Percutaneous gastrostomy

Percutaneous gastrostomy is a well-accepted, widely performed procedure in three main groups... 

Chait PG, Weinberg J, Connolly B, Pencharez P, Richards H, Clift JE et al (1996) Retrograde percutaneous gastrostomy and gastrojejunostomy in 505 children a four-and-a-half year experience. Radiology 201 691-695... 

Dewald CL, Hiette PO, Sewall LE, Fredenberg PG, Palestrant AM (1999) Percutaneous gastrostomy and gastrojejunostomy with gastropexy experience in 701 procedures. Radiology 211 651-656... 

Very rarely, it is not possible to traverse very tight strictures from the oral route. In this unusual situ-tion, it may be possible to cross the stricture from below using the transgastric route. A percutaneous gastrostomy is performed and attempts are made to traverse the stricture from below. Once the stricture has been traversed, a stent can be deployed either via the transgastric route (Novak et al. 1999) or via the peroral route after passage of the guidewire up... 

If a peroral route to the stomach outlet or duodenum is not feasible percutaneous gastrostomy using standard techniques (De Baere et al. 1997 Pinto et al. 2001) allows a more direct access. Using a stiff sheath successful catheterisation of the intestinal lumen beyond the obstruction is possible in virtually all cases and also stents mounted on shorter or relatively stiff introducing devices can then be implanted (Pinto 1997 Pinto et al. 2001 Keymling et al. 1993 Truong et al. 1992 Song et al. 1993). 

A combined radiologic-endoscopic technique should be considered to facilitate peroral stent placement if necessary. This interdisciplinary approach further combines the skill and expertise of two highly specialised teams. By using flexible and long enough instruments in combination with an endoscope a percutaneous gastrostomy as a way of access can almost always be avoided. 

Giuliano AW, Lomis NNT, Yoon HC, Miller FJ (1999) Experience with large bore percutaneous gastrostomy and gastrojejunostomy feeding Tubes. J Vase Interv Radiol lOjSupplj 218-219... 

Figure 2 Percutaneous gastrostomy (fe/i) and jejunostomy (right) tubes positioned in ICU patients.

Russell TR, Brotman M, Norris F (1984) Percutaneous gastrostomy a new simplified and cost effective technique. Am J Surg 148 132-137... 

Douglas JG, Koh W and Laramore GE (2000) Metastasis to a percutaneous gastrostomy site from head and neck cancer radiobiologic considerations. Head Neck 22 826-830... 

Gockel 1, Junginger T, Bernhard G et al. (2004) Heller myotomy for failed pneumatic dilation in achalasia how effective is it Ann Surg 239 371-377 Griffiths M (1996) Single-stage percutaneous gastrostomy button insertion a leap forward. JPEN J Parenter Enteral Nutr 20 237-239... 

Method Nasogastric, nasojejunal, percutaneous gastrostomy, percutaneous jejunostomy Fine bore peripheral cannulae or (for prolonged use) central venous access... 

PEG Percutaneous endoscopic gastrostomy polyethylene R M Routine and microscopic... 

Percutaneous endoscopic gastrostomy Gastric feeding tube placed via endoscopic technique. 

Feeding in the first few days may not be important, but later the patient should be kept well nourished since poor nutrition may be associated with worse outcome. There is no evidence to support early initiation of percutaneous endoscopic gastrostomy feeding in patients with unsafe swallow (Dermis et al. 2005). 

The use of antibiotic prophylaxis for percutaneous endoscopic gastrostomy (PEG) is controversial. Although postoperative peristomal infection can occur in up to 30% of patients, clinical trials with cefazolin given 30 minutes preoperatively in this population are conflicting. A pharmacoeconomic study using a meta-analysis of available studies to determine efficacy suggested that antibiotic prophylaxis cost was effective for patients undergoing PEG placements. ... 

Sharma VK, Howden CW. Meta-analysis of randomized, controlled trials of antibiotic prophylaxis before percutaneous endoscopic gastrostomy. Am J Gastroenterol 2000 95 3133-3136. 

PEG percutaneous endoscopic gastrostomy PEI percutaneous endoscopic jejunostomy PRG percutaneous radiologic gastrostomy PN parenteral nutrition SCEA short-chain fatty acid... 

Angus F, Burakoff R. The percutaneous endoscopic gastrostomy tube. Medical and ethical issues in placement. Am J Gastroenterol 2003 98 272-277. 

Gauderer MW. Percutaneous endoscopic gastrostomy and the evolution of contemporary long-term enteral access. CUn Nutr 2002 21 103-110. 

Clarkston WK, Smith OJ, Walden JM. Percutaneous endoscopic gastrostomy and early mortality. South Med J 1990 83 1433-1436. 

Ozmen MN, Akhan O. Percutaneous radiologic gastrostomy. Eur J Radiol 2002 43 186-195. 

Kobak GE, McClenathan DT, Schurman SJ. Complications of removing percutaneous endoscopic gastrostomy tubes in children. J Pediatr Gastroenterol Nutr 2000 30 404 07. 

Yaseen M, Steele Ml, Grunow JE. Nonendoscopic removal of percutaneous endoscopic gastrostomy tubes Morbidity and mortality in children. Gastrointest Endosc 1996 44 235-238. 

Peitersen-Oberndorff KE, Vos GD, Baeten CG. Serous complications after incomplete removal of percutaneous endoscopic gastrostomy catheters. J Pediatr Gastroenterol Nutr 1999 2 230-232. 

Sookpotarom P, Vejchapipat P, Chongsrisawat V, Mahayos-nond A (2005) Gastric volvulus caused by percutaneous endoscopic gastrostomy a case report. J Ped Surg 40 E21-E23... 

Cory DA, Fitzgerald JF, Cohen MD (1988) Percutaneous non-endoscopic gastrostomy in children. AJR Am J Roentgenol 151 995-997... 

Squire R, Kiely EM, Carr B, Ransley PG, Duffy PG (1993) The clinical application of the Malone antegrade colonic enema. J Pediatr Surg 28 1012-1015 Stellato TA, Gauderer MWL (1987) Percutaneous endoscopic gastrostomy for gastrointestinal decompression. Ann Surg 205 119-122... 

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