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Palle Jeppesen - One of the best experts on this subject based on the ideXlab platform.

  • glucagon like peptide 2 stimulates mucosal microcirculation measured by laser doppler flowmetry in end Jejunostomy short bowel syndrome patients
    Regulatory Peptides, 2013
    Co-Authors: P Hoyerup, Per M Hellstrom, Peter T Schmidt, Christopher F Brandt, C Askovhansen, P B Mortensen, Palle Jeppesen
    Abstract:

    Abstract Background In animal and human studies glucagon-like peptide-2 (GLP-2) has been shown to increase blood flow in the superior mesenteric artery and the portal vein. This study describes the effect of GLP-2 measured directly on the intestinal mucosal blood flow by laser Doppler flowmetry (LDF) in end-Jejunostomy short bowel syndrome (SBS) patients. Methods In five SBS patients with end-Jejunostomy a specially designed laser Doppler probe was inserted into the stoma nipple, and blood flow measured directly on the jejunal mucosa for 105 min in relation to no treatment, systemic saline infusion, topical adrenaline application and a subcutaneous injection of 800 μg native GLP-2. Results The GLP-2 injection increased jejunal mucosal blood flow by 79 ± 37% compared to conditions, where no treatment was given (p  Conclusions GLP-2 raises jejunal microcirculation in SBS patients with end-Jejunostomy. This may explain the redness and increase in the end-Jejunostomy nipple size imminently after commencing GLP-2 injections. The potential beneficial effects of this GLP-2-mediated increase of blood flow in the mesenteric bed should be investigated in clinical conditions other than the short bowel syndrome.

  • teduglutide alx 0600 a dipeptidyl peptidase iv resistant glucagon like peptide 2 analogue improves intestinal function in short bowel syndrome patients
    Gut, 2005
    Co-Authors: Palle Jeppesen, Elizabeth L Sanguinetti, Alan L Buchman, Lyn Howard, J S Scolapio, Thomas R Ziegler, J Gregory, Kelly A Tappenden, Jens J Holst, Per Brobech Mortensen
    Abstract:

    Background and aims: Glucagon-like peptide 2 (GLP-2) may improve intestinal absorption in short bowel syndrome (SBS) patients with an end Jejunostomy. Teduglutide (ALX-0600), a dipeptidyl peptidase IV resistant GLP-2 analogue, prolongs the intestinotrophic properties of GLP-2 in animal models. The safety and effect of teduglutide were investigated in SBS patients with and without a colon in continuity. Methods: Teduglutide was given subcutaneously for 21 days once or twice daily to 16 SBS patients in the per protocol investigational group, 10 with end Jejunostomy (doses of 0.03 (n = 2), 0.10 (n = 5), or 0.15 (n = 3) mg/kg/day), one with Results: Pooled across groups and compared with baseline, teduglutide increased absolute (+743 (477) g/day; p Conclusion: Teduglutide, at three dose levels for 21 days, was safe and well tolerated, intestinotrophic, and significantly increased intestinal wet weight absorption in SBS patients with an end Jejunostomy or a colon in continuity.

Tony P. Smith - One of the best experts on this subject based on the ideXlab platform.

  • Jejunostomy tube insertion for enteral nutrition comparison of outcomes after laparoscopic versus radiologic insertion
    Journal of Vascular and Interventional Radiology, 2020
    Co-Authors: Charles Y. Kim, Rui Dai, Q Wang, James Ronald, Sabino Zani, Tony P. Smith
    Abstract:

    Abstract Purpose To retrospectively compare technical success and major complication rates of laparoscopically versus radiologically inserted Jejunostomy tubes. Materials and Methods In this single-institution retrospective study, 115 patients (60 men; mean age, 59.7 y) underwent attempted laparoscopic Jejunostomy tube insertion as a standalone procedure during a 10-year period and 106 patients (64 men; mean age, 61.0 y) underwent attempted direct percutaneous radiologic Jejunostomy tube insertion during an overlapping 6-year period. Clinical outcomes were retrospectively reviewed with primary focus on predictors of procedure-related major complications within 30 days. Results Patients undergoing laparoscopic Jejunostomy tube insertion were less likely to have previous major abdominal surgery (P Conclusions Laparoscopic and radiologic Jejunostomy tube insertion both showed high success and low complication rates. Previous major abdominal surgery and obesity may be pertinent discriminators for patient selection.

