Efficacy of percutaneous endoscopic gastro‐jejunostomy ( PEG PEG ‐J) decompression therapy for patients with chronic intestinal pseudo‐obstruction ( CIPO CIPO )

摘要

Abstract Backgrounds Chronic intestinal pseudo‐obstruction ( CIPO ) is an intractable rare digestive disease manifesting persistent small bowel distension without any mechanical cause. Intestinal decompression is a key treatment, but conventional method including a trans‐nasal small intestinal tube is invasive and painful. Therefore, a less invasive and tolerable new decompression method is urgently desired. We conducted a pilot study and assessed the efficacy and safety of percutaneous endoscopic gastro‐jejunostomy ( PEG ‐J) decompression therapy in CIPO patients. Methods Seven definitive CIPO patients (2 males and 5 females) were enrolled. All patients received PEG ‐J decompression therapy. The number of days with any abdominal symptoms in a month ( NODASIM ), body mass index ( BMI ), serum albumin level (Alb), and small intestinal volume before and after PEG ‐J were compared in all patients. Results Percutaneous endoscopic gastro‐jejunostomy was well tolerated and oral intake improved in all patients. NODASIM has significantly decreased (24.3 vs 9.3?days/months) and BMI /Alb have significantly increased (14.9 vs 17.2?kg/m 2 and 2.6 vs 3.8?g/dL, respectively), whereas total volume of the small intestine has not significantly reduced (4.05 vs 2.59?L, P =.18). Reflux esophagitis and chemical dermatitis were observed in one case but was successfully treated conservatively. Conclusions & Inferences Percutaneous endoscopic gastro‐jejunostomy decompression therapy can contribute greatly to improvement of abdominal symptoms and nutritional status in CIPO patients. Although sufficient attention should be paid to acid reflux symptoms, PEG ‐J has the potential to be a non‐invasive novel decompression therapy for CIPO available at home. However, accumulation of more CIPO patients and long‐term observation are needed ( UMIN 000017574).