Percutaneous puncture endoscopic gastrostomy under ultrasound control with negative diaphanoscopy

Objective. Optimization the surgical technique of percutaneous puncture endoscopic gastrostomy (PEG) in patients with a typical and subcostal stomach with negative diaphanoscopy. Material and methods. In the period from 2021 to 2023, we studied the results of performing PEG under ultrasound control using an endoscopic balloon in 29 patients: 23 (79.3%) patients with a typical stomach location and 6 (20.7%) patients with a subcostal location, in whom it was not possible to use diaphanoscopy and manual palpation to determine the location of the primary puncture the anterior abdominal wall and the wall of the stomach for the subsequent installation of a gastrostomy tube for the purpose of long-term enteral nutrition. Results. Technical and clinical success in our study was achieved in 100% of cases. There were no intraoperative complications. All patients were provided with enteral nutrition access through a gastrostomy tube. The surgical intervention time ranged from 20 to 40 minutes. The minimum period of hospitalization was 4 days, the maximum period was 7 days. In the early postoperative period, 2 (6.9%) patients had local inflammation of the postoperative wound in the area of the gastrostomy tube placement. These patients underwent local antibiotic therapy with a positive effect. Conclusion. PEG under ultrasound control using an endoscopic balloon in patients who cannot use diaphanoscopy to determine the location of the primary puncture is an effective, convenient and safe method of gastrostomy formation. This technique allows you to complete the PEG procedure without resorting to other methods of gastrostomy formation. Also, our proposed method provides the possibility of removing the stomach below the costal arch for the successful installation of PEG in patients with subcostal stomach.