Department of Surgery, Ludwig-Maximilians-University, Munich, Campus Grosshadern Marchioninistrasse 15, 81377, Munich, Germany.
Surg Endosc. 2013 Apr;27(4):1186-95. doi: 10.1007/s00464-012-2574-z. Epub 2012 Dec 12.
Percutaneous endoscopic gastrostomy (PEG) or percutaneous endoscopic jejunostomy (PEJ) are substantial for patients with swallowing disorders to maintain enteral nutrition or to decompress palliatively intractable small bowel obstruction. Endoscopic placement can be impossible due to previous (gastric) operation, obesity, hepato-splenomegaly, peritoneal carcinosis, inadequate transillumination, or obstructed passage. Computed tomography (CT)-fluoroscopic guidance with or without endoscopy can enable placement of CT-PG/CT-PJ or CT-PEG/CT-PEJ if endoscopically guided placement fails. In this retrospective study, we will evaluate the feasibility and safety of this method.
A total of 101 consecutive patients were referred to our department for feeding support (n = 87) or decompression (n = 14). Reasons were: ENT tumor (n = 51), esophageal cancer (n = 19), mediastinal mass (n = 2), neurological disorder (n = 15). Decompression tubes were placed because of cancer (n = 13) or Crohn's disease (n = 1). The following approaches were chosen: CT fluoroscopy and simultaneous gastroscopy (n = 61), inflation of the stomach via nasogastric tube (n = 29), and direct puncture under CT-fluoroscopic guidance (n = 11).
CT fluoroscopy-guided gastrostomy was feasible in 89 of 101 patients. No procedure-related mortality was observed. One tube was misplaced into the colon in a patient with a history of gastrectomy. No complication was seen after removal. Minor complications: dislodgement (n = 17), peristomal leakage (n = 7), wound infection (n = 1), superficial skin infection (n = 6), tube obstruction (n = 2).
CT fluoroscopy-guided PG/PJ or PEG/PEJ is feasible and safe and provides adequate feeding support or decompression. It offers the benefits of minimally invasive therapy even in patients with contraindications to established endoscopic methods, combining the advantages of both techniques. Long-term complications-mainly tube-related problems-are easily treated.
经皮内镜胃造口术（PEG）或经皮内镜空肠造口术（PEJ）对于吞咽障碍患者维持肠内营养或姑息性治疗难治性小肠梗阻非常重要。由于先前的（胃）手术、肥胖、肝脾肿大、腹膜癌、光照不足或通道阻塞，内镜放置可能无法进行。如果内镜引导放置失败，CT 透视引导下联合或不联合内镜检查可使 CT-PG/CT-PJ 或 CT-PEG/CT-PEJ 得以放置。在这项回顾性研究中，我们将评估这种方法的可行性和安全性。
共有 101 例连续患者因喂养支持（n = 87）或减压（n = 14）被转至我们科室。原因如下：耳鼻喉肿瘤（n = 51）、食管癌（n = 19）、纵隔肿块（n = 2）、神经障碍（n = 15）。减压管放置的原因是癌症（n = 13）或克罗恩病（n = 1）。选择了以下方法：CT 透视和同时进行胃镜检查（n = 61）、经鼻胃管充气（n = 29）和 CT 透视引导下直接穿刺（n = 11）。
101 例患者中有 89 例 CT 透视引导下胃造口术是可行的。未观察到与操作相关的死亡率。1 例既往行胃切除术的患者中，1 根造瘘管错位进入结肠。移除后未见并发症。轻微并发症：移位（n = 17）、造口周围漏（n = 7）、伤口感染（n = 1）、浅表皮肤感染（n = 6）、管腔阻塞（n = 2）。
CT 透视引导下 PG/PJ 或 PEG/PEJ 是可行且安全的，可为患者提供充足的喂养支持或减压。它提供了微创治疗的好处，即使对于不适合既定内镜方法的患者也是如此，结合了两种技术的优势。长期并发症——主要是与管腔相关的问题——很容易治疗。
