Two endoscopic suturing techniques for the prevention of pericutaneous gastrogynostomy tube retrograde migration. These are our disclosures. Pericutaneous endoscopic gastrogynostomy tubes are widely used in patients requiring long-term anterior feeding who do not tolerate gastric feeding or are at risk for aspiration. Migration of the jejunal tube back into the duodenum or stomach is a unique common complication of pericutaneous gastrojejunal tubes occurring in 27 to 42 percent of cases. The patient is a 74-year-old female with HF pancreatic endodontic carcinoma status post-vipal surgery. Post-operatively, the patient developed a fracture repair oral intolerance as well as nausea and vomiting thought to be related to post-surgical anatomy. The patient underwent a J-tube placement for nutrition, with subsequent back migration of the J-tube into her stomach one week later. Endoscopy was then proceeded with the reposition of the J-tube. Given the rapidity of retrograde migration, a decision was made to use endoscopic suturing to fix the J-tube in position. Before the J-tube was inserted into the stomach, the portion of the J-tube which was expected to be located within the stomach was marked. An external suture was then tied to the marked location. As shown in the animation, the J-tube was first juxtaposed to the external portion of the G-tube, and the J-tube position expected to be located within the stomach was marked and an external suture was tied to it. The J-tube was then advanced endoscopically into the apharyngeal junor limb, and endoscopic suturing was then used to fix the external suture to the gastric wall, thus providing the first technique of fixation. Endoscopic suturing was then proceeded with to fix the externally placed suture to the anterior gastric wall. This was performed by first placing the suture at the anterior wall of the gastric antrum. A third suture was then again placed at the anterior wall of the gastric antrum and cinching was then performed, thus fixing the externally placed suture to the anterior wall of the gastric antrum. This concluded the first technique of fixation, fixing the external suture to the anterior gastric wall. The second technique of fixation involved placing a suture, fixing the body of the J-tube to the anterior gastric wall. This was performed by placing a C-shaped running suture at the anterior gastric wall, then exchanging it over the body of the J-tube and cinching it to the anterior wall of the stomach. The first suture was placed at the anterior wall of the gastric antrum. The third suture was then placed at the anterior gastric wall. This concluded the C-shaped running suture, and cinching was then performed to fix the body of the J-tube to the anterior gastric wall, thus concluding the second technique of endoscopic suturing of the J-tube body to the gastric wall. Following the procedure, the patient tolerated J-tube feeds without complications. She was last seen five months after her procedure, and she was still tolerating J-tube feeds without complications. Her BMI increased from 19 to 23 from the time of the initiation of J-tube feeds. In conclusion, endoscopic suturing of PEG-J tubes can provide a safe and successful way of preventing retrograde migration of the J portion, which is a fairly common complication. The utilization of two techniques to suture the J-tube at two different locations through the addition of an externally placed suture may provide more effective fixation. Further research is needed to evaluate the role of endoscopic suturing for PEG-J fixation.

endoscopic suturing

retrograde migration

percutaneous gastrojejunal tubes

long-term anterior feeding

fixation