Standard Percutaneous Endoscopic Gastrostomy Research Articles

Use of a large-diameter 30-French venting gastrostomy tube is effective and safe for symptom palliation in patients with malignant bowel obstruction

BackgroundTreatment options for malignant bowel obstruction are limited, particularly in poor surgical candidates. Standard percutaneous endoscopic gastrostomy (PEG) tubes used for venting are of small caliber, limiting success. This study examines outcomes in patients who received larger-caliber 30-Fr PEGs for treatment of malignant bowel obstruction.MethodRetrospective chart review for all patients who received a large-caliber venting PEGs for malignant bowel obstruction in a series of patients at a single institution.ResultsThirty-six patients were included. The most common primary cancer diagnoses were ovarian (22%), mucinous appendiceal (19%), and colorectal (17%). Symptom relief was achieved in all patients (100%). Four patients (11%) sought medical care for recurrent symptoms due to an incorrect venting technique. Large-caliber venting PEGs were placed on the first admission for obstruction in 17 patients (47%), and were used to replace standard caliber PEGs in 8 patients because of persistent symptoms (22%). Significant ascites was observed in 12 patients (33%), but paracenteses were performed in only 3 of these patients prior to PEG placement. Most large-caliber venting PEGs were placed during hospital admission (34/36, 94%), and facilitated hospital discharge (33/34, 97%). Two significant (6%) and 2 minor adverse events (6%) occurred.ConclusionsThis study demonstrates the efficacy and safety of large-caliber venting PEGs for malignant bowel obstruction. This facilitated hospital discharge in almost all patients and prevented readmissions when a correct venting technique was utilized; these PEGs were also effective in patients who had failed standard PEG tube venting.

Percutaneous Endoscopic Gastrostomy in Children: An Update to the ESPGHAN Position Paper.

The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position paper from 2015 on percutaneous endoscopic gastrostomy (PEG) required updating in the light of recent clinical knowledge and data published in medical journals since 2014. A systematic review of medical literature from 2014 to 2020 was carried out. Consensus on the content of the manuscript, including recommendations, was achieved by the authors through electronic and virtual means. The expert opinion of the authors is also expressed in the manuscript when there was a lack of good scientific evidence regarding PEGs in children in the literature. The authors recommend that the indication for a PEG be individualized, and that the decision for PEG insertion is arrived at by a multidisciplinary team (MDT) having considered all appropriate circumstances. Well timed enteral nutrition is optimal to treat faltering growth to avoid complications of malnutrition and body composition. Timing, device choice and method of insertion is dependent on the local expertise and after due consideration with the MDT and family. Major complications such as inadvertent bowel perforation should be avoided by attention to good technique and by ensuring the appropriate experience of the operating team. Feeding can be initiated as early as 3 hours after tube placement in a stable child with iso-osmolar feeds of standard polymeric formula. Low-profile devices can be inserted initially using the single-stage procedure or after 2-3 months by replacing a standard PEG tube, in those requiring longer-term feeding. Having had a period of non-use and reliance upon oral intake for growth and weight gain-typically 8-12 weeks-a PEG may then safely be removed after due consultation. In the event of non-closure of the fistula the most successful method for closing it, to date, has been a surgical procedure, but the Over-The-Scope-Clip (OTSC) has recently been used with considerable success in this scenario. A multidisciplinary approach is mandatory for the best possible treatment of children with PEGs. Morbidity and mortality are minimized through team decisions on indications for insertion, adequate planning and preparation before the procedure, subsequent monitoring of patients, timing of the change to low-profile devices, management of any complications, and optimal timing of removal of the PEG.

