title: Percutaneous Endoscopic Gastrostomy in Direct Puncture Technique: When, Why and How?
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG) placed in the pull through (PT) technique is a common procedure to restore enteral feeding in patients with swallowing disorders. Limitations of this technique are patients with obstruction of the pharynx or esophagus or with an esophageal stent. We report our experience with the direct puncture (DP) PEG device.
  
  
  METHODS
  We included 154 patients (55 women). One hundred forty patients had cancer. After passing the endoscope into the stomach, 4 gastropexies were performed with a gastropexy device and the PEG was placed with the introducer method. After 1 month, the sutures were removed and a constant gastrocutaneous fistula had been created and the new catheter could be placed safely.
  
  
  RESULTS
  The DP PEG was successfully placed in all patients. Overall complication rate was 11% (minor: 6%, major: 5%). The most common event was tube dislocation (40 cases). In 5 cases of dislocation, this resulted in a major complication with injuring the gastric wall and the necessity for surgical treatment.
  
  
  CONCLUSIONS
  The DP PEG system is safe, and can be used in cases in which a standard PT PEG is not feasible. To avoid dislocation, strict adherence to a post-interventional protocol is highly recommended.
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Schaefer
authors.forename: Carlo
authors.initials: C
authors.lastname: Vivaldi
authors.forename: Till
authors.initials: T
authors.lastname: Herbold
authors.forename: Sebastian
authors.initials: S
authors.lastname: Brinkmann
authors.forename: Martin
authors.initials: M
authors.lastname: Maus
authors.forename: Marc
authors.initials: M
authors.lastname: Bludau
authors.forename: Ulrich
authors.initials: U
authors.lastname: Töx
authors.forename: Tobias
authors.initials: T
authors.lastname: Goeser
authors.forename: Arnulf H
authors.initials: AH
authors.lastname: Hoelscher
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Leers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004750:Enteral Nutrition; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D059485:Gastropexy; D005773:Gastroscopy; D005774:Gastrostomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure / Q000009:adverse effects*; D012189:Retrospective Studies; D013270:Stomach / Q000293:injuries; D055815:Young Adult