A consecutive series (1) of 31 amyotrophic lateral sclerosis patients in whom endoscopic gastrostomy was considered too dangerous to perform underwent CT-guided percutaneous gastropexy and gastrostomy. All procedures were performed with a 15 FR Freka Pexact II gastrostomy kit.

The procedure was performed successfully in 30 of 31 patients with a median age of 60 years.

No serious adverse events such as peritonitis, persistent local bleeding, systemic blood loss, or any local infection requiring surgical intervention were observed. Follow-up resulted in 7,473 cumulative gastrostomy days from the date of first placement.

The results suggest that the gastropexy technique is feasible and secure and may especially be advantageous in cases where endoscopic gastrostomy and sedation are contraindicated.

Patients with head and neck cancers may require nutritional support during and after treatment of their cancers and this is commonly done via a gastrostomy. Endoscopic gastrostomy placement is usually performed using a pull-through technique. However, pulling the PEG bumper past the tumour may risk seeding malignancy to the PEG site. In these cases a direct puncture technique may be preferred.

319 Freka Pexact II insertions (2) were identified in 317 patients with an average age of 58 years. 99% (n=316) patients had a head and neck cancer as the indication.

Insertion via direct puncture was successful in 99% (n=316) and unsuccessful in 3 (0.9%) of patients.

It was concluded that Freka Pexact is a secure and reliable method of gastrostomy tube placement and overall, the complication rate had fallen using the Freka Pexact and the gastropexy technique.

In another study, 89 patient procedures (3) were performed under conscious sedation.

Freka Pexact II PEG placement was achieved in all cases. Minor haemorrhage from the puncture site in one patient was the only immediate operative complication. No significant PEG-site infections were recorded. The overall 30 day complication rate was 12.3%.

Serious complications were rare, but tube displacement remains a significant problem. Minor complication rates were comparable to the standard pull through technique, although PEG site infection appeared less often.In conclusion, Freka Pexact II using the gastropexy technique provided a reliable direct puncture method for PEG placement.

Two different techniques for percutaneous endoscopic gastrostomy (PEG) have been developed: classical pull-through and direct puncture techniques.

Another study (4) compared the complication rate for both techniques in a large retrospective patient cohort.

Clinical data from patients who received a PEG in four high-volume centers for endoscopy were included retrospectively between January 2016 and December 2018. Patient characteristics and complication
rates were correlated in univariate and multivariate analyses.

Data from 1014 patients undergoing a PEG insertion by the pull-through technique were compared to 183 patients for whom the direct puncture technique using the gastropexy device available from Fresenius Kabi was used. The direct puncture technique was associated with a 50% reduction in minor and 85.7% reduction in major complications when compared to the pull-through technique.

Multivariate analysis of these data revealed an odds ratio of 0.067 (0.02–0.226; P < 0.001) for major complications in the direct puncture group.

It was concluded that compared to the pull-through technique, the direct puncture technique resulted in a significant reduction in complications and that the results suggest that the direct puncture technique may be preferable to improve patient safety.