Lee Hong Seok, Lim Chul-Hyun, Park Eun Young, Lee Wook-Hyun, No Jin Hee, Jun Byoung Yeon, Moon Sung Jin, Kim Jin Su, Cho Yu Kyung, Park Jae Myung, Lee In Seok, Kim Sang Woo, Choi Myung-Gyu, Choi Kyu Yong
Department of Internal Medicine, The Catholic University of Korea College of Medicine, #505 Banpo-dong, Seocho-gu, Seoul, 137-701, Korea,
Surg Endosc. 2014 Feb;28(2):603-6. doi: 10.1007/s00464-013-3215-x. Epub 2013 Oct 3.
The introducer method of percutaneous endoscopic gastrostomy (PEG) minimizes procedure-related peristomal infection. Ultrathin transnasal endoscopy (UTE) allows comfortable endoscopic examination of patients with fewer adverse effects and passage of the endoscope through a narrow esophagus or oropharynx. This study aimed to investigate the clinical outcomes for the introducer method of PEG with UTE.
Patients who underwent the introducer method of PEG with UTE between March 2009 and May 2012 were analyzed. The outcomes and complications of the patients within 180 days after gastrostomy placement were investigated.
During the study period, 92 patients (31.9 % male; age, 67.7 ± 16.6 years) underwent the introducer method of PEG with UTE. The major indications for PEG insertion were stroke (40.4 %), esophageal cancer or head and neck cancer (27.1 %), and neurologic disorder (14.9 %). Esophageal stenosis was identified by endoscopy or imaging in 14 patients before PEG. In all the patients, UTE was successfully introduced through the nasal cavity. In 90 (97.8 %) of the 92 patients, PEG was successfully inserted. Insertion of the endoscope into the stomach was impossible in two patients because head and neck cancer caused severe narrowing of the upper esophagus. No procedure-related peristomal infection, gastric contents leakage, or bleeding occurred within 30 days after gastrostomy placement. In eight patients (8.7 %), catheter displacement occurred within 30 days. Catheter displacement in 44 patients (47.8 %) and gastric contents leakage in eight patients (9 %) occurred within 30-180 days after gastrostomy placement.
Introducer PEG with UTE is a useful method for gastrostomy placement with a high success rate. This technique allows procedure-related complications to be avoided and permits the use of endoscopy in patients with narrow esophagi or oropharynges. However, the long-term durability of the balloon-type catheter is questionable.
经皮内镜下胃造口术（PEG）的导入器方法可将与手术相关的造口周围感染降至最低。超薄经鼻内镜检查（UTE）能让患者舒适地接受内镜检查，不良反应较少，且内镜可通过狭窄的食管或口咽。本研究旨在探讨采用UTE的PEG导入器方法的临床效果。
对2009年3月至2012年5月期间接受采用UTE的PEG导入器方法的患者进行分析。调查胃造口术后180天内患者的结局和并发症。
在研究期间，92例患者（男性占31.9%；年龄67.7±16.6岁）接受了采用UTE的PEG导入器方法。PEG置入的主要适应证为中风（40.4%）、食管癌或头颈癌（27.1%）以及神经系统疾病（14.9%）。14例患者在PEG术前经内镜检查或影像学检查发现食管狭窄。所有患者均成功经鼻腔插入UTE。92例患者中有90例（97.8%）成功置入PEG。2例患者因头颈癌导致食管上段严重狭窄，无法将内镜插入胃内。胃造口术后30天内未发生与手术相关的造口周围感染、胃内容物漏出或出血。8例患者（8.7%）在30天内发生导管移位。44例患者（47.8%）在胃造口术后30 - 180天内发生导管移位，8例患者（9%）发生胃内容物漏出。
采用UTE的导入器PEG是一种有用的胃造口术置入方法，成功率高。该技术可避免与手术相关的并发症，并允许在食管或口咽狭窄的患者中使用内镜检查。然而，球囊型导管的长期耐用性值得怀疑。
