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Introduction: Since Ponsky, Gauderer first reported in 1980, PEG has spread rapidly in US and has now becomestandarde a procedure gastrostomy. However, in those d Europe cases that total gastrectomy have was performed, endoscopic jejunostomy was regarded contra-indication. As performed Percutaneous Endoscopic Enterostomy for those patients who underwent total gastrectomy we actively, we report success rate, preoperative tests, perioperative technique, complication, long term prognosis. Subject and Method: The subjects we have tried PEE are 30 cases (sex: 18 cases of male, 12 cases of female, age 64.5 yrs. Old (36~84 yrs. Old)). The purpose of making PEE was 18 cases of feeding, 12 cases of decompression. The reconstruction method of total gastrectomy was, 26 cases of Roux-en Y(posterior colon), 1 case of Roux-en Y (anterior colon), 2 cases of Ileo-colon interposition, 1 case of small intestine interposition. As a rule preoperative test included abdominal x-ray in supine positionand gastrography test of gastrointestine and abdominal CT test upon intubating stomach tube or injectinggastrographine. Similar to PEG procedure, PEE was made with the same kit (24 Fr One-Step Button) in the pull methodunder local anesthetic. In order to decide thepuncture site and to avoid erroneous puncture in enteral, we performed fiber light test(illumination) to observe the light emitted from endoscope through the abdominal wall, finger push test to see the pressureapplied onto the abdominal wall by finger at the expected puncturesite, water injection test to inject water throughendoscope and observe the enteral tract with extracorporeal ultrasonic. After the operation as a rule prophilactic antibiotec was administered for 3 days, and nutrition was started from the third day. 16 Fr N-G tube for decompression was intubated through the enterostomy button. Result: PEE procedure was possible in 23 cases (.7%), puncture of enteral tract were 21 cases in jejunum, 1 case of duodenum and 1 case of large bowel. The average operating time was 22.8 min. (16~42 min.) and complications were 6 cases of peristomal infection (26.1%), 4 cases of furyonikuge (17.4%) and 1 case of peristomal pain (4.3%) which were relatively minor kind and there was no serious complication. Average survival day was 192.5 days (20~565 days) and 14 patients (60.9%) were transferred to home care. Conclusion: With careful preoperative test and proper operating procedure, PEE is considered safe method and offers substantial clinical merits.

PURPOSE: It is to study the clinical issue and clarify the route of peristomal infection (P.I.) after PEG.SUBJECT AND METHOD: Subjects are 114 patients who went through PEG operation from January to October 1998 for the purpose of nutritional support. Pull type was used for the entire procedures and cepham was admini-stered for 3 days after the operation. No antacid was administered as a rule except for that were regarded its use was necessary for treatment. All subjects were observed for 5 days after the operation, and the infection was positive when those cases showed that: there is excretion of pus from the wound, the body temperature was above 38° C and WBC was above 10,000. (i) Microbes from pharynx, (ii) Gastric juice, (iii) wound pus were cultured, (iv) PH in gastric juice was measured, (v) Microbes from wound pus, pharynx and stomach were compared. Furthermore all subjects were divided into 2 groups: the infection and the non-infection. Their age, nutritional status prior to the operation, starting period of enteral nutrition, the period that antibiotic was administered and whether or not there were serious complications between the two groups were compared.RESULT: Peristomal infection (P.I.) after the operation was found in 54 cases. Microbe from pharynx was positive in 95 cases,and the major microbes found in 86 cases were S.aureus (45 cases of MRSA),75 cases of Ps.aeruginosa, 42 cases of S.pyogenes, 41 cases of S.pneumoniae. 6 cases of MRSA and 2 cases of Ps.aeruginosa are found in gastric juice and 48 cases of S.aureus, 45 cases of Ps.aeruginosa, 42 cases of S.pyogenes, 38 cases of S.pneumoniae and 18 cases of E.coli are found in the wound pus. PH of gastric juice was 2.8 and was very strong. Microbes from wound pus and pharynx were consistent in 52 cases. The timing to start enteral nutrition was 6.6 days and 2.1 day,and enteral nutrition was started significantly early in P.I.(-) group (p < 0.01). Also the period that antibiotics were administered was 3.5 days in P.I (-) and 7.8 days in P.I. (+) showing that it was significantly short in P.I. (-) (p<0.01). CONCLUSION:1. Microbes in the wound pus were identical to that of pharynx, and peristomal infection is closely related to the infection of microbes in pharynx during the operation.2. Although peristomal infection does not cause serious complications, it affects overall medical expenses by extending the period of antibiotics use, delaying enteral nutrition and extending hospital stay.