Three-Point Fixation of Stomach to Abdominal Wall in the Percutaneous Endoscopic Gastrostomy Procedure

 

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Peritonitis, resulting from either malpositioning of the gastrostomy tube or leakage to the peritoneal cavity [1] [2] [3] is reported as a major complication following the percutaneous endoscopic gastrostomy (PEG) procedure, which may lead to lethal conditions including sepsis.

The aim of this study was to evaluate safety with regard to a novel step: a three-point triangular fixation of the stomach to the abdominal wall in the PEG procedure (Fig. [1]). We applied this three-point fixation, using a commercially available fixation kit, the ”Funada-style” kit (TOP Corporation, Tokyo, Japan), in 31 patients with stroke or hypoxic encephalopathy, between November 2001 and October 2003 at Kanazawa Medical University Hospital.

Figure 1 Three-point triangular fixation of stomach to abdominal wall with a commercially available fixation kit, in a percutaneous endoscopic gastrostomy (PEG) procedure (intragastric view).

The presence of complications following PEG was retrospectively analyzed by reviewing the hospital medical charts. The complication rate following the PEG with a triple gastropexy was compared with that following PEG without gastropexy (n = 10). No adverse events, including peritonitis or hemorrhage, were observed during the follow-up period after the PEG with three-point fixation, except for transient mild fever (less than 38 °C) in two patients. On the other hand, subcutaneous abscess (complication rate 40 %) and gastric ulcer caused by the bumper on the mucosa (20 %) were observed in the patients who underwent PEG without gastropexy. Using the three-point fixation method, we were able to obtain a minimal distance (30 - 40 mm) between the stomach and the abdominal wall, and it appears that this mainly contributed to the lower occurrence of complications following PEG.

Our results suggest that three-point triangular fixation of the stomach to the abdominal wall in the PEG procedure might establish a safe route for tube feeding. Future studies with larger numbers and nonselected patient groups, and with long-term follow up, are needed to clarify the possible advantage of this method.

Endoscopy_UCTN_Code_TTT_1AO_2AK

References

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T. Kanda, M. D.

Department of General Medicine
Kanazawa Medical University

1-1 Daigaku, Uchinada-machi
Kahoku-gun
Ishikawa 920-0293
Japan

Fax: +81-76-2862702

Email: kandat@kanazawa-med.ac.jp