Ultrasound-guided percutaneous endoscopic gastrostomy in patients with negative diaphanoscopy

Background and study aims: Negative results from diaphanoscopy are often regarded as a contraindication for percutaneous endoscopic gastrostomy (PEG). The aim of this study was to evaluate whether ultrasonography can identify the reasons for failure of diaphanoscopy and help in guiding the PEG procedure. Patients and methods: From December 2002 to May 2006 ultrasonography was used to guide PEG in patients with inadequate findings on diaphanoscopy (n = 15). The results and safety of this procedure were evaluated retrospectively. Results: In 14 of 15 cases, sonographic guidance enabled completion of the procedure. Gastrostomies were satisfactory in all 14 cases. In the 15th patient, no safe introduction site could be identified due to a previous Billroth II operation. The reasons for failure of diaphanoscopy were: scar formation, unusual stomach location, obesity, tumor infiltration of the stomach and peritoneal carcinosis. In four patients, decompressive gastrostomy was carried out as palliative therapy for vomiting or gastric outlet obstruction that was resistant to medical therapy and was caused by peritoneal carcinosis, linitis plastica or malignant infiltration of the duodenum. Conclusions: Sonographic guidance enables completion of PEG despite inadequate findings on diaphanoscopy, usually rendering radiological or surgical gastrostomy procedures unnecessary.