Percutaneous gastrostomy and gastroenterostomy: 2. Clinical experience.

This report describes the authors' initial experience with percutaneous gastrostomy (PG) and gastroenterostomy (PGE) in 40 patients. Indications for PG and PGE included alimentation (35 patients) and small bowel decompression (five). Seldinger technique with air distension of the stomach via a nasogastric tube (20 patients) is a simple method to insert small (7-9 French) and firm catheters; tube exchanges for larger and softer catheters often are necessary by this method (23 procedures in 17 patients). Coaxial trocar technique (19 patients) permits initial insertion of softer and often larger catheters (9-14 French feeding tubes), which are less likely to clog or require exchange; the intragastric balloon support method facilitates trocar insertion. Now preferred is a system that uses 18-gauge needle puncture and allows coaxial insertion of a final soft feeding tube at the initial procedure. Small bowel catheter positioning (PGE) (31 patients) was more common than gastrostomy alone (8 patients); "downhill puncture" toward the gastric antrum assists direct guide-wire cannulation of the duodenum via the gastric puncture (12 patients). Five complications occurred; two were major and included catheter dislodgement in one patient. Another patient, who had a pharyngeal tumor, suffered profound respiratory difficulty from premedication and nasogastric tube malposition; patients with head and neck tumors present particular problems with nasogastric tube passage and airway monitoring. Inability to pass a nasogastric tube does not preclude PG and PGE, as direct puncture of the stomach is feasible.