Endoscopic ultrasound-guided percutaneous endoscopic gastrostomy

Sandra Baile-Maxía, Lucía Medina-Prado, Maryana Bozhychko, Carolina Mangas-Sanjuan, Francisco Ruiz, Luis Compañy, Juan Martínez, Juan Antonio Casellas, José Ramón Aparicio
Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society 2020 April 4
Percutaneous endoscopic gastrostomy (PEG) is the method of choice for feeding and nutritional support in patients with a normal gastrointestinal function who require long-term enteral nutrition. We report our experience regarding an alternative endoscopic ultrasound (EUS)-guided PEG technique. A retrospective clinical experience case series study was conducted from January 2019 to November 2019 at a tertiary center. Adult patients deemed unfit for conventional PEG due to absence of transillumination or previous gastric surgery were enrolled. An EUS target was created by filling a glove with saline and placing it in the abdomen. EUS was performed and target identified from stomach. Abdominal wall was punctured from stomach and a guidewire was advanced. The guidewire was knotted to a string, which was passed into the stomach and drawn back through the mouth. The procedure was continued following the traditional technique. 4 patients underwent EUS-PEG in our center during the study period. Mean age was 65 years and 50% were male. 2 patients (50%) had a Body Mass Index over 30. PEG indications were tongue malignancies (50%), cerebrovascular disease (25%) and dementia (25%). 1 patient had a Roux-en-Y gastric bypass and percutaneous endoscopic jejunostomy was performed. Technical success rate was 100% and no complications occurred. This case series shows that EUS-guided PEG technique is a safe alternative in patients deemed unfit for conventional PEG.

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