Three-Point Fixation of Stomach to Abdominal Wall in the Percutaneous Endoscopic Gastrostomy Procedure

Inhaltsübersicht

Peritonitis, resulting from either malpositioning of the gastrostomy tube or leakage to the peritoneal cavity [1] [2] [3] is reported as a major complication following the percutaneous endoscopic gastrostomy (PEG) procedure, which may lead to lethal conditions including sepsis.

The aim of this study was to evaluate safety with regard to a novel step: a three-point triangular fixation of the stomach to the abdominal wall in the PEG procedure (Fig. [1]). We applied this three-point fixation, using a commercially available fixation kit, the ”Funada-style” kit (TOP Corporation, Tokyo, Japan), in 31 patients with stroke or hypoxic encephalopathy, between November 2001 and October 2003 at Kanazawa Medical University Hospital.

Figure 1 Three-point triangular fixation of stomach to abdominal wall with a commercially available fixation kit, in a percutaneous endoscopic gastrostomy (PEG) procedure (intragastric view).

The presence of complications following PEG was retrospectively analyzed by reviewing the hospital medical charts. The complication rate following the PEG with a triple gastropexy was compared with that following PEG without gastropexy (n = 10). No adverse events, including peritonitis or hemorrhage, were observed during the follow-up period after the PEG with three-point fixation, except for transient mild fever (less than 38 °C) in two patients. On the other hand, subcutaneous abscess (complication rate 40 %) and gastric ulcer caused by the bumper on the mucosa (20 %) were observed in the patients who underwent PEG without gastropexy. Using the three-point fixation method, we were able to obtain a minimal distance (30 - 40 mm) between the stomach and the abdominal wall, and it appears that this mainly contributed to the lower occurrence of complications following PEG.

Our results suggest that three-point triangular fixation of the stomach to the abdominal wall in the PEG procedure might establish a safe route for tube feeding. Future studies with larger numbers and nonselected patient groups, and with long-term follow up, are needed to clarify the possible advantage of this method.

Endoscopy_UCTN_Code_TTT_1AO_2AK

References

• 1 Grant J P. Percutaneous endoscopic gastrostomy. Initial placement by single endoscopic technique and long-term follow-up.  Ann Surg. 1993;  217 168-174
• 2 Peteren T I, Kruse A. Complications of percutaneous endoscopic gastrostomy.  Eur J Surg. 1997;  163 351-356
• 3 Kimber C P, Khattak I U, Kiely E M. et al . Peritonitis following percutaneous gastrostomy in children: management guidelines.  Aust N Z J Surg. 1998;  68 268-270