Techniques
Two major techniques for placing PEGs have been described in the literature.
The Gauderer-Ponsky technique involves performing a gastroscopy to evaluate the anatomy of the stomach. The anterior stomach wall is identified and techniques are used to ensure that there is no organ between the wall and the skin:
- digital pressure is applied to the abdominal wall, which can be seen indenting the anterior gastric wall by the endoscopist.
- transillumination (diaphanoscopy): the light emitted from the endoscope within the stomach can be seen through the abdominal wall.
- a small (21G, 40mm) needle is passed into the stomach before the larger cannula is passed.
An angiocath is used to puncture the abdominal wall through a small incision, and a soft guidewire is inserted through this and pulled out of the mouth. The feeding tube is attached to the guidewire and pulled through the mouth, esophagus, stomach, and out of the incision.
In the Russell introducer technique, the Seldinger technique is used to place a wire into the stomach, and a series of dilators are used to increase the size of the gastrostomy. The tube is then pushed in over the wire.
Read more about this topic: Percutaneous Endoscopic Gastrostomy
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