Percutaneous gastrostomy and gastroenterostomy: 1. Techniques derived from laboratory evaluation

Various techniques, guidance systems, instruments, and the postmortem effects of percutaneous gastrostomy (PG) and percutaneous gastroenterostomy (PGE) were evaluated in 30 laboratory animals and five human cadavers. Methods to distend the stomach included air, fluid, intragastric balloon, and percutaneous needle inflation; a variety of trocar systems and catheters inserted by Seldinger technique (including those adapted from other uses and several designed specifically) were assessed. Fluoroscopy was the preferred guidance system, though sonography proved valuable (liver position, depth calculation to the stomach, localization of vessels to avoid), and the entire PG procedure was performed under sonographic guidance in four animals. Although the procedure was safe in most cases, several major complications did occur: laceration of a low-lying liver with exsanguination, malpositioned catheters in the lesser sac and adjacent to the spleen, and violation of the backwall of the stomach with laceration of celiac and splenic vessels. The animals and cadavers underwent autopsy. Autopsy revealed that firm gastrocutaneous tracts were formed by 7 days. There were few instances of wound infection, intraperitoneal fluid leakage, or evidence of trauma to the stomach when the catheters were well seated. Injury to the inferior epigastric artery is a potential hazard, and in cadaver dissections was located between the middle third and outer margin of the rectus abdominis muscle. Laboratory experience has been, and continues to be, an important means to improve and use new techniques for PG and PGE.