Application of percutaneous endoscopic gastrostomy with jejunal extension in a case of post-gastrectomy Roux Stasis syndrome

We present herein on a 74-years-old man, who underwent distal gastrectomy and Roux-en-Y reconstruction for stomach cancer, and developed gastro-jejunostomy obstruction. Re-anastomosis, however, did not relieve the symptoms. Delayed gastric emptying without mechanical obstruction lead to a diagnosis of Roux stasis syndrome (RSS). To achieve both gastric decompression and nutritional therapy, a percutaneous endoscopic gastrostomy-jejunostomy (PEG-J) was performed in two steps. Firstly, a gastrostomy was placed endoscopically and then a jejunal catheter was inserted through the gastrostomy tube. This system can feed nutritional solution through the jejunal catheter while gastric juice is drained from the gastrostomy tube. The patient was spared an uncomfortable nasal gastric tube and long-term central-venous hyperalimentation, and his RSS was completely cleared 134 days later. This experience suggested that PEG-J can be one of the options in the conservative treatment of RSS.