Ultrasound-guided percutaneous endoscopic gastrostomy in patients with negative diaphanoscopy

Introduction

The first percutaneous endoscopic gastrostomy (PEG) was performed in 1979 in a 4.5-month-old child with inadequate oral intake. Since its introduction in 1980 [1] [2], PEG has become a standard procedure by means of which to ensure long-term enteral feeding in patients in critical care or with neurological disorders who are not able to swallow [3]. Considerable progress has been made in techniques for the placement of the tubes for enteral nutrition. Consequently, PEG has replaced surgical gastrostomy as the procedure of choice in these patients. Sonographically or radiologically guided gastrostomies are alternatives which are employed especially in patients with contraindications to PEG [4] [5] [6]. Failure of diaphanoscopy is regarded as a contraindication to PEG [7]. Since 2002 we have been using ultrasonography at our institution to identify the causes of failure of diaphanoscopy and to guide PEG placement. We describe the technique of ultrasound-guided PEG placement in patients in whom transillumination is impossible.

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