PERCUTANEOUS ENDOSCOPIC GASTROSTOMY PLACEMENT USING THE PULL-THROUGH OR PUSH-THROUGH TECHNIQUES - IS THE 2ND PASS OF THE GASTROSCOPE NECESSARY

Background and Study Aims: The pull-through and push-through technique s widely used for placing a percutaneous endoscopic gastrostomy (PEG) require two passes of the gastroscope, The second pass is considered n ecessary to assess the correct positioning of the internal bumper The aim of the present study was to verify whether the second pass is in f act necessary, or whether it could be omitted in most cases. Patients and Methods: Eighty patients undergoing pull-through or push-through P EG placement mere included in this prospective study, and were randoml y assigned to two groups, In the first group, two passes of the gastro scope were carried out, while in the second group the second pass was omitted and the position of the internal bumper was manually assessed by finger palpation of the abdominal wail after the feeding tube had b een pulled out through the abdomen. If finger palpation was not consid ered satisfactory, a control gastroscopy was carried out, In the other cases, plain radiographs of the abdomen were carried out within six h ours of the procedure. Results: Thirty-nine patients underwent two-pas s PEG placement, and 41 received one-pass PEG placement. In one patien t who had a one-pass procedure, the finger palpation was not considere d satisfactory; however, a control gastroscopy showed that the interna l bumper was correctly placed. In all other one-pass PEG patients, pla in radiography of the abdomen showed that the internal bumper was at a n adequate distance from the abdominal wall, No major or minor complic ations associated with the procedure were observed in either group, Bo wel sounds reappeared within 24 hours of the procedure in all patients except for one in the two-pass group, in whom they reappeared after 3 6 hours. One wound infection, treated with systemic antibiotics, occur red in each group within 30 days of the PEG placement, The procedure t ime saved in the one-pass PEG group averaged 1.5 minutes. Conclusions: One-pass PEG placement appears to be as safe as the classic pull-thro ugh and push-through PEG methods, and can be used routinely to make th e procedure quicker and reduce the discomfort for the patient, as well as reducing the risks and costs associated with the second pass of th e gastroscope. A control gastroscopy can be reserved for patients with morbid obesity, or for cases in which finger palpation is not conside red satisfactory.