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The safety and feasibility of percutaneous endoscopic gastrostomy placement
Takamitsu Sasaki1, Daisuke Fukumori, Koutaro Sakai
1First Department of Surgery, Fukuoka University School of Medicine, Fukuoka, Japan. takamitu@fc4.so-net.ne.jp
Insights
Pre-procedure imaging, including computed tomography (CT) and contrast radiography, effectively identifies high-risk patients for percutaneous endoscopic gastrostomy (PEG), preventing dangerous colon perforations.
Area of Science:
- Gastroenterology
- Medical Imaging
- Surgical Safety
Background:
- Percutaneous endoscopic gastrostomy (PEG) is a common procedure with a risk of serious complications.
- Iatrogenic colon perforation is a particularly dangerous complication associated with PEG placement.
Purpose of the Study:
- To evaluate the safety and feasibility of using preoperative computed tomography (CT) and contrast radiography to reduce PEG complications.
- To stratify patients into low-risk and high-risk groups for PEG based on anatomical variations.
Main Methods:
- Routine preoperative abdominal CT with air insufflation (pre-PEG CT) to assess stomach and colon proximity.
- Classification of patients into low-risk and high-risk groups based on pre-PEG CT findings.
- High-risk patients underwent PEG combined with contrast radiography of the large intestine.
Main Results:
- Pre-PEG CT identified 84.4% of patients as low-risk and 15.6% as high-risk.
- All high-risk patients received contrast radiography prior to or during PEG.
- No cases of iatrogenic colon perforation occurred in any patients.
Conclusions:
- Combining pre-PEG CT with contrast radiography is an effective strategy for minimizing serious complications during PEG.
- This imaging approach enhances the safety and feasibility of PEG procedures, particularly in high-risk individuals.
Background/Aims:
Percutaneous endoscopic gastrostomy (PEG) is now becoming increasingly popular. However, an increasing number of complications has also been reported. Regarding such complications, iatrogenic perforation of the colon is considered to be the most dangerous.
Methodology:
We routinely check the course of the colon using preoperative abdominal computed tomography with air injected into the stomach (pre-PEG CT), and thereafter the patients are classified into two groups, consisting of a Low-risk group and High-risk group, according to the locations of the stomach and colon. The patients in the High-risk group underwent PEG in combination with contrast radiography of the large intestine. We evaluated the safety and feasibility of PEG placement using a Pre-PEG CT and contrast radiography of the large intestine.
Results:
A Pre-PEG CT showed a Low-risk type in 84.4% and a High-risk type in 15.6%. High-risk type patients underwent contrast radiography on the large intestine in conjunction with PEG. As a result, we were able to perform PEG safely with no iatrogenic perforation in any patients.
Conclusions:
A pre-PEG CT and contrast radiography of the large intestine combination with PEG are thus considered to be an effective modality for reducing the incidence of serious complications of PEG.
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