Twenty- or 24F-diameter dilation prevents severe bleeding associated with 27F-diameter dilation for direct percutaneous endoscopic gastrostomy tube placement

Severe bleeding sometimes occurs after percutaneous endoscopic gastrostomy (PEG) placement using a modified introducer method (direct method). We hypothesized that using a smaller diameter dilator rather than the 27F dilator contained in the commercial kit would reduce the incidence of this complication. The aim of this study was to compare procedure-related complications with the use of 27F dilators and 20F/24F dilators. Consecutive patients who underwent the direct method for PEG placement were studied. The 27F dilator was used from January 2007 to July 2008 (27F dilator group) and the 20F and 24F dilators were used from August 2008 to December 2009 (20F/24F dilator group). The success rates, procedure times, and procedure-related complications within 30 days of the procedure were evaluated retrospectively in 136 patients: 66 in the 27F dilator group and 70 in the 20F/24F dilator group. The success rates and mean procedure times of the groups were similar. Severe bleeding occurred in five patients in the 27F dilator group versus none in the smaller dilator group (P=0.025). Complications such as peristomal infection, peritonitis, and respiratory depression did not occur in either group. There was no significant difference in 30-day mortality between the groups (2 vs. 1, P=0.61). We concluded that the direct method using 20F/24F dilators has less procedure-related severe bleeding than that using the 27F dilator contained in the commercial kit of 24F button-bumper-type devices.