More than 30 years since it was initially described, direct percutaneous endoscopic jejunostomy (DPEJ) is nowadays indicated for patients requiring long-term enteral nutrition and presenting an altered gastric anatomy, impaired gastric emptying, or a high risk of aspiration. 1 Arvanitakis M. Gkolfakis P. Despott E.J. et al. Endoscopic management of enteral tubes in adult patients - part 1: definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

Endoscopy. 2021; 53: 81-92

However, and unlike its “big brother,” PEG, DPEJ seems to not to have been widely adopted in endoscopic routine practice. This is probably due to the technically challenging features of the procedure and also to the fact that DPEJ often involves frail patients, therefore raising concerns about unfavorable outcomes.