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

Area of Science:

• Gastroenterology
• Surgical Techniques
• Medical Device Evaluation

Background:

• Percutaneous gastrostomy (PG) and percutaneous gastroenterostomy (PGE) are common procedures.
• Optimizing techniques and understanding potential complications are crucial for patient safety.

Purpose of the Study:

• To evaluate various techniques, guidance systems, and instruments for PG and PGE.
• To assess the postmortem effects and potential complications of these procedures.

Main Methods:

• Evaluation of 30 laboratory animals and five human cadavers.
• Assessment of different stomach distension methods (air, fluid, balloon, needle inflation).
• Testing of various trocar systems and catheters, including Seldinger technique insertion, with fluoroscopy and sonography guidance.

Main Results:

• Fluoroscopy was preferred, but sonography provided valuable information for vessel avoidance and depth calculation.
• Major complications included liver laceration, catheter malpositioning, and vessel injury (celiac, splenic, inferior epigastric artery).
• Firm gastrocutaneous tracts formed by 7 days; few instances of infection or leakage occurred with well-seated catheters.

Conclusions:

• Laboratory models are essential for refining PG and PGE techniques.
• Careful attention to anatomical hazards, such as the inferior epigastric artery, is necessary.
• Continuous improvement of instruments and procedural guidance is vital for enhancing safety and efficacy.