Successful new method of extracorporeal percutaneous endoscopic gastrostomy (E-PEG).
BACKGROUND
Although percutaneous endoscopic gastrostomy (PEG) has become popular for patients with swallowing disorders as a nutrition support or a decompressant of gastrointestine, perioperative complications associated with PEG have not decreased, especially peristomal infections. To reduce peristomal infections, we designed a new method of gastrostomy by extracorporeal approach under endoscopic observation, named as extra-corporeal PEG (E-PEG).


METHODS
Experimental studies for E-PEG were performed repeatedly using pigs under general anesthesia to confirm the safety of its procedure for human use. After approval of institutional ethics review board in our university, thirty patients with prior consent participated in this study. The operation time, the incidence rate of complications and the hospital stay were compared between E-PEG and ordinary pull-method PEG groups.


RESULTS
Two patients (6.7%) in E-PEG group had postoperative complications, i.e., aspiration pneumonia and surgical site infection. The operation time of E-PEG group was 5-16 (mean +/- SD: 10.3 +/- 2.96) min as compared to 14-37 (mean +/- SD: 26.9 +/- 8.39) min with pull-method PEG. The postoperative hospital day of E-PEG was within two days except for the two complicated cases. Significance differences of operation time, complication rate and postoperative hospital stay between those groups observed statistically.


CONCLUSIONS
These results indicate that E-PEG was safe, tolerable and speedy when compared ordinary pull-method PEG.
Toyama
Yoichi
Y
Department of Surgery, Jikei University School of Medicine, Kashiwa, Chiba, Japan. yoichitoyama@k7.dion.ne.jp
Usuba
Teruyuki
T
Son
Kyonsu
K
Yoshida
Seiya
S
Miyake
Ryou
R
Ito
Ryusuke
R
Tsuboi
Kazuto
K
Kashiwagi
Hideyuki
H
Tajiri
Hisao
H
Yanaga
Katsuhiko
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000601:surgery*; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome