A KNACK FOR PERCUTANEOUS ENDOSCOPIC GASTROSTOMY AND TECHNIQUES TO AVOID COMPLICATIONS

Abstract

Details of the percutaneous endoscopic gastrostomy (PEG) procedure such as classification of technique, endoscope insertion route (transnasal vs. transoral), effect of endoscope insertion position and design of the inserting point are described here.
There are two methods of performing PEG, the pull/push method and introducer method. The two methods are distinguished by the catheter insertion route, i.e., whether it is inserted through the oral cavity or not. The pull/push method is, in other words, “upward” insertion and the introducer method is “downward” insertion.
We must use different techniques and methods according to the specific cases. Especially in laryngeal MRSA carriers, patients with stenosis of esophagus, and head and neck tumor patients with an esophagus lesion, the introducer method is required. On the other hand, in patients with obesity and patients where gastropexy failed, the pull/push method is desired.
In every case, gastropexy is required to safely perform PEG. Especially in case of inadvertent removal of the catheter before fistula formation, gastropexy inhibits progression of serious peritonitis.
Complications of PEG include bleeding, inadvertent puncture of another organ, pneumonia, paralytic ileus, peritonitis, pneumoperitoneum, and wound infection.
Misplacement of the catheter into the peritoneal cavity leading to misinjection of enteral formula is the most serious complication associated with catheter replacement. To avoid this complication, we must confirm that the new catheter is placed in the stomach.