2731 Duodenal Pressure Ulcer Secondary to Migratory PEG Tube

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) tubes allow for long-term nutritional support in patients with preserved gastrointestinal function and dysphagia. The procedure and long-term presence of a PEG tube is well tolerated, with a complication rate of 0.4% to 4.4%. Adverse events include infection, skin breakdown, and aspiration. Upper GI bleeding, secondary to gastric or duodenal pressure ulcers is a rare complication. We present a case of duodenal pressure ulcers secondary to a PEG tube, along with a review of the literature and a proposed mechanism for this injury. CASE DESCRIPTION/METHODS: A 94-year-old non-verbal woman with a history of dementia and oral squamous cell carcinoma presented to the ED for RLQ abdominal pain. She was found to have leakage around the replacement PEG tube. Given comorbidities, patient was initially managed conservatively, but eventually underwent an endoscopy (EGD) due to persistent melena and down trending hemoglobin. The EGD demonstrated that the intragastric retention balloon had migrated beyond the pyloric channel resulting in a partial gastric outlet obstruction. The balloon was deflated revealing a large nonbleeding duodenal pressure ulcer. Since no stigmata of bleeding were identified, the replacement PEG was removed and new mushroom catheter and internal bumper was placed through the original tract. The patient was placed on an IV PPI to allow for adequate healing and melena resolved. DISCUSSION: Standard replacement PEG tubes are secured with an external bumper on the skin with an intragastric saline filled balloon. Ideal distance between the retainer and skin is 1-2 cm. If a PEG balloon is pulled too tightly there is a risk for pressure ulcer formation at the gastrostomy site. Conversely, if the PEG tube is too loose there is the risk of PEG balloon migration. With intense gastric peristalsis, the saline-filled balloon can migrate through the stomach, pylorus, and into the duodenum. While this is rare, case reports of gastric and duodenal outlet obstruction have been observed. In this case, the migration of the balloon into the duodenum led to a partial gastric outlet obstruction leading the patient to present with leakage, pain, melena, and anemia due to a large duodenal pressure ulcer. Proper PEG placement and care should be the main source of pressure ulcer prevention, and this rare complication should be considered in patients with melena and anemia.

Laparoscopic Magnet-Assisted Percutaneous Endoscopic Gastrostomy Placement

There are various methods to place a gastrostomy tube. We report a laparoscopic method to place a standard percutaneous endoscopic gastrostomy (PEG) tube without the use of endoscopy. Laparoscopic magnet-assisted PEG placement was carried out using an orogastric tube attached with a magnet that is used to retrieve the PEG wire that has been percutaneously placed into the stomach. Four pediatric patients (mean age 31 months) underwent a PEG tube placement using the laparoscopic magnet-assisted PEG tube insertion technique during 2017. There were no immediate and long-term tube placement complications. Retrieval of the PEG wire using the magnet-tipped orogastric tube was successful in all patients. Laparoscopic magnet-assisted PEG tube placement allows precise PEG tube placement without the need for endoscopy.

Trends and Outcomes of Early Versus Late Percutaneous Endoscopic Gastrostomy Placement in Patients With Traumatic Brain Injury: Nationwide Population-based Study

Oral intake for traumatic brain injury (TBI) patients is often not an option because of facial trauma, swallowing dysfunctions, altered consciousness, etc. These patients often require percutaneous endoscopic gastrostomy (PEG) placement for nutrition support. To date, there is lack of studies examining the relationship between the timing of PEG placement and patient outcome in the TBI group. We conducted a population-based study in a retrospective cohort of TBI patients undergoing PEG, using the national inpatient sample for years 2011 to 2013. A total of 96,625 patients were identified for TBI and 3343 of those patients received PEG. TBI patients who undergo an early or late PEG placement had a higher rate of in-hospital mortality, when compared with patients with a standard timing of PEG placement. Late PEG was preferably placed in patients with higher Charlson index and trauma-related comorbidities, and these patients had a higher incidence of complications, that is, sepsis, urinary tract infection, acute respiratory distress syndrome/pneumonia, and deep vein thrombosis/pulmonary embolism. When stratified by mortality-risk groups, early PEG was associated with higher rates of in-hospital mortality while standard PEG was associated with best mortality outcomes in low-mortality-risk group and moderate-mortality-risk group. The results of this study suggest that if a PEG placement is indicated for a TBI patient, a standard (7 to 14 d) timing may be associated with better patient outcomes. However, secondary to limitations associated with the use of administrative databases, further prospective studies are needed to establish clear guidelines regarding the optimal timing of placing PEG in TBI patients.

Nurse-Assisted Percutaneous Endoscopic Gastrostomy Tube Placement Is a Safe Procedure in Adult Patients.

