Suzuki Yutaka, Urashima Mitsuyoshi, Yoshida Hideki, Iwase Tsuyoshi, Kura Toshiroh, Imazato Shin, Kudo Michiaki, Ohta Tomoyuki, Mizuhara Akihiro, Tamamori Yutaka, Muramatsu Hirohito, Nishiguchi Yukio, Nishiyama Yorihiro, Takahashi Mikako, Nishiwaki Shinji, Matsumoto Masami, Goshi Satoshi, Sakamoto Shigeo, Uchida Nobuyuki, Ijima Masashi, Ogawa Tetsushi, Shimazaki Makoto, Takei Shinichi, Kimura Chikou, Yamashita Satoyoshi, Endo Takao, Nakahori Masato, Itoh Akihiko, Kusakabe Toshiro, Ishizuka Izumi, Iiri Takao, Fukasawa Shingo, Arimoto Yukitsugu, Kajitani Nobuaki, Ishida Kazuhiko, Onishi Koji, Taira Akihiko, Kobayashi Makoto, Itano Yasuto, Kobuke Toshiya
Department of Surgery, International University of Health and Welfare, Otawara.
Intern Med. 2009;48(24):2077-81. doi: 10.2169/internalmedicine.48.2598.
During tube exchange for percutaneous endoscopic gastrostomy (PEG), a misplaced tube can cause peritonitis and death. Thus, endoscopic or radiologic observation is required at tube exchange to make sure the tube is placed correctly. However, these procedures cost extensive time and money to perform in all patients at the time of tube exchange. Therefore, we developed the "sky blue method" as a screening test to detect misplacement of the PEG tube during tube exchange.
First, sky blue solution consisting of indigocarmine diluted with saline was injected into the gastric space via the old PEG tube just before the tube exchange. Next, the tube was exchanged using a standard method. Then, we checked whether the sky blue solution could be collected through the new tube or not. Finally, we confirmed correct placement of the tube by endoscopic or radiologic observation for all patients.
A total of 961 patients were enrolled. Each tube exchange took 1 to 3 minutes, and there were no adverse effects. Four patients experienced a misplaced tube, all of which were detectable with the sky blue method. Diagnostic parameters of the sky blue method were as follows: sensitivity, 94% (95%CI: 92-95%); specificity, 100% (95%CI: 40-100%); positive predictive value, 100% (95%CI: 100-100%); negative predictive value, 6% (95%CI: 2-16%).
These results suggest that the number of endoscopic or radiologic observations to confirm correct replacement of the PEG tube may be reduced to one fifteenth using the sky blue method.
在经皮内镜下胃造口术（PEG）换管期间，置管位置不当可导致腹膜炎甚至死亡。因此，换管时需要进行内镜或放射学检查以确保导管位置正确。然而，这些检查在所有患者换管时进行会花费大量时间和金钱。因此，我们开发了“天蓝色法”作为一种筛查试验，以检测PEG换管期间导管位置不当。
首先，在换管前，通过旧的PEG管将由靛胭脂用生理盐水稀释而成的天蓝色溶液注入胃腔。接下来，使用标准方法进行换管。然后，我们检查天蓝色溶液是否能通过新管收集到。最后，我们通过内镜或放射学检查确认所有患者的导管位置是否正确。
共纳入961例患者。每次换管耗时1至3分钟，且无不良反应。4例患者出现导管位置不当，所有这些情况均可通过天蓝色法检测到。天蓝色法的诊断参数如下：灵敏度为94%（95%CI：92-95%）；特异度为100%（95%CI：40-100%）；阳性预测值为100%（95%CI：100-100%）；阴性预测值为6%（95%CI：2-16%）。
这些结果表明，使用天蓝色法可将确认PEG管正确更换所需的内镜或放射学检查次数减少至十五分之一。
