Endoscopic ultrasound guided percutaneous endoscopic gastrostomy for enteral feeding tube placement

Aim: To evaluate the feasibility and safety of Endoscopic ultrasound (EUS) guiding PEG (percutaneous endoscopic gastrostomy) in patients.

Methods: Three male inpatients between 79 to 87 years old who need PEG for enteral feeding tube placement were enrolled in our study between November 2008 and June 2009. With the patients intravenous anesthesia in the supine position, the convex scanning EUS (OLYPUS EUM-2000)was passed into the stomach and the probe was placed over the anterior gastric wall to identify the anterior abdominal wall. A FNA cytology needle was then passed through the shortest way between the gastric lumen and the anterior abdominal wall, while the real-time EUS guidance was used for avoiding any interposition of bowel, blood vessels and liver tissue between the stomach and the abdominal-wall skin. The skin on the abdomen was routinely disinfected then the surgical towel was shopped. Finger indentation of the abdominal was visualized by EUS to identify an adequate site and also to facilitate delineation of layers of the abdominal wall. A 3-mm to 5-mm puncture was made alongside the protruding needle in the anterior abdominal wall. A trocar was inserted over the needle into the gastric lumen. The needle was withdrawn into the echoendoscope, and the standard pull-type gastrostomy kit was deployed by using standard PEG techniques to place an enteral feeding tube.

Result: PEG was successful under EUS guidance in all patients in an average of 30 minutes without any complications.

Conclusion: Endoscopic ultrasound guided PEG for enteral feeding tube placement is feasibility and utility for avoiding complications of PEG such as gastrocolic fistula though the operation is more complicated.