CONFIRMATION OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBE REPLACEMENT USING A DISPOSABLE COLORMETRIC CO₂ DETECTOR

Abstract

Purpose : Percutaneous endoscopic gastrostomy (PEG) is widely used. However, there are concerns with the adverse effects caused by improper PEG tube replacement. In order to confirm whether the PEG tube has been properly placed in the stomach, the presence of gastric juice was determined using a disposable colormetric CO₂ detector (CO₂nfirm Now^TM, Tyco Healthcare, Japan) and 7% sodium bicrbonate solution (Mylon^TM). The usefulness of this procedure was evaluated.
Method : 10 patients (males 6, females 4 ; 22 to 99 years old, mean 69.9 years old). All were outpatients. The PEG sizes used included 18 to 24Fr (Bumper type) in 9 patients, and a 16Fr (Tube type) in 1 patient. The PEG tube was replaced using a routine procedure. After replacement, Mylon^TM (3ml) was injected through the replacement tube. When the PEG tube was properly placed in the stomach, carbon dioxide (CO₂) was generated. The CO₂nfirm Now^TM test was used to identify color changes consistent with the presence of CO₂ in the stomach cavity.
Result : All patients, including three patients treated with a proton pump inhibitor or H2-blocker, had immediate and unambiguous color changes consistent with the presence of CO₂. There were no complications caused by the injection of Mylon^TM.
Conclusion : Our new method of confirming gastric juice using the CO₂nfirm Now^TM test and Mylon^TM may be useful in patients requiring PEG tube replacement. It can be easily and safely performed even at the bedside.