Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
J Gastroenterol Hepatol. 2013 Dec;28 Suppl 4:118-22. doi: 10.1111/jgh.12300.
Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure. However, failure to transilluminate the anterior wall of the stomach or visualize the indentation of the physician's finger represents the most frequent obstacles encountered by the endoscopist in safely completing PEG tube placement. We described several methods to safely assess PEG placement in high-risk patients. An abdominal plain film after gastric insufflated with 500 mL of air is obtained before PEG in patients. The body of the stomach near the angularis, equidistant from the greater and lesser curves, was defined as the optimal gastric puncture point. The location of the puncture points varied greatly, being situated over the right upper quadrant in 31% of patients, left upper in 59%, left lower in 5%, and right lower quadrant in 5% of patients. If there is any question of safe puncture site selection, safe track technique can be used to provide the information of depth and angle of the puncture tract. Computed tomography can provide detailed anatomy and orientation along the PEG tube and show detailed anatomical images along the PEG tract. Computed tomography-guided PEG tube placement is used when there is difficulty either insufflating the stomach, or the patients had previous surgery, or anatomical problems. Full assessment of the position of the stomach and adjacent organs prior to gastric puncture may help minimize the risk for potential complications and provide safety for the high-risk patients.
经皮内镜胃造口术（PEG）是一种微创操作。然而，未能透照胃前壁或未能观察到医生手指的凹陷是内镜医生在安全完成 PEG 管放置时最常遇到的障碍。我们描述了几种方法来安全评估高危患者的 PEG 放置。在进行 PEG 之前，先向胃内注入 500 毫升空气，然后拍摄腹部平片。将靠近角切迹的胃体、距大弯和小弯等距的部位定义为最佳胃穿刺点。穿刺点的位置差异很大，31%的患者位于右上象限，59%的患者位于左上象限，5%的患者位于左下腹象限，5%的患者位于右下象限。如果对安全穿刺部位的选择有任何疑问，可以使用安全轨道技术提供穿刺路径的深度和角度信息。CT 可以提供 PEG 管的详细解剖结构和方向，并显示 PEG 管的详细解剖图像。当胃充气困难、患者有既往手术史或存在解剖问题时，可采用 CT 引导 PEG 管放置。在胃穿刺前全面评估胃和邻近器官的位置，可能有助于降低潜在并发症的风险，为高危患者提供安全保障。
