This descriptive study investigates the outcomes of PEG-J extension using Transnasal Endoscopy (TNE) through an existing stoma opening at a single tertiary center.

This is a retrospective descriptive study conducted at James Cook University Hospital. Data were collected from patient records including demographics, medical history, indications for PEG-J, tube size, number of PEG-J replacements, time intervals between replacements, method of placement, and causes of PEG-J exchange. Descriptive statistics were used to analyze the collected data.

The old PEG or PEG/J tube was usually removed and TNE was used through the gastrostomy stoma into the stomach and then was advanced as deep as possible into the duodenum. A guidewire was then introduced deep in the duodenum and TNE was withdrawn leaving the guidewire in place. The new PEG/J tube was then lubricated with oil before being fed over the wire in exchange one-to-one process. The balloon was then inflated and the tube fixed in place. 

A total of 11 patients (6 female, 5 male) were included in the study, with a mean age of 43.9 ± 18.5 years (range 18-76 years). The mean number of PEG-J replacements was 7.0 ± 2.6 (range 3-10). The most common indications for PEG-J placement were: gastroparesis (n=5), followed by dysphagia (n=2). Other indications included oesophageal aperistalsis, feeding difficulties, recurrent chest infections with tracheostomy, and brain stem stroke (n=1 each). The predominant tube size used was 16f (n=7), with 18f used in 4 patients. The primary causes for PEG-J exchange were coiled tube back to stomach (n=6), blocked tube (n=3), and burst balloon (n=2).

This study provides insights into the outcomes of PEG-J extension using TNE through stoma opening in a single-center cohort. The findings highlight the common indications and causes for tube exchange, which can inform clinical practice and guide future research. Further larger-scale studies are warranted to validate these findings and explore long-term outcomes and technical success rates.