ADVANCES IN THE MODIFIED INTRODUCER TECHNIQUE FOR PEG: CLINICAL APPLICATION OF SHEATH-GUIDED BUMPER-IN-CAPSULE CATHETERS

Abstract

A modified introducer method for percutaneous endoscopic gastrostomy（PEG）effectively prevents peristomal infection and tumor seeding. However, conventional bumper-type catheters are limited by physical resistance and potential tissue trauma during insertion and removal. This article describes a minimally invasive approach using a next-generation device, which features a unique insertion mechanism that encapsulates the bumper within a gelatin capsule to maintain a streamlined profile. For removal, it employs low-resistance mechanism that collapses the bumper into a thin silicone membrane upon extracting a shape-memory nickel-titanium ring. During placement, a single-step dilator simplifies tract dilation, whereas a peel-away sheath prevents axis misalignment and gastric wall injury, ensuring smooth insertion. During replacement, removal of the internal wire allows for atraumatic extraction without scraping the fistulous tract. Furthermore, reinsertion using a dedicated obturator over a guidewire minimizes misplacement risk. By minimizing invasiveness from initial placement to subsequent replacement, this system standardizes the procedure and reduces reliance on operator experience. This innovative approach contributes significantly to alleviating patient discomfort and enhancing medical safety during enteral access.