Percutaneous endoscopic stomas.

Percutaneous endoscopic gastrostomy was introduced in 1980 as a method for the creation of a feeding gastrostomy without the need for laparotomy or general anesthesia. The technique originally described, the pull method, involves puncturing the apposed gastric and abdominal walls under endoscopic control. A suture is then passed from the exterior into the gastric lumen and grasped with a snare. The suture is pulled out of the mouth, affixed to the end of a gastrostomy tube, and then pulled back down into the stomach. The gastrostomy tube is thus pulled into the stomach, and its end exits the abdominal wall. Modifications of this technique have included pushing the gastrostomy tube over a guidewire (the push method) and direct puncture of the stomach under endoscopic control with an introducer and outer peel-away sheath. All of these methods have been used with good results. Complications have included infection of the abdominal wall and intraperitoneal leakage. These may be minimized by attention to detail. The indications for the method have been expanded to include gastric decompression, administration of unpalatable medications in children, and creation of a conduit for bile replacement. Careful judgment in patient selection is crucial if good results are to obtained. This technique also introduces the concept of percutaneous endoscopic fixation of a loop of bowel to the abdominal wall. This concept may be employed in other areas of the gastrointestinal tract.