictor of outcome before attempted direct percutaneous endoscopic jejunostomy.
MedLine Citation:
PMID:  16500390     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Direct percutaneous endoscopic jejunostomy (DPEJ) placement succeeds in 72% to 86% of attempts. Failure is most often because of inadequate transillumination or gastroduodenal obstruction. Even in failed cases, patients are exposed to the risks of anesthesia, exploratory percutaneous needle punctures, and the cost burden of suboptimal resource utilization. Hence, a preprocedure predictor of outcome would be useful. OBJECTIVE: To evaluate whether review of clinically available abdominal CTs can predict the outcome of subsequent DPEJ attempts. DESIGN: Retrospectively conducted blinded review of abdominal CTs performed within 30 days before attempted DPEJ. Objective anatomic features potentially pertinent to DPEJ success were scored, and a prediction of the anticipated procedural outcome was made. SETTING: A large tertiary referral center. PATIENTS: A total of 115 patients who underwent attempted DPEJ and who also had an abdominal CT in the preceding 30 days. MAIN OUTCOME MEASUREMENTS: Reviewer's overall prediction of success, 3 objective anatomic measurements. RESULTS: For the overall prediction of success, a CT performed poorly, with a sensitivity of 60%, a specificity of 53%, a positive predictive value of 71%, and a negative predictive value of 40%. Mean abdominal-wall thickness was significantly greater in the failures than the successes (27 vs 21 mm, P = .02), and just 39% of the procedures in patients with an abdominal-wall thickness >3 cm were successful. LIMITATIONS: Retrospective. CONCLUSIONS: Failed DPEJ attempts were associated with greater patient abdominal-wall thickness, and this should be taken into consideration before attempted DPEJ. Otherwise, review of existing abdominal CTs appears to have limited utility in predicting DPEJ outcome.
John T Maple; Bret T Petersen; Todd H Baron; Gavin C Harewood; C Daniel Johnson; Grant D Schmit
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  63     ISSN:  0016-5107     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-02-27     Completed Date:  2006-08-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  424-30     Citation Subset:  IM    
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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MeSH Terms
Abdominal Wall
Endoscopy, Gastrointestinal*
Jejunum / radiography*
Middle Aged
Predictive Value of Tests
Radiography, Abdominal
Retrospective Studies
Tomography, X-Ray Computed*
Treatment Failure
Comment In:
Gastrointest Endosc. 2006 Mar;63(3):431-2   [PMID:  16500391 ]

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