Transnasal stent-assisted targeting technique for percutaneous jejunostomy placement in patients with hiatal hernias

To report the transnasal stent-assisted targeting technique for percutaneous jejunostomy placement in patients with hiatal hernias. 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. 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. The transnasal stent-assisted targeting technique is a novel method for primary jejunostomy placement in patients with hiatal hernias.