The safety and feasibility of percutaneous endoscopic gastrostomy placement

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is now becoming increasingly popular. However, an increasing number of complications has also been reported. Regarding such complications, iatrogenic perforation of the colon is considered to be the most dangerous. METHODOLOGY: We routinely check the course of the colon using preoperative abdominal computed tomography with air injected into the stomach (pre-PEG CT), and thereafter the patients are classified into two groups, consisting of a Low-risk group and High-risk group, according to the locations of the stomach and colon. The patients in the High-risk group underwent PEG in combination with contrast radiography of the large intestine. We evaluated the safety and feasibility of PEG placement using a Pre-PEG CT and contrast radiography of the large intestine. RESULTS: A Pre-PEG CT showed a Low-risk type in 84.4% and a High-risk type in 15.6%. High-risk type patients underwent contrast radiography on the large intestine in conjunction with PEG. As a result, we were able to perform PEG safely with no iatrogenic perforation in any patients. CONCLUSIONS: A pre-PEG CT and contrast radiography of the large intestine combination with PEG are thus considered to be an effective modality for reducing the incidence of serious complications of PEG.