  • Comparison of primary Jejunostomy tubes versus gastroJejunostomy tubes for percutaneous enteral nutrition.
    Journal of Vascular and Interventional Radiology, 2013
    Co-Authors: Charles Y. Kim, Bjorn I. Engstrom, Jeffrey J. Horvath, Matthew P. Lungren, Paul V. Suhocki, Tony P. Smith
    Abstract:

    Abstract Purpose To evaluate technical success and long-term outcomes of percutaneous primary Jejunostomy tubes for postpyloric enteral feeding compared with percutaneous gastroJejunostomy (GJ) tubes. Materials and Methods Over a 25-month interval, 41 consecutive patients (26 male; mean age, 55.9 y) underwent attempted fluoroscopy-guided direct percutaneous Jejunostomy tube insertion. Insertions at previous Jejunostomy tube sites were excluded. The comparison group consisted of all primary GJ tube insertions performed over a 12-month interval concomitant with the Jejunostomy tube interval (N = 169; 105 male; mean age, 59.4 y). Procedural, radiologic, and clinical data were retrospectively reviewed. Intervention rates were expressed as events per 100 catheter-days. Results The technical success rate for percutaneous Jejunostomy tube insertion was 96%, versus 93% for GJ tubes ( P = .47). Mean fluoroscopy times were similar for Jejunostomy and GJ tubes (9.8 vs 10.0 min, respectively; P value not significant). Jejunostomy tubes exhibited a lower rate of catheter dysfunction than GJ tubes, with catheter exchange rates of 0.24 versus 0.93, respectively, per 100 catheter-days ( P = .045). GJ tube tip retraction into the stomach occurred in 9.5% of cases, at a rate of 0.21 per 100 catheter-days. Intervention rates related to leakage were 0.19 and 0.03 for Jejunostomy and GJ tubes, respectively ( P Conclusions Percutaneous insertion of primary Jejunostomy tubes demonstrated technical success and complication rates similar to those of GJ tubes. Jejunostomy tubes exhibited a lower dysfunction rate but a higher leakage rate compared with GJ tubes.

John V Reynolds - One of the best experts on this subject based on the ideXlab platform.

  • post oesophagectomy early enteral nutrition via a needle catheter Jejunostomy 8 year experience at a specialist unit
    Clinical Nutrition, 2006
    Co-Authors: Aoife M Ryan, S Rowley, L A Healy, Philomena M Flood, Narayanasamy Ravi, John V Reynolds
    Abstract:

    Summary Background & Aims The purpose of this study was to prospectively evaluate post-operative Jejunostomy feeding in terms of nutritional, biochemical, gastrointestinal and mechanical complications in patients undergoing upper gastrointestinal surgery for oesophageal malignancy. Methods The study included 205 consecutive patients who underwent oesophagectomy for malignancy. All patients had a needle catheter Jejunostomy (NCJ) inserted at the conclusion of laparotomy. Patients were followed prospectively to record nutritional intake, type of feed administered, rate progression, tolerance, weight changes and complications either mechanical, biochemical or gastrointestinal. Results Ninety-two per cent of patients were successfully fed exclusively by NCJ post-oesophagectomy, and 94% of patients were tolerating a maintenance regimen of 2000 ml feed over 20 h by day 2 post-operatively. Patients spent a median of 15 days on Jejunostomy feeding post-surgery (range 2–112 days); however, 26% required prolonged Jejunostomy feeding (>20 days). Minor gastrointestinal complications were effectively managed by slowing the rate of infusion, or administering medication. Three (1.4%) serious complications of Jejunostomy feeding occurred, all requiring re-laparotomy, one resulting in death. NCJ feeding was extremely effective in preventing severe post-operative weight loss in the majority of oesophagectomy patients post-op. However, oral intake was generally poor at discharge with only 65% of requirements being met orally. Sixteen patients (8%) patients required home Jejunostomy feeding. By the first post-operative month, a further 6% (12) patients were recommenced on Jejunostomy feeding. Conclusion NCJ feeding is an effective method of providing nutritional support post-oesophagectomy, and allows home support for the subset that fail to thrive. Serious complications, most usually intestinal ischaemia or intractable diarrhoea, are rare.

