Subject(s)
Drainage , Endoscopy , Intraoperative Complications/surgery , Pancreatic Pseudocyst , Self Expandable Metallic Stents , Adult , Drainage/adverse effects , Drainage/instrumentation , Drainage/methods , Endoscopy/adverse effects , Endoscopy/instrumentation , Endoscopy/methods , Female , Humans , Male , Middle Aged , Pancreatic Pseudocyst/diagnostic imaging , Pancreatic Pseudocyst/etiology , Pancreatic Pseudocyst/surgery , Pancreatitis/complications , Surgery, Computer-Assisted/methods , Treatment Outcome , Ultrasonography, Interventional/methodsABSTRACT
BACKGROUND: Patients without adequate abdominal-wall transillumination are at a high risk of developing complications after PEG. OBJECTIVE: We evaluated the feasibility and utility of EUS to guide PEG in patients lacking abdominal-wall transillumination. DESIGN: Single-center case series. SETTING: Tertiary-referral center. PATIENTS: Six 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. INTERVENTIONS: Patients underwent EUS-guided PEG and deployment of a standard enteral feeding tube. MAIN OUTCOME MEASUREMENTS: Technical success and complication rates. RESULTS: PEG 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. LIMITATIONS: A small number of patients, uncontrolled study, and short follow-up period. CONCLUSIONS: This technique may facilitate deployment of PEG in patients who lack adequate abdominal-wall transillumination.