EUS-guided percutaneous endoscopic gastrostomy for enteral feeding tube placement

BackgroundPatients without adequate abdominal-wall transillumination are at a high risk of developing complications after PEG.ObjectiveWe evaluated the feasibility and utility of EUS to guide PEG in patients lacking abdominal-wall transillumination.DesignSingle-center case series.SettingTertiary-referral center.PatientsSix patients who lacked adequate abdominal-wall transillumination and 2 patients with a large laparotomy scar deemed to be at high risk of developing complications after PEG.InterventionsPatients underwent EUS-guided PEG and deployment of a standard enteral feeding tube.Main Outcome MeasurementsTechnical success and complication rates.ResultsPEG was successful under EUS guidance in 5 of 8 patients. Causes of failure included an inadequate EUS window because of a prior Billroth 1 gastrectomy in one and suspected bowel interposition in 2 patients. There were no complications.LimitationsA small number of patients, uncontrolled study, and short follow-up period.ConclusionsThis technique may facilitate deployment of PEG in patients who lack adequate abdominal-wall transillumination.