title: A new form of access for endo-organ surgery. The initial experience with percutaneous endoscopic gastrostomy.
abstract: BACKGROUND
  Intraluminal gastric surgery provides a new treatment option for various disease processes. This study assesses the safety of a new large-diameter percutaneous endoscopic gastrostomy (PEG) for intraluminal surgery.
  
  
  METHODS
  Investigators at six institutions were asked to complete a standard questionnaire to assess the difficulties associated with the assembly and introduction of the PEG, plus intraoperative and postoperative problems related to placement of the device.
  
  
  RESULTS
  In terms of assembly; 1.9% of respondents reported difficulty obtaining complete vacuum of the balloon tip, and 3.8% had difficulty fitting the graduated dilator to the balloon-tipped cannula. Difficulties associated with introduction of the PEG included disengagement of the dilator from the balloon-tipped cannula (0%), extraction of the dilator-port assembly (0%), difficult PEG pullout (1.9%), abdominal wall bleeding (0%), and difficult PEG dilator separation (7.5%). Intraoperatively, 7.5% of respondents reported inadequate skin bolster fitting, 1.9% had CO(2) leakage into the peritoneal cavity, 0% had inadvertent PEG extraction, and 0% reported injury to the esophagus, colon, or small intestine. Postoperatively, there was a 9.4% rate of wound infection, a 1.9% rate of gastrocutaneous fistula, and a 1.9% rate of esophageal, colon, or small intestine injury.
  
  
  CONCLUSIONS
  The large-diameter PEG is safe and effective for endo-organ surgery. Additional preventive measures for PEG site infection should be investigated.
authors.affiliation: Department of Surgery, Creighton University, 601 N. 30th Street, Suite 3740, Omaha, NE 68131, USA.
authors.forename: T
authors.initials: T
authors.lastname: Tomonaga
authors.forename: S G
authors.initials: SG
authors.lastname: Houghton
authors.forename: C J
authors.initials: CJ
authors.lastname: Filipi
authors.forename: R A
authors.initials: RA
authors.lastname: Hinder
authors.forename: J
authors.initials: J
authors.lastname: Hunter
authors.forename: B
authors.initials: B
authors.lastname: Dallemagne
authors.forename: N
authors.initials: N
authors.lastname: Katkhouda
authors.forename: R
authors.initials: R
authors.lastname: Kozarek
authors.forename: T R
authors.initials: TR
authors.lastname: DeMeester
authors.forename: R
authors.initials: R
authors.lastname: Deeik
authors.forename: Y
authors.initials: Y
authors.lastname: Shiino
authors.forename: Z T
authors.initials: ZT
authors.lastname: Awad
authors.forename: R E
authors.initials: RE
authors.lastname: Marsh
mesh_terms: D000328:Adult; D000368:Aged; D019723:Endoscopes; D005774:Gastrostomy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies