A new form of access for endo-organ surgery - The initial experience with percutaneous endoscopic gastrostomy

Background: Intraluminal gastric surgery provides a new treatment option fo r various disease processes. This study assesses the safety of a new large- diameter percutaneous endoscopic gastrostomy (PEG) for Intraluminal surgery . Methods: Investigators at six institutions were asked to complete a standar d questionnaire to assess the difficulties associated with the assembly and introduction of the PEG, plus intraoperative and postoperative problems re lated to placement of the device. Results: In terms of assembly; 1.9% of respondents reported difficulty obta ining complete vacuum of the balloon tip, and 3.8% had difficulty fitting t he graduated dilator;to the balloon-tipped cannula, Difficulties associated with introduction of the PEG included disengagement of the dilator from th e balloon-tipped cannula (0%), extraction of the dilator-port assembly (0%) , difficult PEG pullout (1.9%), abdominal wall bleeding (0%), and difficult PEG dilator separation (7.5%), Intraoperatively, 7.5% of respondents repor ted inadequate skin holster fitting, 1.9% had CO2 leakage into the peritone al cavity, 0% had inadvertent PEG extraction, and 0% reported injury to the esophagus, colon, or small Intestine. Postoperatively, there was a 9.4% ra te of wound infection, a 1.9% rate of gastrocutaneous fistula, and a 1.9% r ate of esophageal, colon, or small intestine injury. Conclusions: The large-diameter PEG is safe and effective for endo-organ su rgery. Additional preventive measures for PEG site infection should be inve stigated.