Fine-needle endoscopic percutaneous gastrostomy

A procedure for percutaneous endoscopic gastrostomy is described. Under direct endoscopic control, the surgeon introduces, percutaneously, into the inflated stomach a 9 French Foley catheter through a special needle, which may then be opened for removal. After positioning, the terminal balloon of the Foley is inflated with 7-8 ml of air and the catheter is placed under slight traction to appose the gastric and abdominal walls. Such a method has been used in 5 patients with cancer of the cardia requiring enteral feeding prior to surgery. No complications due to the positioning of the gastrostomy catheter have been observed. We believe that this simple, reliable and inexpensive method constitutes an improvement on the previously described endoscopic percutaneous gastrostomy techniques.     

经皮穿刺内镜下胃造瘘术和空肠造瘘术的临床应用

目的 探讨经皮穿刺内镜下胃造瘘术(PEG)和空肠造瘘术(PEJ)的临床应用价值.方法 2007年4月～2009年4月对15例患者施行PEG/PEJ.其中,9例行PEG胃肠内营养,6例行PEG胃肠减压加PEJ空肠营养.结果 15例患者手术均成功,所有患者术后停止静脉营养,营养状况得到明显改善.3例患者局部有分泌物及红肿,经相应处理后缓解,未出现严重并发症.结论 PEG/PEJ是建立长期肠内营养简便、安全、微创、有效的方法,具有一定的临床应用价值.     

Palliative use of percutaneous endoscopic gastrostomy and percutaneous endoscopic cecostomy tubes

Percutaneous endoscopic gastrostomy (PEG) tubes are most commonly placed for feeding purposes with the intention of maintenance or improvement in nutritional status; however, they may also be used in a palliative role in patients who have terminal illnesses for feeding or decompression. Percutaneous endoscopic cecostomy (PEC) tubes can be used to decompress malignant and functional bowel disorders with accepted morbidity and mortality. This article reviews the use of PEG and PEC tubes for palliative use.     

Managing the percutaneous endoscopic gastrostomy tube

Percutaneous endoscopic gastrostomy is an effective means of providing alimentation to patients who are unable to swallow. Commercial kits that contain the necessary equipment are now available and are easy to assemble and insert. Because of its safety, efficacy, and cost-effectiveness, this procedure will probably become the preferred technique for inserting the feeding tube. Management of the patient and the tube, as reviewed here, can be learned quickly.     

经皮内镜下胃造口术的护理

经皮内镜下胃造口术(PEG)已成为肠内营养(EN)支持的优选途径.我院2006年7月-2010年6月,共施行PEG 42例,取得满意效果,现将护理总结如下. 1 资料与方法 1.1 临床资料 42例PEG病人中男29例,女13例;年龄17岁~82岁(65.7岁±18.6岁);体质指数(BMI)24.2 kg/m2~28.6 kg/m2;病种:脑血管疾病18例,运动神经元病7例,阿尔茨海默病5例,胰腺癌、重度裂孔病、胃瘫、高位截瘫和肺癌脑转移各2例;其中意识障碍8例,但均有肠功能.     

Indications and complications of percutaneous endoscopic gastrostomy

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) plays an important role in maintaining enteral nutrition in patients with swallowing disorders of different etiologies. The aim of our study was to record indications and complications of PEG-placement in a one-year period. METHODS: All patients were investigated prospectively regarding indications, wound infections, other complications and mortality between 1999-10-01 and 2000-09-30. The exit site was examined daily, after 30 days a follow-up by telephone was carried out. RESULTS: The PEG-procedure was performed in 93 patients, one patient received a percutaneous endoscopic jejunostomy. The mean age of the patients was 65.4 years (range 7 months--92 years). The most frequent indications were neurological diseases (n = 61, 65%). 21 patients had a PEG-placement because of malignancies (22%), 9 patients following brain injury (10%) and 3 patients (3%) due to other benign swallowing disorders. 63 patients (67%) had no complications, 28 patients (30%) had wound infections, and in two patients hemorrhage was observed (small hematoma requiring no further intervention). One patient had laparotomy because of suspected perforation--however, laparotomy was negative. In 7 patients (7%) wound infections (n = 28) were mild and needed only local or no therapy. In 18 patients (19%) we found a relevant infection that required systemic antibiotic therapy. 2 patients had serious local infections that caused further interventions. One patient died from sepsis caused by wound infection. Patients receiving antibiotic therapy at the time of PEG-placement suffered from wound infections in 25%. Patients with malignant diseases more often had wound infections. 8 patients died after 7 days and 19 patients after 30 days (8% and 19%, respectively) from their underlying disease. CONCLUSIONS: PEG is regarded as a small intervention with low morbidity and mortality. However, our analysis of daily practice shows a remarkable rate of complications. The high mortality in our study reflects the seriousness of the comorbidities. Antibiotic therapy failed to prevent wound infection in 25% of our patients.     

