Percutaneous endoscopic gastrostomy and jejunostomy: Indications and techniques

Figure 1 Case of percutaneous endoscopic gastrostomy failure. Subsequent computed tomography scan showed colonic interposition between the stomach with nasogastric tube and the anterior abdominal wall due to fecal stasis.

Figure 2 Steps of percutaneous endoscopic gastrostomy placement with “pull” technique. A: Location of the puncture site via transillumination; B: Avoidance of bowel interposition confirmed by the absence of bubbles at aspiration; C: Introduction of the trocar; D: Introduction of the guidewire; E: Grasping the guidewire with an endoscopic snare; F: Final result.

Figure 3 Graphic representation of percutaneous endoscopic gastrostomy placement technique. A: “Pull” technique; B: “Introducer” technique.

Figure 4 Percutaneous endoscopic gastrostomy displacement and development of colocutaneous fistula. A: Computed tomography scan image showing percutaneous endoscopic gastrostomy balloon located in the transverse colon (red arrow); B: Endoscopic view of the percutaneous endoscopic gastrostomy balloon within the colon; C: Endoscopic closure of the colonic fistulous orifice with clips.

Figure 5 Wound infections. A: Superficial infection of the abdominal wall; B: Wound infection with abscess formation within the anterior abdominal wall.

Figure 6 Gastrocutaneous fistula. A: External appearance of a gastrocutaneous fistula in the first case; B: Endoscopic appearance of the gastrocutaneous fistulous orifice; C: Endoscopic closure of the gastric fistulous orifice with an over-the-scope metal clip in the first case (OTSC – Ovesco Endoscopy AG, Tubingen, Germany); D: Endoscopic appearance of a large gastrocutaneous fistula, with detection of the gauze placed from the outside at the cutaneous end of the tract (red arrow) in the second case; E: Endoscopic placement of four metal clips at the margins of the fistulous orifice; F: Placement of an endoloop over the metal clips to achieve complete closure of the fistulous orifice.

Figure 7 Percutaneous endoscopic transgastric jejunostomy placement. A: Endoscopic appearance of the percutaneous endoscopic transgastric jejunostomy with jejunal extension entering from the percutaneous endoscopic transgastric device towards the jejunum; B: Final fluoroscopic appearance of the percutaneous endoscopic transgastric jejunostomy with distal end of the jejunal extension into the proximal jejunum after injection of contrast medium.

Figure 8 Graphic representation. A: Percutaneous endoscopic gastrostomy with jejunal extension; B: Direct percutaneous endoscopic jejunostomy.