Abstract
Background and Purpose:
The pull or push technique for percutaneous endoscopic gastrostomy (PEG) placement has some disadvantages. We have safely performed PEG with the introducer technique using an anchoring device that secures the stomach to the abdominal wall.
Patients and Methods:
Two patients with neurologic impairment and one with lockjaw underwent PEG with the introducer technique because of feeding difficulties. In the former patients, retroflexion of the neck developed excessively, and periodic changing of the feeding tube was hard to perform. With the patient under general anesthesia, two fixing sutures for gastropexy were placed 2 cm apart using the anchoring device. Between the fixing sutures, a puncture needle with a peel-away sheath was passed into the stomach, and a 13F Silastic catheter was passed through the sheath. The catheter was secured after a balloon was inflated. Feeding was started 24 hours after the catheter insertion.
Results:
The operative times for the various cases were 42, 65, and 22 minutes. There was no complication associated with the PEG procedure and no clinical evidence of gastroesophageal reflux.
Conclusion:
Gastropexy using the anchoring device makes it possible to overcome the disadvantages of the introducer technique such as unreliability of gastric puncture and possible balloon malfunction leading to major intraperitoneal leakage. The introducer technique combined with gastropexy is extremely useful in performing PEG because it avoids some risks inherent in the push or pull technique, including pericatheter infection and potential injury to the pharynx or esophagus.
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