Percutaneous endoscopic gastrostomy: a nonoperative technique for feeding gastrostomy

Feeding gastrostomy is a useful means of providing nutrition in patients unable to swallow. Percutaneous endoscopic gastrostomy provides a means for creating a feeding gastrostomy without the necessity for laparotomy. It adds a new tool to the armamentarium of the therapeutic endoscopist.     

Percutaneous endoscopic gastrostomy:Indications,technique,complications and management

Percutaneous endoscopic gastrostomy(PEG)is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition.Besides its wellknown advantages over parenteral nutrition,PEG offers superior access to the gastrointestinal system over surgical methods.Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide,knowing its indications and contraindications is of paramount importance in current medicine.PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish.Broadly,the two main indications of PEG tube placement are enteral feeding and stomach decompression.On the other hand,distal enteral obstruction,severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients.Although generally considered to be a safe procedure,there is the potential for both minor and major complications.Awareness of these potential complications,as well as understanding routine aftercare of the catheter,can improve the quality of care for patients with a PEG tube.These complications can generally be classified into three major categories:endoscopic technical difficulties,PEG procedure-related complications and late complications associated with PEG tube use and wound care.In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance.Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the"pull"technique being the most common method.In the last section of this review,the reader is presented with a brief discussion of these procedures,techniques and related issues.Despite the mentioned PEG tube placement complications,this procedure has gained worldwide popularity as a safe enteral access for nutrition in patients with a functional gastrointestinal system.     

Percutaneous retrieval of a deformed guidewire by a modified snaring technique

An attempt to percutaneously remove a guidewire from the inferior vena cava was hampered by kinks developing in the wire during snaring. A modified technique was adopted that permitted its retrieval, obviating the need for a formal venotomy. © 1993 Wiley-Liss, Inc.     

Percutaneous endoscopic cecostomy: a case series

BACKGROUND: There are few reports of percutaneous endoscopic cecostomy in adult patients. METHODS: All cases of acute colonic pseudo-obstruction (n = 2) and neurogenic bowel (n = 3) in adults in which percutaneous endoscopic cecostomy was performed were reviewed retrospectively. OBSERVATIONS: Percutaneous endoscopic cecostomy was a definitive treatment. In 1 of the 2 patients with acute colonic pseudo-obstruction, the percutaneous endoscopic cecostomy tube was clamped and subsequently removed 10 weeks after placement; in the other patient with acute colonic pseudo-obstruction, the percutaneous endoscopic cecostomy tube remains in place. In 2 of the 3 patients with neurogenic bowel, the percutaneous endoscopic cecostomy tube continues to function well; the third patient did well for 6 months and then died of underlying comorbid disease. There was no mortality or need for surgical intervention for any patient. Complications occurred in 2 patients; 1 developed transient fever and leukocytosis and 1 had self-limited bleeding during anticoagulation. CONCLUSIONS: Percutaneous endoscopic cecostomy is a safe and effective treatment for both acute colonic pseudo-obstruction and neurogenic bowel when aggressive albeit conservative treatment is unsuccessful.     

Percutaneous endoscopic gastrostomy.

From March 87 to March 92, fifty eight patients were referred to our department for percutaneous endoscopic gastrostomy (PEG). The modality of the feeding tube insertion is described. The most common indications for placement were neurologic disorders in 62% of the cases (n = 36) and malignant diseases in 32% (n = 19). The success rate of the technique was 98.3% (n = 57). No procedure-related mortality was observed. A low rate of major complication (1.7%) and minor complication (10.5%) was noted. Feeding tubes were removed in 21% of patients (n = 12); none of them with malignant disease. Survival curve analysis demonstrated that 50% of patients died within 3 months of PEG placement. Such results raise questions about the selection of patients undergoing PEG. Our experience of patients undergoing PEG. Our experience suggests that PEG is easy and safe, even in debilitated patients, having an acceptable life expectancy.     

Percutaneous removal of common bile duct stones using a modified balloon technique

To evaluate the effectiveness of percutaneous removal of common bile duct (CBD) stones using a modified balloon technique (balloon catheter sphincteroplasty and expulsion of the stones using half-captured balloons within the sheath) in patients difficult to treat with endoscopy.Fifty patients underwent a modified balloon technique (balloon group), and 53 patients underwent CBD stone removal by the basket method (stone basket group) between 2016 and 2019. We compared the balloon and stone basket groups to evaluate the effectiveness of the modified balloon technique. Outcome variables such as demographics, technical success rates, procedural details, and complications were analyzed. Statistical analysis was performed using Student t test, Fisher exact test, or the χ² test.The technical success rate in the balloon group was 66% (33/50) in 1 session, 32% (16/50) in 2 sessions, and 2% (1/50) in 3 sessions. That of the stone basket group was 45% (24/53) in 1 session, 38% (20/53) in 2 sessions, and 17% (9/53) in 3 sessions.The total procedure time was significantly shorter in the balloon group (29.5 ± 15.1 minutes) than in the stone basket group (41.7 ± 20.2 minutes) (P < .01), whereas the number of stones was higher in the balloon group than in the stone basket group (P = .03). Maximal stone size, balloon size, pancreatitis, and hospitalization stay did not show statistical differences between the 2 groups. Most complications (9 patients, balloon group; 8 patients, stone basket group) were mild and transient. Major complications occurred in one patient in the stone basket group, who experienced hemobilia due to arterial injury caused by percutaneous transhepatic biliary drainage, which was treated by endovascular embolization without mortality.The modified balloon technique is an effective and safe treatment method for CBD stone removal in patients presenting difficulties in the endoscopic approach.     

Percutaneous endoscopic gastrostomy: results of 115 cases

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy is one of the gastrostomy methods used for patients who are unable to take food orally. We aimed to present our results for percutaneous endoscopic gastrostomy. METHODOLOGY: One hundred and fifteen patients undergoing percutaneous endoscopic gastrostomy by pull technique were retrospectively evaluated in terms of indications, complications, durability of tube, and mortality. RESULTS: Of the 115 cases, 60 were males and 55 females with the median age of 67 (2-93) years. Indications for percutaneous endoscopic gastrostomy placement were cerebrovascular accident in 39, brain tumors in 24, subarachnoidal hemorrhage in 21, several neurologic disorders in 17, miscellaneous extracerebral tumors in 6, head injury in 5, hypoxic encephalopathy in 2, and iatrogenic in 1. The durability of the tube was a median of 242 (9-1988) days. The tube was removed in 16 patients and was changed in 11 patients with a median interval of 142.5 (35-427) and 133 (24-1251) days, respectively. Four wound infections, two buried bumper syndromes, and two aspiration pneumonias developed. Total follow-up was 114.1 patient-years with procedure-related mortality, 30-day mortality, and overall mortality of 0%, 3.5% (4/115), and 17.4% (20/115), respectively. The mortality rate was 45% for patients who had brain tumor and 11.6% for the remainder. CONCLUSIONS: Percutaneous endoscopic gastrostomy is a minimally invasive gastrostomy method with low morbidity and mortality rates, easy to follow-up, and easy to replace when clogged.     

Percutaneous endoscopic gastrostomy tube replacement

Percutaneous endoscopic gastrostomy (PEG) is undertaken in order to provide long-term nutrition in patients with dysphagia. Over time, the PEG tubes will deteriorate and will need to be replaced. We describe a method of replacement which is cost-effective and which does not require repetition of the endoscopy.