The percutaneous endoscopic gastrostomy (PEG) procedure is normally carried out by two doctors. Preliminary experience has suggested that this procedure may be accomplished with the same safety level using one doctor and a specially trained endoscopy nurse. The aim of the study was to assess the immediate outcome and 30 days' procedure-related morbidity following nurse-assisted percutaneous endoscopic gastrostomy (NA-PEG) in an unselected population of adult patients. Retrospective, nonconsecutive analysis of NA-PEG procedures were registered between 2008 and 2014. Demographic data, indications, and early and late procedure complications were registered. During the study period, a total of 222 nonconsecutive adult patients had a NA-PEG placement. Neurologic (56%) and malignant diseases (35%) were the major indications for the PEG placement. The NA-PEGs were performed by six specially trained endoscopy nurses. NA-PEG-related overall morbidity was 24%, and all complications were minor. No procedure-related mortality occurred. When NA-PEG was compared with standard PEG placement literature, there was no increase in the number of complications, and the types of complications were similar. Despite being performed in patients with multiple co-morbid conditions, NA-PEG was a safe procedure with no mortality and minor complications. We suggest that NA-PEG should be used on a larger scale with the intention of saving time and medical costs.

Percutaneous sonographically assisted endoscopic gastrostomy for difficult cases with interposed organs.

The aim of this retrospective observational study was to clarify the usefulness and safety of percutaneous sonographically assisted endoscopic gastrostomy or duodenostomy (PSEGD) using the introduction method. The information for the sequential 22 patients who could not undergo standard percutaneous endoscopic gastrostomy (PEG) and underwent PSEGD for 3 y was extracted and was reviewed. In standard PEG, we performed pushing out of the stomach from the mediastinum and full distention to adhere the gastric wall to the peritoneal wall without interposing of the intraperitoneal tissues by air inflation and a turning-over procedure of the endoscope, four-point square fixation of the stomach to the peritoneal wall by using a Funada-style gastric wall fixation kit under diaphanoscopy, extracorporeal thumb pushing, and in difficult cases extracorporeal ultrasound guidance, and if necessary confirmation of fixation of the gastric wall to the peritoneal wall and placement of the PEG tube without any interposed tissues by using ultrasound. Twenty-one patients (95.5%) successfully underwent PSEGD. Early complications (more than grade 2 in Clavien-Dindo classification) just after the procedure occurred in one case (active oozing). We did not encounter a case with mispuncture of the intraperitoneal organs and tissues. Delayed complications occurring within 1 mo were pneumonia in five patients, including death in three cases; bleeding from puncture site in two patients; and atrial fibrilation in one patient. PSEGD using the introduction method is a useful procedure for difficult patients in whom intraperitoneal organ or tissue is suspected to be interposed between the abdominal wall and stomach.

Mo1199 Novel Palliative Gastric Venting Using a Bariatric Gastric Drainage Tube for Cancer Patients With Malignant Bowel Obstruction in Advanced Ovarian Cancer Patients

Malignant small bowel obstruction (SBO) is a common complication of advanced stage metastatic tumors such as ovarian cancer. Obstructions typically occur from peritoneal metastatic disease and frequently lead to a poor quality of life. Management options include venting gastrostomy tubes to palliate nausea and vomiting however standard percutaneous endoscopic gastrostomy (PEG) feeding tubes are small diameter (20-24 Fr) and can become obstructed easily. The purpose of this study is to evaluate the feasibility of a large caliber modified PEG tube which was created for bariatric weight loss.

Efficacy and future of endoscopic bariatric surgery in the treatment of obesity and metabolic diseases

The emerging endoscopic technologies are proved to be effective treatments for obesity in selected patients and to offer the potential advantages of reduced invasiveness, reversibility and repeatability. From the view of operation principle, endoscopic technologies can be classified as restrictive procedure, malabsorption procedure and endoscopic revision of gastric bypass. Restrictive procedures include intragastric balloon, aspiration therapy, endoscopic sleeve gastroplasty (ESG) and transoral gastroplasty. Intragastric balloon employs space occupying, volume restriction and satiety mechanisms, which is superior to drugs and lifestyle change, but shorter than sleeve and bypass surgery. Aspiration therapy is similar to standard percutaneous endoscopic gastrostomy, while there are no available data regarding the obesity and metabolic improvement. Compared with traditional bariatric surgery, ESG does not excise gastric tissue with less complications and without weight regain, but it can not be used as an independent operation still now. Transoral gastroplasty is rarely applied clinically whose efficacy and long-term complications need further studies. Malabsorption surgery includes endoscopic duodenojejunal bypass sleeve (EDJBS) and endoscopic gastroduodenojejunal bypass sleeve(EGDJBS). EDJBS may have the similar mechanism like bypass reducing the blood glucose. Even with obvious effect of weight loss, EDJBS has high morbidity of complications and requirements of the skilled operators. EGDJBS, which imitates bypass anatomy changes and belongs to the mixed operation, should be superior to the above procedures in reducing weight theoretically, but due to the lack of clinical data, its short-term and long-term efficacy still need further clinical observation. As compared to the complexity and risks associated with telescopic surgical revision, endoscopic suturing has been confirmed as less invasive and safer for stomal revisions, while its long-term efficacy of reducing weight and improvement of diabetes are not yet clear. Even if long-term efficacy of reducing weight and morbidity of complication in endoscopic bariatric surgery are still indefinite, and clinical trial researches of large sample and long-term follow-up are absent, with the development of endoscopic skill and the gradual clinical application, endoscopic bariatric surgery will provide a new option for the patients of obesity and metabolic diseases.

Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy Combined with CT-GC

ABSTRACTPurpose: Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. Materials and Methods: In total, seven high-risk individuals diagnosed using computed tomography (CT)-gastrocolonography (GC) underwent laparoscopic-assisted PEG (LAPEG) placement. Study endpoints included the success of LAPEG under local anesthetic and intravenous sedation, inability to thread the PEG tube, the eventual tube location, the number of tube adjustments needed, adverse events, the operating time, and PEG tube-related infection. Results: In total, 135 PEG procedures were performed during this study. Successful CT-GC was achieved in all 135 patients, and we successfully used a standard PEG technique to place the gastrostomy tube in 128 patients (95%). In seven patients (5%), the LAPEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. LAPEG procedure-related minor complications were observed in two patients. Conclusions: LAPEG combined with CT-GC can be used for patients with difficult anatomical orientations and may minimize the risk of complications in PEG placement.

Percutaneous Endoscopic Gastrostomy in Direct Puncture Technique: When, Why and How?

Background: Percutaneous endoscopic gastrostomy (PEG) placed in the pull through (PT) technique is a common procedure to restore enteral feeding in patients with swallowing disorders. Limitations of this technique are patients with obstruction of the pharynx or esophagus or with an esophageal stent. We report our experience with the direct puncture (DP) PEG device. Methods: We included 154 patients (55 women). One hundred forty patients had cancer. After passing the endoscope into the stomach, 4 gastropexies were performed with a gastropexy device and the PEG was placed with the introducer method. After 1 month, the sutures were removed and a constant gastrocutaneous fistula had been created and the new catheter could be placed safely. Results: The DP PEG was successfully placed in all patients. Overall complication rate was 11% (minor: 6%, major: 5%). The most common event was tube dislocation (40 cases). In 5 cases of dislocation, this resulted in a major complication with injuring the gastric wall and the necessity for surgical treatment. Conclusions: The DP PEG system is safe, and can be used in cases in which a standard PT PEG is not feasible. To avoid dislocation, strict adherence to a post-interventional protocol is highly recommended.

PTU-098 Improving PEG Completion Rates: Adoption of an Algorithm to Maximise Success: An 18 Month Single-Centre Review

Introduction Percutaneous endoscopic gastrostomy (PEG) placement is an established technique for nutritional support, with a procedural success rate around 95% in most case series. 1 Failed procedures generally need alternative surgical or radiolofical approaches. In recent years we have adopted an algorithm for maximising PEG placement success rate and have now reviewed our outcomes. Methods Referrals are vetted by the nutrition support team before selection and cases accepted for PEG are listed on a consultant gastroenterologist’s list. The preferred procedural algorithm is: 1 A standard PEG technique is used with finger indentation and a safe-track technique; transillumination not considered necessary. 2 Trochar insertion into the stomach is assisted by counter-traction on the surrounding mucosa with a snare if necessary. 3 If this doesn’t help then the PEG trochar +/- sheath are removed and a long drainage access (kellett) needle is passed to assist gastric puncture. 4 If the PEG is unsuccessful, then a further attempt on another day is considered with another endoscopist if necessary. For this review, the nutrition team, endoscopy and clinical databases were reviewed for all patients accepted for PEG placement for 18 months from July 2014 onwards. Outcome measures included PEG success rates, techniques used, procedural complications and 30 day mortality. Results 154 patients were accepted for first PEG placement. Five patients did not proceed to PEG attempt owing to death or swallowing recovery. In the 149, all patients (100%) achieved successful PEG insertion at first or second attempt. Most cases (140/149, 94%) were done with the standard pull-through technique. In 6 cases (4%) a Kellett needle was used. In 3 cases (2%) a second endoscopy procedure was required for PEG completion: in 2/3 of these cases, initial failure was attributed to inadequate trans-illumination but successful completion was later done by another endoscopist. In the third case the oesophagus could not be intubated due to a large pharyngeal pouch; this was later overcome with the help of an oesophageal guidewire placed under fluoroscopic guidance. There were no identified procedural complications and overall 30 day mortality was 9%. Conclusion The procedural algorithm we have described for PEG placement, which excludes the need for transillumination, includes optional usage of a long drainage access needle and considers a second endoscopy procedure if the first procedure fails, led to a 100% completion rate in this case series. Adoption of this approach may therefore minimise the need for other higher-risk alternatives. Reference 1 Potack JZ, Chokhavatia S. Complications of and controversies associated with PEG: Report of a case and literature review. Medscape J Med 2008; 10 (6):142. Disclosure of Interest None Declared

