A319 A NOVEL METHOD FOR PEG-J TUBE INSERTION USING SINGLE BALLOON ENTEROSCOPY AND THE WEDGE TECHNIQUE
Bibliographic record
Abstract
Percutaneous endoscopic gastrostomy tubes with jejunal extensions (PEG-J) are used to deliver nutrition and medications directly into the proximal jejunum. Insertion can be difficult due to a tendency for the J-extension to fall back into the stomach during the procedure. To describe a new technique using a single balloon enterscope to wedge the J-extension in place to prevent backwards migration during the procedure. A case series over an 18 month period was performed using this novel technique. In brief, a J-extension was fed through a pre-existing PEG tube, grasped with a biopsy forcep, and brought into the proximal jejunum using the single balloon enteroscope with the overtube deflated in the duodenal bulb. Once the desired depth was reached, the overtube balloon was inflated and the enteroscope withdrawn while holding the tip of the J-extension in place with the biopsy forcep. Next, the biopsy forcep was opened and pulled back into the enteroscope while the overtube balloon remained inflated to wedge the J-extension in place. Finally, the overtube balloon was deflated and withdrawn with the enteroscope. The primary outcome was successful insertion into the proximal jejunum confirmed on a post-procedure abdominal xray (AXR). Secondary outcomes included the number of pyloric intubations required to insert the J-extension and the duration of the J-extension portion of the procedure. 17 patients underwent PEG-J tube insertion during the study. The mean age (SD) was 61.8 (16.9) and 64.7% were females. 58.8% of procedures were performed with a combination of benzodiazpene and narcotic and 41.2% with propofol. The wedge technique successfully inserted the J-extension into the proximal jejunum confirmed on AXR in all patients. Only one pyloric intubation was required in 15 patients (88%) and 2 patients required a second intubation (12%). The mean (SD) time for the J-extension insertion was 16.9 minutes (8.6). There were no adverse events related to the J-extension insertion. The wedge technique is a quick and effective method for inserting a J-extension and prevents proximal migration back into the stomach during the procedure. Abbvie
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".