Feasibility and Safety of Percutaneous Endoscopic Gastrostomy with Modified Introducer Technique for One-Stage Button Placement

Abstract

Purpose: Percutaneous endoscopic gastrostomy (PEG) with introducer technique has an essential advantage to eliminate infectious complications, but limitation of this technique is initial placement of a small-bore balloon catheter. If a large-bore button catheter is desired, certain interval is required before replacement. A novel device (Direct IDEAL PEG, Olympus Medical Systems, Tokyo) enables one-stage placement of a button catheter. The aim of this study is to evaluate feasibility and safety of modified introducer technique using this new device. Methods: Seven patients with ordinary indications for gastrostomy underwent PEG placement using this new device. After dual gastropexy, a wire-guided dilator is directly introduced into the stomach, followed by a 24Fr button placement. Technical feasibility and complications were evaluated, as compared with 15 cases of PEG placement with standard pull technique during the same period. Results: Placement of 24Fr button was successful in all 7 patients using this modified introducer technique. Although operators did not feel technical difficulty, mean procedure time required for PEG placement using this technique was 16.8 min, as compared to 10.0 min with standard pull technique. No major or minor complications were encountered within 30 days after PEG placement with modified introducer technique. Among 15 patients underwent standard PEG placement, 2 died of concomitant diseases within 30 days, 1 developed peritonitis requiring laparotomy, 1 developed peristomal infection, and leakage of liquid nutrient from the stoma was noted in 2 patients. Conclusion: Modified introducer technique is feasible and safe procedure for initial placement of a large-bore button catheter.