EUS-guided percutaneous endoscopic gastrostomy for enteral feeding tube placement

Dalton M Chaves, Atul Kumar, Marcos E Lera, Fauze Maluf, Everson L Artifon, Eduardo G Moura, Bhawna Halwan, Shinichi Ishioka, Paulo Sakai
Gastrointestinal Endoscopy 2008, 68 (6): 1168-72

BACKGROUND: Patients without adequate abdominal-wall transillumination are at a high risk of developing complications after PEG.

OBJECTIVE: We evaluated the feasibility and utility of EUS to guide PEG in patients lacking abdominal-wall transillumination.

DESIGN: Single-center case series.

SETTING: Tertiary-referral center.

PATIENTS: Six patients who lacked adequate abdominal-wall transillumination and 2 patients with a large laparotomy scar deemed to be at high risk of developing complications after PEG.

INTERVENTIONS: Patients underwent EUS-guided PEG and deployment of a standard enteral feeding tube.

MAIN OUTCOME MEASUREMENTS: Technical success and complication rates.

RESULTS: PEG was successful under EUS guidance in 5 of 8 patients. Causes of failure included an inadequate EUS window because of a prior Billroth 1 gastrectomy in one and suspected bowel interposition in 2 patients. There were no complications.

LIMITATIONS: A small number of patients, uncontrolled study, and short follow-up period.

CONCLUSIONS: This technique may facilitate deployment of PEG in patients who lack adequate abdominal-wall transillumination.

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