title: Usefulness of the introducer method for percutaneous endoscopic gastrostomy using ultrathin transnasal endoscopy.
abstract: BACKGROUND
  The introducer method of percutaneous endoscopic gastrostomy (PEG) minimizes procedure-related peristomal infection. Ultrathin transnasal endoscopy (UTE) allows comfortable endoscopic examination of patients with fewer adverse effects and passage of the endoscope through a narrow esophagus or oropharynx. This study aimed to investigate the clinical outcomes for the introducer method of PEG with UTE.
  
  
  METHODS
  Patients who underwent the introducer method of PEG with UTE between March 2009 and May 2012 were analyzed. The outcomes and complications of the patients within 180 days after gastrostomy placement were investigated.
  
  
  RESULTS
  During the study period, 92 patients (31.9 % male; age, 67.7 ± 16.6 years) underwent the introducer method of PEG with UTE. The major indications for PEG insertion were stroke (40.4 %), esophageal cancer or head and neck cancer (27.1 %), and neurologic disorder (14.9 %). Esophageal stenosis was identified by endoscopy or imaging in 14 patients before PEG. In all the patients, UTE was successfully introduced through the nasal cavity. In 90 (97.8 %) of the 92 patients, PEG was successfully inserted. Insertion of the endoscope into the stomach was impossible in two patients because head and neck cancer caused severe narrowing of the upper esophagus. No procedure-related peristomal infection, gastric contents leakage, or bleeding occurred within 30 days after gastrostomy placement. In eight patients (8.7 %), catheter displacement occurred within 30 days. Catheter displacement in 44 patients (47.8 %) and gastric contents leakage in eight patients (9 %) occurred within 30-180 days after gastrostomy placement.
  
  
  CONCLUSIONS
  Introducer PEG with UTE is a useful method for gastrostomy placement with a high success rate. This technique allows procedure-related complications to be avoided and permits the use of endoscopy in patients with narrow esophagi or oropharynges. However, the long-term durability of the balloon-type catheter is questionable.
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea College of Medicine, #505 Banpo-dong, Seocho-gu, Seoul, 137-701, Korea, lhscd11@naver.com.
authors.forename: Hong Seok
authors.initials: HS
authors.lastname: Lee
authors.forename: Chul-Hyun
authors.initials: CH
authors.lastname: Lim
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Park
authors.forename: Wook-Hyun
authors.initials: WH
authors.lastname: Lee
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: No
authors.forename: Byoung Yeon
authors.initials: BY
authors.lastname: Jun
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Moon
authors.forename: Jin Su
authors.initials: JS
authors.lastname: Kim
authors.forename: Yu Kyung
authors.initials: YK
authors.lastname: Cho
authors.forename: Jae Myung
authors.initials: JM
authors.lastname: Park
authors.forename: In Seok
authors.initials: IS
authors.lastname: Lee
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Kim
authors.forename: Myung-Gyu
authors.initials: MG
authors.lastname: Choi
authors.forename: Kyu Yong
authors.initials: KY
authors.lastname: Choi
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008904:Miniaturization / Q000295:instrumentation*; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation*; D009666:Nose; D012189:Retrospective Studies