1992 Volume 34 Issue 11 Pages 2655-2660
Percutaneous endoscopic gastrostomy (PEG) was performed on four patients with previous distal gastrectomy. Previous diseases were gastric cancer in two patients, gastric ulcer in one and duodenal ulcer in one. Three patients had Billroth I reconstruction and one had Billroth II. In the first two patients, visualization of the transverse colon with contrast material and ultrasound scanning of the major hepatic pedicles in the overlying liver were initially done. Then, avoiding these structures, the gastric remnant was carefully punctured with a 22-gauge needle. A 14 French trocar introducer with a peel-away sheath in a commercially available PEG kit (Create Medic Co.) was inserted just beside the initial puncture needle. Finally a 12 Fr. balloon catheter was indwelled. In the remaining two patients, we made some modifications. We inserted a long intestinal tube to the duodenal or jejunal loop and inflated a balloon to occlude the gastric outlet in order to obtain good endoscopic insufflation. An 18G needle was inserted into the gastric remnant with radiographic and sonographic aid. To hold the safe tract made by the pilot puncture, we used a guide wire and a coaxial trocar introducer that we had modified because the original trocar in the PEG kit was not coaxial. One patient in the first series developed a high fever, pleural effusion and disseminated intravascular coagulation : however, recovery occurred in two weeks. The other patients had no complications. Feeding from PEG was possible in all four cases. PEG is allegedly better than nasal intubation for long-term tube feeding. This is true not only for patients with an intact stomach but also for those with a gastric remnant. We believe our methods provide a safer way of applying PEG to a gastric remnant.
