APPLICATION AND PRACTICE OF COLONOSCOPY-ASSISTED PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (C-PEG)

Abstract

Percutaneous endoscopic gastrostomy (PEG) has become a common medical treatment, but sometimes unexpected events occur (e.g., mispuncture or inoperable puncture) due to interposition of the transverse colon or the mesentery. Computed tomographic (CT) scanning prior to PEG helps to detect such obstacles. Our routine CT scanning revealed that air injection into the stomach in the left-side down position is advisable to resolve those obstacles and to narrow down eligible candidates for colonoscopy-assisted PEG (C-PEG). If CT scanning shows the transverse colon or mesentery on the ventral side of the stomach, colonoscopy is feasible to relocate the colon that is laid over the stomach downward so that PEG can be performed (C-PEG). In our hospital, 426 cases underwent CT scanning prior to PEG during 2006-2017. The CT scanning procedure detected 38 cases who were eligible for C-PEG, and 37 (97.4%) of them underwent C-PEG successfully. There was no mispuncturing of the colon or the mesentery. Therefore, we consider that C-PEG is safe and useful for cases that have interposition of the transverse colon or the mesentery. Here we report our C-PEG strategy and practical methods including CT screening.