Abstract / Summary
Direct percutaneous endoscopic duodenostomy (D-PED) may offer a safe and effective route for enteral nutrition in patients unable to maintain adequate oral intake and in whom conventional percutaneous endoscopic gastrostomy (PEG) is poorly tolerated, contraindicated, or technically infeasible. We report the case of a 12-year-old boy who underwent multiple surgeries for severe caustic alkali injury to the esophagus, resulting in complex postsurgical anatomy with an intrathoracic stomach and a pharyngogastric anastomosis. His condition was further complicated by severe malnutrition, an indwelling tracheostomy tube, pneumonia caused by multidrug-resistant (MDR) organisms, and type I respiratory failure. Following a preoperative multidisciplinary team (MDT) assessment, an initial attempt at D-PED placement using the introducer technique was unsuccessful due to puncture-site bleeding and tube dislodgement. After reassessment, D-PED was successfully completed using the pull technique with a feeding tube equipped with an internal retention plate. During follow-up, the patient showed marked improvements in nutritional status, respiratory function, and quality of life. This case suggests that, with multidisciplinary collaboration, comprehensive contingency planning, and an individualized procedural strategy, D-PED may be a feasible and safe option for establishing reliable long-term enteral access in high-risk pediatric patients with markedly altered upper gastrointestinal anatomy, multiple prior surgeries, respiratory failure, and severe malnutrition. To our knowledge, no comparable pediatric case has been previously reported. Further experience and longer follow-up are required to establish the safety and durability of this approach.