title: Modified technique for introducer-type percutaneous endoscopic gastrostomy and jejunostomy: assisted by a novel trocar and fasteners.
abstract: OBJECTIVE
  Commercially available kits for percutaneous endoscopic gastrostomy (PEG) and jejunostomy comprise a substantial proportion of the cost of patients for this procedure. A modified introducer-type technique and new instrumentation for PEG and jejunostomy that substantially reduces the cost of the kit were tested for efficacy and safety.
  
  
  METHODS
  This technique was tested on 10 pigs as a pilot study, and then applied to seven consecutive patients undergoing gastrostomy and three patients undergoing gastrostomy with jejunostomy. The endoscopy and site selection for gastrostomy were the same as in standard PEG. Two novel fasteners for fixing the gastric wall to the abdominal wall and a guide-wire in the selected site were inserted separately into the stomach through 15-gauge needles. A stainless steel trocar with a detachable sheath was introduced into the stomach over the guide-wire. After the inner stylet was removed, a 24-French Foley catheter was inserted as a feeding tube. Gastrostomy was completed after balloon inflation and external fixation. If jejunostomy was indicated, a 12-French nasogastric tube was inserted through the gastrostomy. The procedure time, complications, and costs were compared with those for another 15 consecutive patients who underwent the conventional pull-through method of PEG and jejunostomy using commercially available kits.
  
  
  RESULTS
  No significant difference was found in procedure time between patients who underwent the modified or conventional gastrostomy procedures (mean +/- standard deviation, 15.4 +/- 5.6 min). There was a similar incidence of short-term complications in the two treatment groups. The feeding catheters required replacement more quickly than did those in the commercial kits (80 +/- 58 vs 217 +/- 140 d). The cost to patients was much less with the new method than with conventional PEG.
  
  
  CONCLUSIONS
  The new gastrostomy method achieves the same medical quality at far less cost for patients.
authors.affiliation: Department of Internal Medicine, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan.
authors.forename: X Z
authors.initials: XZ
authors.lastname: Lin
authors.forename: C Y
authors.initials: CY
authors.lastname: Chen
authors.forename: C S
authors.initials: CS
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D005260:Female; D005773:Gastroscopy; D005774:Gastrostomy / Q000379:methods*; D017048:Health Care Costs; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013525:Surgical Instruments; D013552:Swine