Endoscopy 2007; 39(8): 686-691
DOI: 10.1055/s-2007-966604
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Ultrasound-guided percutaneous endoscopic gastrostomy in patients with negative diaphanoscopy

K.  Schlottmann1 , F.  Klebl1 , R.  Wiest1 , S.  Grüne1 , F.  Kullmann1 , J.  Schölmerich1 , D.  Schacherer1
  • 1Department of Internal Medicine I, University Hospital of Regensburg, Germany
Weitere Informationen

Publikationsverlauf

eingereicht 6 August 2006

akzeptiert 17 January 2007

Publikationsdatum:
30. Juli 2007 (online)

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.

References

  • 1 Ponsky J L, Gauderer M WL. Percutaneous endoscopic gastrostomy. A non-operative technique for feeding gastrostomy.  Gastrointest Endosc. 1981;  27 9-11
  • 2 Gauderer M W. Twenty years of percutaneous endoscopic gastrostomy: origin and evolution of a concept and its expanded applications.  Gastrointest Endosc. 1999;  50 879-883
  • 3 . Guidelines of the German Association of Nutritional Medicine: Enteral Feeding.  Aktuel Ernahrungsmed. 2003;  28: Suppl 1 26-35
  • 4 Vogt W, Messmann H, Lock G. et al . CT-guided percutaneous endoscopic gastrostomy: a successful method if transillumination is not possible.  Dtsch Med Wochenschr. 1996;  121 359-363
  • 5 Bleck J S, Reiss B, Gebel M. et al . Percutaneous sonographic gastrostomy: method, indications, and problems.  Am J Gastroenterol. 1998;  93 941-945
  • 6 De Baere T, Chapot R, Kuoch V. et al . Percutaneous gastrostomy with fluoroscopic guidance: single-center experience in 500 consecutive cancer patients.  Radiology. 1999;  210 651-654
  • 7 Panzer S, Harris M, Berg W. et al . Endoscopic ultrasound in the placement of a percutaneous endoscopic gastrostomy tube in the non-transilluminated abdominal wall.  Gastrointest Endosc. 1995;  42 88-90
  • 8 Schlottmann K, Gelbmann C, Schölmerich J, Lock G. Intercostal percutaneous ultrasound guided decompressive gastrostomy (PUG) - a case report.  Ultraschall Med. 2001;  22 153-155
  • 9 Herman L L, Hoskins W J, Shike M. Percutaneous endoscopic gastrostomy for decompression of the stomach and small bowel.  Gastrointest Endosc. 1992;  38 314-318
  • 10 Larson D E, Burton D D, Schroeder K W, Di Magno E P. Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients.  Gastroenterology. 1987;  93 48-52
  • 11 Benkov K J, Kazlow P G, Waye J D, Leleiko N S. Percutaneous endoscopic gastrostomies in children.  Pediatrics. 1986;  77 248-250
  • 12 Ponsky J L, Gauderer M W, Stellato T A. Percutaneous endoscopic gastrostomy. Review of 150 cases.  Arch Surg. 1983;  118 913-914
  • 13 Ponsky J L, Gauderer M W, Stellato T A, Aszodi A. Percutaneous approaches to enteral alimentation.  Am J Surg. 1985;  149 102-105
  • 14 Foutch P G, Haynes W C, Ballapravalu S, Sanowski R A. Percutaneous endoscopic gastrostomy (PEG). A new procedure comes of age.  J Clin Gastroenterol. 1986;  8 10-15
  • 15 Cosentini E P, Sautner T, Gnant M. et al . Outcomes of surgical, percutaneous endoscopic, and percutaneous radiologic gastrostomies.  Arch Surg. 1998;  133 1076-1083
  • 16 Mamel J J. Percutaneous endoscopic gastrostomy.  Am J Gastroenterol. 1989;  84 703-710
  • 17 Mequid M M, Williams L F. The use of gastrostomy to correct malnutrition.  Surg Gynecol Obstet. 1979;  149 27-32
  • 18 Cory D A, Fitzgerald J F, Cohen M D. Percutaneous nonendoscopic gastrostomy in children.  AJR Am J Roentgenol. 1988;  151 995-997
  • 19 Vargo J J, Germain M M, Swenson J A, Harrison C R. Ultrasound-assisted percutaneous endoscopic gastrostomy in a patient with advanced ovarian carcinoma and recurrent intestinal obstruction.  Am J Gastroenterol. 1993;  88 1946-1948
  • 20 Höroldt B S, Lee F KT, Gleeson D. et al . Ultrasound guidance in the placement of a percutaneous endoscopic gastrostomy (PEG): an adjuvant technique in patients with abdominal varices.  Dig Liver Dis. 2005;  37 709-712
  • 21 Loser C, Aschl G, Hebuterne X. et al . ESPEN guidelines on artificial enteral nutrition - percutaneous endoscopic gastrostomy (PEG).  Clin Nutr. 2005;  24 848-861
  • 22 Ponsky J L. Transilluminating percutaneous endoscopic gastrostomy.  Endoscopy. 1998;  30 621-622

K. Schlottmann, MD

Department of Internal Medicine I

University Hospital of Regensburg

93042 Regensburg

Germany

Fax: +49-941-9447004

eMail: klaus.schlottmann@klinik.uni-regensburg.de