Albrecht Heinz, Hagel Alexander F, Schlechtweg Philipp, Foertsch Thomas, Neurath Markus F, Mudter Jonas
1 Department of Medicine 1, University of Erlangen-Nuremberg, Erlangen, Germany.
2 Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
Nutr Clin Pract. 2017 Apr;32(2):212-218. doi: 10.1177/0884533616653806. Epub 2016 Jul 9.
An effective method for long-term enteral feeding or stomach decompression is the use of a percutaneous gastrostomy (PEG) or sometimes jejunostomy (PEJ). Under certain circumstances (eg, inadequate transillumination), endoscopic placement of PEG/PEJ tubes is impossible. In these cases, computed tomography (CT)-guided PEG/PEJ may represent an alternative technique. In this study, we evaluate indications, results, and complications of CT-guided PEG/PEJ.
A total of 102 consecutive referred patients were enrolled in the study. Patients came to the endoscopy unit of our department to undergo a CT-guided PEG/PEJ for long-term intragastric/intrajejunal feeding (n = 57) or decompression (n = 45). The majority (n = 98) received a pull-through PEG/PEJ with simultaneous gastroscopy/jejunoscopy. Dose length product and the effective dose for every patient were calculated.
PEG/PEJ tube placement was successful in 87.3% (89 of 102). Feeding PEG/PEJ tube placement was successfully completed in 91.2% (52 of 57); decompressive PEG/PEJ tube placement was likewise successfully completed in 82.2% (37 of 45). No procedure-related mortality was observed. Minor complications (eg, tube dysfunction, local bleeding, minimal leakage, local skin infection) were observed in 13 patients. The complication rate was similar between the feeding and decompression groups ( P = .9).
CT-guided PEG/PEJ is a feasible and safe method with a low procedure-related morbidity rate for patients where endoscopic placement via transillumination is not successful. Thus, the procedure is an attractive alternative to surgical tube placement. Long-term complications, mainly tube disturbances, can be treated easily.
长期肠内喂养或胃减压的一种有效方法是使用经皮胃造口术（PEG），有时也使用空肠造口术（PEJ）。在某些情况下（如透照不充分），无法通过内镜放置PEG/PEJ管。在这些病例中，计算机断层扫描（CT）引导下的PEG/PEJ可能是一种替代技术。在本研究中，我们评估了CT引导下PEG/PEJ的适应证、结果及并发症。
本研究共纳入102例连续转诊患者。患者前来我科内镜室接受CT引导下的PEG/PEJ，用于长期胃内/空肠内喂养（n = 57）或减压（n = 45）。大多数患者（n = 98）接受了同步胃镜/空肠镜引导下的拖出式PEG/PEJ。计算每位患者的剂量长度乘积和有效剂量。
PEG/PEJ管置入成功率为87.3%（102例中的89例）。喂养用PEG/PEJ管置入成功完成率为91.2%（57例中的52例）；减压用PEG/PEJ管置入同样成功完成率为82.2%（45例中的37例）。未观察到与操作相关的死亡病例。13例患者出现轻微并发症（如导管功能障碍、局部出血、少量渗漏、局部皮肤感染）。喂养组和减压组的并发症发生率相似（P = 0.9）。
对于经透照内镜放置不成功的患者，CT引导下的PEG/PEJ是一种可行且安全的方法，与操作相关的发病率较低。因此，该操作是手术置管的一种有吸引力的替代方法。长期并发症主要是导管问题，易于处理。
