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CT fluoroscopy guided percutaneous gastrostomy or jejunostomy without (CT-PG/PJ) or with simultaneous endoscopy (CT-PEG/PEJ) in otherwise untreatable patients.
Surg Endosc. 2013 Apr; 27(4):1186-95.SE

Abstract

PURPOSE

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.

METHODS

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).

RESULTS

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).

CONCLUSIONS

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.

Authors+Show Affiliations

Department of Surgery, Ludwig-Maximilians-University, Munich, Campus Grosshadern Marchioninistrasse 15, 81377, Munich, Germany. fritz.spelsberg@gmx.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23232989

Citation

Spelsberg, Fritz W., et al. "CT Fluoroscopy Guided Percutaneous Gastrostomy or Jejunostomy Without (CT-PG/PJ) or With Simultaneous Endoscopy (CT-PEG/PEJ) in Otherwise Untreatable Patients." Surgical Endoscopy, vol. 27, no. 4, 2013, pp. 1186-95.
Spelsberg FW, Hoffmann RT, Lang RA, et al. CT fluoroscopy guided percutaneous gastrostomy or jejunostomy without (CT-PG/PJ) or with simultaneous endoscopy (CT-PEG/PEJ) in otherwise untreatable patients. Surg Endosc. 2013;27(4):1186-95.
Spelsberg, F. W., Hoffmann, R. T., Lang, R. A., Winter, H., Weidenhagen, R., Reiser, M., Jauch, K. W., & Trumm, C. (2013). CT fluoroscopy guided percutaneous gastrostomy or jejunostomy without (CT-PG/PJ) or with simultaneous endoscopy (CT-PEG/PEJ) in otherwise untreatable patients. Surgical Endoscopy, 27(4), 1186-95. https://doi.org/10.1007/s00464-012-2574-z
Spelsberg FW, et al. CT Fluoroscopy Guided Percutaneous Gastrostomy or Jejunostomy Without (CT-PG/PJ) or With Simultaneous Endoscopy (CT-PEG/PEJ) in Otherwise Untreatable Patients. Surg Endosc. 2013;27(4):1186-95. PubMed PMID: 23232989.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - CT fluoroscopy guided percutaneous gastrostomy or jejunostomy without (CT-PG/PJ) or with simultaneous endoscopy (CT-PEG/PEJ) in otherwise untreatable patients. AU - Spelsberg,Fritz W, AU - Hoffmann,Ralf-Thorsten, AU - Lang,Reinhold A, AU - Winter,Hauke, AU - Weidenhagen,Rolf, AU - Reiser,Maximilian, AU - Jauch,Karl-Walter, AU - Trumm,Christoph, Y1 - 2012/12/12/ PY - 2012/03/27/received PY - 2012/09/03/accepted PY - 2012/12/13/entrez PY - 2012/12/13/pubmed PY - 2013/9/24/medline SP - 1186 EP - 95 JF - Surgical endoscopy JO - Surg Endosc VL - 27 IS - 4 N2 - PURPOSE: 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. METHODS: 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). RESULTS: 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). CONCLUSIONS: 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. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/23232989/CT_fluoroscopy_guided_percutaneous_gastrostomy_or_jejunostomy_without__CT_PG/PJ__or_with_simultaneous_endoscopy__CT_PEG/PEJ__in_otherwise_untreatable_patients_ L2 - https://doi.org/10.1007/s00464-012-2574-z DB - PRIME DP - Unbound Medicine ER -