Per Brobech Mortensen - One of the best experts on this subject based on the ideXlab platform.

  • teduglutide alx 0600 a dipeptidyl peptidase iv resistant glucagon like peptide 2 analogue improves intestinal function in short bowel syndrome patients
    Gut, 2005
    Co-Authors: Palle Jeppesen, Elizabeth L Sanguinetti, Alan L Buchman, Lyn Howard, J S Scolapio, Thomas R Ziegler, J Gregory, Kelly A Tappenden, Jens J Holst, Per Brobech Mortensen
    Abstract:

    Background and aims: Glucagon-like peptide 2 (GLP-2) may improve intestinal absorption in short bowel syndrome (SBS) patients with an end Jejunostomy. Teduglutide (ALX-0600), a dipeptidyl peptidase IV resistant GLP-2 analogue, prolongs the intestinotrophic properties of GLP-2 in animal models. The safety and effect of teduglutide were investigated in SBS patients with and without a colon in continuity. Methods: Teduglutide was given subcutaneously for 21 days once or twice daily to 16 SBS patients in the per protocol investigational group, 10 with end Jejunostomy (doses of 0.03 (n = 2), 0.10 (n = 5), or 0.15 (n = 3) mg/kg/day), one with Results: Pooled across groups and compared with baseline, teduglutide increased absolute (+743 (477) g/day; p Conclusion: Teduglutide, at three dose levels for 21 days, was safe and well tolerated, intestinotrophic, and significantly increased intestinal wet weight absorption in SBS patients with an end Jejunostomy or a colon in continuity.

Ravi N. Srinivasa - One of the best experts on this subject based on the ideXlab platform.

  • transnasal stent assisted targeting technique for percutaneous Jejunostomy placement in patients with hiatal hernias
    Abdominal Radiology, 2019
    Co-Authors: Jeffrey Forris Beecham Chick, Neil Jairath, Joseph J Gemmete, Anthony N Hage, Jacob J Bundy, Nishant Patel, Evan Johnson, Mamdouh Khayat, Ravi N. Srinivasa
    Abstract:

    PURPOSE To report the transnasal stent-assisted targeting technique for percutaneous Jejunostomy placement in patients with hiatal hernias. MATERIALS AND METHODS Four patients, including three (75%) females and one (25%) male, with mean age of 77.5 years (range 73-78 years), and with a hiatal hernia and intrathoracic stomach precluding gastrostomy placement and loop snare placement into the mid-jejunum underwent the transnasal stent-assisted targeting technique for percutaneous Jejunostomy placement. In all patients, a duodenal stent was inserted into the jejunum in a transnasal fashion. The stent was partially unsheathed in an anterior loop of jejunum and percutaneously targeted using an 18-gauge needle through which a guidewire was advanced, trapped within the stent, and removed through the nose. The tract was serially dilated and a Jejunostomy was placed. Technical success, procedure time, fluoroscopy time, radiation exposure, complications, time to enteral feeding, and follow-up were recorded. RESULTS Technical success was 100% (4/4) with all four patients requiring only one needle pass before successful jejunal cannulation. Mean procedure time was 108 min. Mean fluoroscopy time was 44 min. Mean dose area product was 3969.3 μGym2. No minor or major complications occurred. All four patients received enteral feeding one day after the procedure. Mean follow-up was 366 days. CONCLUSION The transnasal stent-assisted targeting technique is a novel method for primary Jejunostomy placement in patients with hiatal hernias.

  • Transgastric jejunal snare technique facilitates primary Jejunostomy placement
    Elsevier, 2018
    Co-Authors: Ravi N. Srinivasa, William M. Sherk, Jeffrey Forris Beecham Chick, Md, Mph Dabr, Kyle Cooper, Md Rpvi, Joseph Gemmete, Md J. Fsir
    Abstract:

    Placement of percutaneous Jejunostomy tubes using fluoroscopy may be technically challenging because of the peristaltic motion of small bowel loops within the peritoneum. Furthermore, fluoroscopic Jejunostomy placement has an inherent risk of complications, including peritonitis and death. A transnasal snare technique to facilitate direct Jejunostomy in patients with a surgically altered gastric anatomy has been previously reported. This report describes a patient with gastroparesis and a chronic nasojejunal tube who underwent a percutaneous transgastric snare technique to facilitate the placement of a direct Jejunostomy