Percutaneous Endoscopic Gastrostomy in Direct Puncture Technique: When, Why and How?

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Surgical Innovation

Background:

• Percutaneous endoscopic gastrostomy (PEG) is vital for enteral feeding in patients with swallowing difficulties.
• The standard pull-through (PT) technique has limitations, particularly in cases of pharyngeal/esophageal obstruction or stents.
• Direct puncture (DP) PEG offers an alternative approach.

Purpose of the Study:

• To evaluate the safety and efficacy of the direct puncture (DP) percutaneous endoscopic gastrostomy (PEG) device.
• To assess DP-PEG as an alternative when PT-PEG is not feasible.

Main Methods:

• A cohort of 154 patients, predominantly with cancer (140), underwent DP-PEG placement.
• The procedure involved gastropexies followed by PEG insertion using an introducer method.
• A gastrocutaneous fistula was established after one month, allowing for safe catheter exchange.

Main Results:

• Successful DP-PEG placement was achieved in all patients.
• The overall complication rate was 11% (6% minor, 5% major).
• Tube dislocation occurred in 40 cases, leading to major complications and surgical intervention in 5 instances.

Conclusions:

• The DP-PEG system demonstrates safety and utility when standard PT-PEG is contraindicated.
• Strict adherence to post-interventional protocols is essential to minimize the risk of tube dislocation.