Prevention of PEG tube misplacement in the transverse colon: Method of introducing a Gastrografin into the stomach

Hiromi Ono, Hitoshi Yokoyama, Haruyuki Yoshida, Hiraku Fukushima, Masato Kawakami, Mikio Okamura, Takanori Aoki, Naoki Asakage, Kimimoto Nagashima, Yasushi Danjo, Hideyuki Hayashi, Hiroshi Nishihara, Yuichi Shimizu, Tsuyoshi Shimamura, Mitsuo Kusano


AIM: A colocutaneous fistula is a rare late complication of percutaneous endoscopic gastrostomy (PEG) feeding placement that occurs as a result of the interposition of the colon between the anterior abdominal and gastric walls. In the current study, we sought to retrospectively study the method of introducing the water-soluble contrast agent into the stomach by using a nasogastric tube before PEG feeding placement, with the intention to develop a method to prevent PEG-related colocutaneous fistula.

MATERIALS AND METHODS: Between October 2003 and April 2020, 341 patients underwent PEG placement at Seiwa Memorial Hospital. Patients were divided into two groups: 232 patients in Group A were given water-soluble contrast agent and 109 patients in Group B were not. All patients underwent PEG using introducer method placement after gastropexy under fluoroscopy.

RESULTS: In Group A, 139 (59.9%) patients received PEG with a water-soluble contrast agent placed into the transverse colon, 75 (32.3%) received PEG with gas in the colon, and 7 (3.0%) patients received surgical gastrostomy. In Group B, 38 (34.8%) patients received PEG with gas in the colon, 60 (55.1%) patients received PEG with finger palpation and transillumination, and 10 (9.2%) patients received surgical gastrostomy. Colocutaneous fistula was not observed in either group, but there was a significant difference in the frequency of surgical gastrostomy between Group A and B (p = 0.0148).

CONCLUSION: The use of water-soluble contrast agent in the stomach was safe, reliable, and cost effective for PEG tube placement, and is recommended to decrease surgical gastrostomy.


Colocutaneous fistula; Diatrizoate meglumine and diatrizoate sodium; Gastrografin; Percutaneous endoscopic gastrostomy; Transverse colon


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