Is abdominal sonography helpful in advance of percutaneous endoscopic gastrostomies?

Purpose: Percutaneous endoscopic gastrostomy was first described in 1980. It is generally excepted as method of choice for providing enteral nutrition in dysphagic patients. Overall complication rates are 27 to 39% at two months in several surveys. Diaphanization is assessed as not necessary in advance of the intervention. Our question was, whether pre-endoscopic abdominal ultrasound is helpful to avoid complications.

Material and methods: From March 2010 to February 2013 we performed abdominal sonography in 125 of 568 patients, who were sent for percutaneous gastrostomy to our endoscopic unit (Group A). 69 Patients with ENT- tumors received their percutaneous gastrostomy during surgical resection in the operation theatre without sonography (Group B).

Results: In group A we examined 75 male and 50 female patients. Age ranged from 32 to 88 years in male patients (average 67.57 years), 45 to 95 years in female patients (average 77.8 years). Most of them had neurologic disorders (head injury or stroke) or dementia, only few had tumors of head and neck. We found four cases of ascites (3.2%), so that percutaneous endoscopic gastrostomy was contraindicated, and one upside down stomach (0.08%), which resulted in primary transthoracic percutaneous gastrostomy. Group B consisted of 69 patients (52 male, 38 – 78 years, average 55.6 years, 17 female, 38 – 82 years, average age 55.5 years). Here we found two ascites fistulas in male patients due to not detected liver cirrhoses, and one failed puncture due to upside down stomach.

Conclusion: In our study, preendoscopic ultrasound discovered contraindications against percutaneous gastrostomy in 3.2% of our patients. In one case we avoided an incorrect attempt, in four cases we avoided endoscopic interventions in a situation, which was likley for complications. We recommend further studies concerning this topic.