Computed tomography-gastro-colonography for percutaneous endoscopic gastrostomy using a helical computed tomography

BackgroundDespite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. MethodsIn total, 48 individuals underwent computed tomography-gastro-colonography (CT-GC)-guided PEG placement. Study end points included success of CT-GC, inability to thread the PEG tube, the eventual tube location, tube adjustments needed, adverse events, operating time, and PEG tube-related infection. ResultsA successful CT-GC was achieved in all 48 patients (100%), and we successfully used a standard PEG technique to place the gastrostomy tube in 44 patients (92%). In 4 patients (8%), the laparoscopic-assisted PEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. The overall procedure-related minor complication rate was 8%. ConclusionCT-GC is an optional method for the estimation of intra-abdominal, anatomical orientations that may minimize the risk of complications before PEG placement.

Endoscopic hemoclips to immediately close gastric perforation from a failed attempt at PEG in a morbidly obese patient

A serious, immediate complication of percutaneous endoscopic gastrostomy (PEG), associated with morbid obesity, that was successfully treated by endoscopic hemoclips is reported. A 52-year-old, morbidly obese woman (body mass index [BMI] 1⁄4 35.6 kg/m) without prior abdominal surgery or gastrointestinal diseases was referred for PEG after tracheostomy for prolonged ventilator-dependent respiratory failure after admission for diabetic ketoacidosis. Before this admission, she had refused referral for bariatric surgery for her morbid obesity associated with diabetes mellitus and hypertension. Esophagogastroduoderoscopy (EGD) during PEG revealed no gastrointestinal abnormalities. The PEG site was identified in the distal gastric body by transillumination and manual external pressure. PEG was performed conventionally by passing a catheter through abdominal/gastric walls into gastric lumen, passing a guidewire through the catheter, grasping the guidewire by endoscopic snare, and pulling the guidewire outside the mouth. A 20 French PEG tube (EndoVive Standard PEG kit, Boston Scientific, Spencer, IN) was tied to the guidewire and pulled through the mouth, into gastric lumen and through the gastric wall, but became stuck in the thick abdominal wall fat. The PEG tube could not be delivered anterograde through the skin, despite an adequately-sized skin incision, using multiple attempts at

Laparoscopy-assisted percutaneous endoscopic gastrostomy enables enteral nutrition even in patients with distorted anatomy

To analyzed whether laparoscopy-assisted percutaneous endoscopic gastrostomy (PEG) could be a valuable option for patients with complicated anatomy. A retrospective analysis of twelve patients (seven females, five males; six children, six young adults; mean age 19.2 years) with cerebral palsy, spastic quadriparesis, severe kyphoscoliosis and interposed organs and who required enteral nutrition (EN) due to starvation was performed. For all patients, standard PEG placement was impossible due to distorted anatomy. All the patients qualified for the laparoscopy-assisted PEG procedure. In all twelve patients, the laparoscopy-assisted PEG was successful, and EN was introduced four to six hours after the PEG placement. There were no complications in the perioperative period, either technical or metabolic. All the patients were discharged from the hospital and were then effectively fed using bolus methods. Laparoscopy-assisted PEG should become the method of choice for gastrostomy tube placement and subsequent EN if PEG placement cannot be performed safely.

