In the 2022 revision of medical service fees, pre-fixation of the gastric and abdominal walls was made a requirement for reimbursement in percutaneous endoscopic gastrostomy (PEG). However, the medical technique of gastric and abdominal wall fixation was not properly evaluated. To reassess the clinical benefits of this procedure and the need for additional reimbursement, a nationwide survey was conducted in 2023, receiving responses from 232 physicians. The survey confirmed the medical benefits of gastric and abdominal wall fixation, while numerous questions were raised about the lack of proper evaluation. Notably, 92% of physicians supported the addition of reimbursement for this technique.

The purpose of this study was to investigate whether the positioning of the pressure bag and feeding tube and the addition of a sponge could improve the symptoms of skin problems (redness and excessive granulation) frequently observed in gastrostomy patients in our hospital. The pressure bag and feeding tube were tilted by their own weight, and as a result of changing to the opposite position, the symptoms improved. Therefore, we judged that the tilt of the catheter was important, and fixed it using a sponge to prevent excessive tilt, and the symptoms improved.

It is necessary to examine the thickness of the sponge in the future, but we believe that it is useful for preventing skin problems.

Aim: This study aimed to investigate the usefulness of ELENTAL^®, an elemental diet (ED) when administered after percutaneous endoscopic gastrostomy (PEG).

Methods: This single-center retrospective study included 204 patients who received enteral nutrition with liquid nutrients after undergoing PEG, all performed by the same attending physician. Patients’ backgrounds and 30-day post-PEG mortality (early mortality) were compared between the ED group (n = 120) and the non-ED group (n = 84).

Results: The proportion of patients without preoperative enteral nutrition was significantly higher in the ED group compared to the non-ED group (44.2% vs. 21.4%, p < 0.001). Nevertheless, early mortality was significantly lower in the ED group than in the non-ED group (1.7% vs. 8.3%, p < 0.05).

Conclusion: This study demonstrated the potential usefulness of ELENTAL^® administered after PEG in reducing early mortality.

【Aim】This study aimed to evaluate the impact of COVID-19 on the number of gastrostomy procedures in Japan.

【Methods】Changes in the number of gastrostomies from fiscal years (FY) 2019 to 2022 were analyzed. Prefecture-level data included: duration of activity restrictions, proportion of the population aged 65 and over, changes in average annual income, number of board-certified fellows of the Japan Gastroenterological Endoscopy Society (JGES) per 100,000 persons aged 65 and over, and number of NST-operating facilities certified by the Japanese Society for Parenteral and Enteral Nutrition Therapy per 100,000 persons aged 65 and over. Spearman’s rank correlation coefficient was used to assess correlations between changes in gastrostomy numbers and the above variables.

【Results】The number of gastrostomies in FY2019, FY2020, FY2021, and FY2022 was 54,513; 53,165; 53,509; and 51,622, respectively. There was a significant positive correlation between the change in procedure numbers from FY2019 to FY2022 and the number of JGES-certified fellows (r＝0.3, p<0.05).

【Conclusion】In Japan, the number of gastrostomy procedures decreased by 5.3 % in FY2022 compared to FY2019.

【Background】We compared the current status and prognosis between inpatients from emergency room and inpatients from ambulatory who underwent percutaneous endoscopic gastrostomy (PEG).

【Methods】We divided 481 patients who underwent PEG between 2005 and 2024 into two groups: inpatients from emergency room (group ER) and inpatients from ambulatory (group non-ER) at the Veritas Hospital. We retrospectively compared the following parameters between group ER and non-ER: age, gender, primary diseases, nutritional methods and conditions, PEG indication, PEG method, rate of admission from home, hospitalization period, discharge destination, mortality rate, survival rate, and the cause of death.

【Results】Gender (p＝0.0441), rate of admission from home (p<0.0001), rate of admission from convalescent-type hospital (p<0.0001), cerebrovascular disease rate (p<0.0001), serum albumin levels (p＝0.00112), total cholesterol levels (p＝0.0029), white blood cell levels (p<0.001), dysphagia rate (p<0.001), anorexia rate (p<0.0001), modified introducer method (p<0.001), hospitalization period (p<0.0001), and interval from admission to PEG (p<0.0001) differed significantly between the two groups. The difference in survival rate between the two groups was not statistically significant (p＝0.348). Respiratory diseases were the most common cause of death in both groups.

【Conclusion】In both groups, patients were almost discharged from our hospital to convalescent-type hospitals or nursing facilities, and in the ER group, gastrostomy was identified as a means to promote transfer to the convalescent-type hospitals or nursing facilities. It is important to find a way to facilitate early gastrostomy placement, swallowing training, and discharge to home.

At the Annual Meeting of the PEG and Home Medical Care Society, the PEG Team Medical Committee organized a workshop featuring medical professionals with firsthand experience responding to disasters such as earthquakes, typhoons, and floods. These professionals shared lesser-known realities from affected areas. Afterwards, the committee conducted a questionnaire survey among the attendees. Of the 49 respondents, 48 (98.0%) indicated that they found the workshop informative. It was shown that the dissemination of disaster response efforts by members of society was valuable. Although differences in interest were observed among professions depending on the type of disaster, the results overall suggested a high level of interest in disaster preparedness and response among the participants.

We experienced the difficult case of gastrostomy catheter replacement. Percutaneus endoscopic gastrostomy (PEG) was performed in another hospital. There was a stenotic scar of gastrostomy, an infection and a long history of non-exchange.

It seemed important to get information beforehand, and raise awareness that serious consequences can occur if catheters are not managed properly, including regular replacement.

Objectives: To ensure safe and reliable gastrostomy creation and use, gastric wall fixation is mandatory in our hospital. To shorten the hospitalization period, we developed a gastric wall fixation method (implantation method) that omits suture removal after 3 weeks.

Results: From February 2015 to April 2024, 143 patients (60 males and 83 females) underwent implantation. The mean age was 79.3 years (45-97). The average implantation time was 16.6 minutes. The mean hospital stay after gastrostomy implantation was 16.4 days. The mean hospital stay after gastrostomy with gastric wall fixation using the Funada device was 21.1 days, showing a notable reduction in stay duration.

Conclusions: Gastric wall fixation by implantation is a safe and rapid procedure. It may be useful in reducing hospitalization time.

For the LCIG treatment system in patients with advanced Parkinson’s disease, the establishment of a percutaneous endoscopic gastrostomy (PEG) is generally required. We successfully introduced the LCIG treatment system by performing a one-stage laparoscopic-assisted percutaneous endoscopic gastrostomy-jejunostomy (LAPEG-J) in a patient for whom PEG was difficult to perform. In this case, the gastric puncture site was located beneath the left thoracic wall, and the use of LAPEG-J enabled us to safely initiate LCIG therapy. LAPEG-J could serve as an alternative option for constructing an LCIG treatment system in cases where PEG is not feasible.