内镜下胃造瘘术护理的概述

内镜下胃造瘘术是目前治疗消化系统疾病不可缺少的重要手段,其围手术期的护理更是确保手术成功及减少术后并发症的重要组成部分.本文从现代医学角度对内镜下胃造瘘术的适应证、禁忌证及围手术期护理和并发症的观察及护理进行详尽的综述,从而为内镜下胃造瘘术护理的研究奠定理论基础.     

Home percutaneous endoscopic gastrostomy feeding: perceptions of patients, carers, nurses and dietitians

AIM: This paper is a report of a study to compare the perceptions of adult patients, family carers, nurses and dietitians regarding home percutaneous endoscopic gastrostomy feeding. BACKGROUND: Healthcare professionals have a major role in patient selection for gastrostomy placement and the provision of aftercare but it is not clear if patients, their carers and healthcare professionals have similar perceptions of the initiation and delivery of feeding and of the care in general. METHOD: A cross-sectional mixed-method study using purposive sampling, semi-structured interviews and questionnaires was performed. Interviews were undertaken during 2005 with adult patients and carers of adults receiving home feeding. A questionnaire containing comparable questions was distributed to the lead district nurse and dietitian providing the individual patient's care. Binomial regression was used to analyse any differences in perceptions across the groups of respondents. RESULTS: Nurses and dietitians had similar perceptions of gastrostomy feeding in adults. Family carers' perceptions matched those of professionals more closely than did those of patients. The greatest difference in perceptions was between patients and their family carers. Respondents' views about success of feeding and the appropriateness of the feeding regimen were similar, but greater differences existed regarding quality of life, withdrawal of feeding and choice in decision-making about tube placement. CONCLUSION: There is a need for increased patient and carer involvement in decision-making and for sufficient, appropriate information to facilitate informed decision-making. Practitioners who involve carers in decision-making, where patients lack capacity, need to be aware that carers may not represent the views of patients.     

经皮内镜下胃造瘘和空肠造瘘术临床应用

目的:探讨经皮内镜下胃造瘘(PEG)和经皮内镜下空肠造瘘术(PEJ)的临床应用价值。方法:回顾性分析该院2003年1月至2009年1月进行PEG 33例(其中PEG加PEJ 5例)的临床资料。结果:33例PEG(其中5例PEG加PEJ)均成功完成(成功率100%)。术后3例出现腹部造瘘口皮肤感染,1例出现瘘口少量渗血,1例出现造瘘管蘑菇头滑脱胃壁与腹壁间窦道。所有患者开始注食后营养状况逐渐好转,水电解质平衡得到纠正。术前14例反复发作吸入性肺炎均在抗感染后治愈。结论:PEG及PEJ是一种安全、高效、方便、经济,既符合生理、且人性化的肠内营养方法。由于其操作简便、安全易行、并发症少,值得广泛应用。     

Abdominal wall metastasis following percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) has become a widely used method for nutritional support, particularly in patients with advanced head and neck carcinomas. Since the method is easy and widely established it is necessary to assess possible complications, even rare ones. In this paper we report on two patients with vaccination metastasis following PEG insertion. Both patients had advanced squamous cell carcinoma of the head and neck or the upper esophagus. In three patients previous bougienage was performed, because of considerable stenosis of the pharynx and/or esophagus. Fast-growing metastases were found at the site of PEG insertion, with and without involvement of the gastric wall. In neither case was abdominal wall metastasis the cause of death. There is a small but definite risk of tumor seeding into the abdominal wall after PEG insertion for obstructive malignant tumors. The clinical impact of this finding, however, is still undefined and needs further investigation.     

经皮内窥镜胃造瘘术患者的护理

回顾分析25例行经皮内窥镜胃造瘘患者的疗效和并发症发生情况,结果表明其疗效良好,且操作简便,并发症少。术前做好心理护理,沟通护患关系,取得患者与家属的配合。术后加强技术指导,特别是掌握科学的管饲方法及如何清洁、保护PEG管,观察可能出现的问题,及时采取正确的解决方法等,将明显提高患者的生活质量,延长生存期。