PMO-203 Direct gastric puncture and gastropexy (Freka® Pexact) insertion technique for percutaneous endoscopic gastrostomy reduces peristomal infection rates compared with standard pull-through insertion in patients with head and neck cancer

IntroductionPatients with head and neck cancer often have a percutaneous endoscopic gastrostomy (PEG) inserted to provide nutritional support while undergoing treatment. The standard pull-through PEG technique is associated with a...

PMO-070 FREKA® pexact placement in patients with head and neck cancer—the city hospital experience

IntroductionPatients with head and neck cancer are at risk of malnutrition as a direct result of the tumour or as a result of treatment, that is, chemo-radiotherapy. Oral intake may...

Sa1689 Freka® Pexact Percutaneous Endoscopic Gastrostomy Placement in Patients With Head and Neck Cancer

Patients with head and neck cancer are at risk of malnutrition as a direct result of the tumour or as a result of treatment, i.e. chemo-radiotherapy. Oral intake may not be enough to maintain nutrition, therefore many patients receive enteral feeding via a percutaneous endoscopic gastrostomy (PEG). A standard pull-through PEG may expose patients to the risk of tumour seeding within the tract in patients with oro-pharyngeal and oesophageal cancers. Current British Society of Gastroenterology guidelines recommend consideration for a direct gastric puncture technique and gastropexy for percutaneous feeding tube placement, with the technique being considered mandatory in those patients being treated with curative intent.

Single loop-and-clips technique (king closure) for gastrotomy closure after transgastric ovariectomy: a survival experiment

IntroductionA safe closure technique of transluminal access is essential for the widespread application of natural orifice transluminal endoscopic surgery (NOTES).AimTo evaluate the feasibility and effectiveness of a novel single loop-and-clips closure technique (KING closure).Material and methodsAn experimental survival study using female laboratory pigs was performed. A gastrotomy was performed using a standard percutaneous endoscopic gastrostomy technique. A peritoneoscopy with an ovariectomy was then performed with a double-channel endoscope, on a total of 14 pigs. Two different techniques of gastrotomy closure were analysed: a loop-and-clips closure technique (n = 7) and a standard closure using endoclips (n = 7). After a follow-up period of 30 days, the animals were euthanized for post-mortem examination.ResultsIn the “loop-and-clip” closure group, the correct placement of an endoloop and clips was achieved in all animals. At necropsy, no animal showed signs of an abscess or peritonitis. Histological examination demonstrated a patent full-thickness gastric wall closure without evidence of local complications in all instances. In the “clips” group, the gastrotomy closure was assessed as probably unsafe in three animals. At necropsy 3 (42.9%) abscesses and 1 (14.3%) case of peritonitis were found.ConclusionsA single loop-and-clips closure technique (KING closure) represents a feasible, simple and effective method of gastric incision closure. It appears to be superior to the standard endoscopic closure technique using clips.

Evaluation of Gastropexy and Stoma Tract Maturation Using a Novel Introducer Kit for Percutaneous Gastrostomy in a Porcine Model

Fluoroscopic placement of percutaneous gastrostomy (PG) requires the use of T-bar fasteners to affix the stomach to the anterior abdominal wall; the effect of T-fasteners on stoma tract maturation is unknown. The authors studied PG stoma tract maturation, comparing PG + gastropexy with standard percutaneous endoscopic gastrostomy (PEG). Sixteen pigs underwent PG placement using a novel introducer kit. Three absorbable suture T-fasteners were placed around the stoma site, and PG was placed using the Russell method. A standard PEG was then placed using the Ponsky pull method, allowing each animal to serve as its own control. Gross and histopathological integrity of stoma tract formation was assessed at 1-3 weeks. At sacrifice, all PGs were intact with no evidence of infection, disruption, or significant leakage. Stoma tracts of all test and control sites were robust and histologically mature at all time points. Stoma tract diameters were also similar between test and control PGs (mean ± SEM: control 13.1 ± 0.7 mm, test 12.1 ± 0.4 mm; P = .2, n = 15). Histopathological evaluation demonstrated a generally comparable tissue response between test and control PGs, with slight decreases in fibrosis noted in test compared to control sites (P = .02, n = 15). Stoma tract maturation of PG with gastropexy provides similar results to standard PEG. Stoma tracts were mature at 1 week regardless of placement method. Placement and performance of PG using the new introducer kit with novel T-fasteners and absorbable suture yields effective gastric anchoring and has similar ease of use as standard PEG placement.