Table 2.

Case summaries of three examples of DPEJ insertion where particular procedural difficulties were encountered, and where the drainage access needle was helpful in ensuring a successful outcome. No case developed any complication.

Case	Procedural challenge	Technique
Male, 25. Severe cerebral palsy with dysphagia and recurrent aspiration pneumonia	Large paraoesophageal hernia with proximal jejunum in thorax	Enteroscope with overtube used. Jejunum punctured within thorax (via diaphragmatic hiatus from abdominal wall approach) with fluoroscopic guidance
Female, 53. Pancreatic cancer with partial duodenal obstruction and peritoneal metastases	Large volume of omental malignancy and moderate amount of ascites	Enteroscope used. Deep loop of jejunum punctured with fluoroscopic guidance
Female, 65. Gastric linitis plastica with peritoneal metastases	Overweight patient with mobile jejunum	Enteroscope used. Jejunum punctured with fluoroscopic guidance