Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 10, 2016; 8(3): 186-191
Published online Feb 10, 2016. doi: 10.4253/wjge.v8.i3.186
Percutaneous endoscopic gastrostomy under steady pressure automatically controlled endoscopy: First clinical series
Hiroyuki Imaeda, Kiyokazu Nakajima, Naoki Hosoe, Masanori Nakahara, Shinichiro Zushi, Motohiko Kato, Kazuhiro Kashiwagi, Yasushi Matsumoto, Kayoko Kimura, Rieko Nakamura, Norihito Wada, Masahiko Tsujii, Naohisa Yahagi, Toshifumi Hibi, Takanori Kanai, Tetsuo Takehara, Haruhiko Ogata
Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan
Kiyokazu Nakajima, Division of Next Generation Endoscopic Intervention, Osaka University, Osaka 565-0871, Japan
Naoki Hosoe, Kazuhiro Kashiwagi, Kayoko Kimura, Rieko Nakamura, Haruhiko Ogata, Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo 160-8582, Japan
Masanori Nakahara, Shinichiro Zushi, Yasushi Matsumoto, Department of Gastroenterology, Ikeda City Hospital, Osaka 563-8510, Japan
Motohiko Kato, Masahiko Tsujii, Tetsuo Takehara, Department of Gastroenterology and Hepatology, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
Norihito Wada, Department of Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan
Naohisa Yahagi, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo 160-8582, Japan
Toshifumi Hibi, Takanori Kanai, Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
Author contributions: Imaeda H and Nakajima K planed the study design; Hosoe N and Kashiwagi K advised the study design, data analyst and enrollment of patients; Nakahara M, Zushi S, Kato M and Matsumoto Y enrolled the patients; Kimura K and Nakamura R were the endoscopist; Wada N, Tsujii M, Yahagi N, Hibi T, Kanai T, Takehara T and Ogata H supervised the study.
Institutional review board statement: The study protocol was approved by the institutional review board at our institutions.
Informed consent statement: Written informed consent was obtained from all the patients.
Conflict-of-interest statement: The authors disclosed no financial relationships relevant to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hiroyuki Imaeda, MD, Department of General Internal Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan. imaedahi@yahoo.co.jp
Telephone: +81-49-2761667 Fax: +81-49-2761667
Received: September 11, 2015
Peer-review started: September 16, 2015
First decision: October 21, 2015
Revised: November 8, 2015
Accepted: December 8, 2015
Article in press: December 11, 2015
Published online: February 10, 2016
Processing time: 142 Days and 11.5 Hours
Abstract

AIM: To elucidate the safety of percutaneous endoscopic gastrostomy (PEG) under steady pressure automatically controlled endoscopy (SPACE) using carbon dioxide (CO2).

METHODS: Nine patients underwent PEG with a modified introducer method under conscious sedation. A T-tube was attached to the channel of an endoscope connected to an automatic surgical insufflator. The stomach was inflated under the SPACE system. The intragastric pressure was kept between 4-8 mmHg with a flow of CO2 at 35 L/min. Median procedure time, intragastric pressure, median systolic blood pressure, partial pressure of CO2, abdominal girth before and immediately after PEG, and free gas and small intestinal gas on abdominal X-ray before and after PEG were recorded.

RESULTS: PEG was completed under stable pneumostomach in all patients, with a median procedural time of 22 min. Median intragastric pressure was 6.9 mmHg and median arterial CO2 pressure before and after PEG was 42.1 and 45.5 Torr (NS). The median abdominal girth before and after PEG was 68.1 and 69.6 cm (NS). A mild free gas image after PEG was observed in two patients, and faint abdominal gas in the downstream bowel was documented in two patients.

CONCLUSION: SPACE might enable standardized pneumostomach and modified introducer procedure of PEG.

Keywords: Percutaneous endoscopic gastrostomy; Steady pressure automatically controlled endoscopy; Carbon dioxide

Core tip: We report the safety of percutaneous endoscopic gastrostomy (PEG) under steady pressure automatically controlled endoscopy (SPACE) using carbon dioxide (CO2). Nine patients underwent PEG with a modified introducer method under conscious sedation. The stomach was inflated under the SPACE system. PEG was completed under stable pneumostomach in all patients. Median arterial CO2 pressure before and after PEG was 42.1 and 45.5 Torr (NS). The median abdominal girth before and after PEG was 68.1 and 69.6 cm (NS). A mild free gas image after PEG was observed in two patients. SPACE might enabled standardized pneumostomach which leads to easier and safer PEG procedures.