Introducer法经皮内镜胃造瘘术10例报告

目的探讨经皮内镜下胃造瘘术（PEG）的临床应用价值。方法采用Introducer法PEG治疗10例食管癌患者。结果手术成功,术后无造瘘管周围皮下感染、出血、瘘管滑脱及堵塞等并发症,患者营养迅速恢复,减少静脉补液。结论 PEG是肠内营养的一种新的治疗方法,安全、有效、降低医疗费用、并发症少。     

Introducer法经皮胃镜下胃造瘘术的临床应用

经皮内镜下胃造瘘术（percutaneous endoscopic gastrostomy,PEG）是一种通过胃镜介导放置胃造瘘管进行肠内营养且无需外科手术及全身麻醉的胃造瘘术。利用PEG进行胃造瘘管饲营养,是解决不能经口进食而胃肠功能良好患者营养问题的一种有效的肠内营养方法。我院2008年8月至2009年9月对9例具有适应证的患者采用Introducer法行PEG,取得了较好的临床效果,现报道如下。     

经皮内镜胃造瘘术10例临床分析

我们自１９９６年４月至１９９８年５月开展经皮内镜胃造瘘术（ｐｅｒｃｕｔａｎｅｏｕｓｅｎｄｏｓｃｏｐｉｃｇａｓｔｒｏｓｔｏｍｙＰＥＧ）１０例,术后对患者进行随访,取得满意疗效。现对于操作技术、并发症预防和处理、造瘘管置换等方面报道如下。一、对象和方法１．病例选择：本组１０例中脑梗塞患者５例,脑出血术后２例,脑外伤术后１例,精神异常昏迷１例,胃底贲门梗阻１例。男６例,女４例;年龄２２～８１岁,平均５４岁。本组例１患者置鼻胃管长达４５９ｄ,导致鼻腔、咽喉及食管部位粘膜糜烂、出血,且因张口呼吸致颞颌关节…     

经皮内镜下胃造瘘术应用进展

经皮内镜下胃造瘘术应用进展湛先保，李兆申综述许国铭审校自１９７９年Ｐｏｎｓｋｙ等创用经皮内镜下胃造瘘术（Ｐｅｒｃｕｔａｎｅｏｕｓｅｎｄｏｓｃｏｐｉｃｇａｓｔｒｏｓｔｏｍｙ，ＰＥＧ）以来，其在国外已广泛应用。近年来关于ＰＥＧ技术改进、临床应用及并发症方...     

Pull和Introducer两种经皮内镜下胃造瘘方法的比较

目的介绍和比较Pull和Introducer两种胃造瘘方法的特点和应用价值。方法对8例连续住院需胃造瘘病人分别施行Pull(5例)和Introducer(3例)经皮内镜下胃造瘘。比较两种方法操作的时间、安全性和并发症。在术后第2～3周,在床边无内镜监视下对Introducer胃造瘘患者更换造瘘管。结果采用两种方法进行胃造瘘均取得了成功。胃造瘘的时间Pull法平均为(17±2.3)min,Introducer法平均为(17±3.6)min。两组均无并发症。对Introducer胃造瘘患者更换胃造瘘管平均用时(5±1.3)min,患者无任何不适。结论Pull和Introducer两种胃造瘘法都是安全的。Introducer法在更换胃营养管时不需要再次内镜监视,特别适于各种原因所致食管上段或咽喉部狭窄的患者。     

经皮内镜下胃造瘘术体会

经皮内镜下胃造瘘术(PEG)是通过内镜的协助，经腹壁穿刺放置胃造瘘管，以达到胃肠道营养或长期胃肠减压之目的。现将我院PEG的体会总结如下。     

经皮内镜下胃造瘘术

１９９４年９月～１９９５年２月共行经皮内镜下胃造瘘术３７例，全部成功，平均手术时间为１５分钟，仅６例出现局部皮肤炎症反应，无任何严重并发症。结果表明：经皮内镜下胃造瘘术安全、便捷、有效，为患者提供了一个不需剖腹手术安放胃造瘘管的新方法，颇具推广价值。本文也对操作经验及注意事项进行了总结。     

经皮内镜胃造瘘术的临床应用

经皮内镜胃造瘘术（ｐｅｒｃｕｔａｎｅｏｕｓ　ｅｎｄｏｓｃｏｐｉｃ　ｇａｓｔｒｏｓｔｏｍｙ，ＰＥＧ）是一项无需外科手术及全身麻醉的胃造瘘术，由于它具有简单易行、经济实惠、安全快捷等优点，近年来，国内也日益推广应用，已部分地替代了手术胃造瘘术，我院自１９９８年以来先后为２７例脑外伤或脑血管意外的患者施行了手术，效果满意，现总结报告如下。一、临床资料１９９８年２月至２００１年１月住院患者２７例，男２１例，女６例，年龄１８～７９岁，平均５１岁，所有病例均为心脑疾病造成昏迷或神志不清者，在行ＰＥＧ之前大多…     

经皮内镜下胃造瘘术25例临床应用体会

经皮内镜下胃造瘘术(percutaneous endoscopic gastrostomy，PEG)是20世纪八十年代开始应用于临床一种新的内镜介入技术管饲方法，经临床验证取得满意疗效，目前已成为胃造瘘管饲的首选方法。在国内已有多家医院开展该项技术。本人在广州南方医院进修期间，参加12例次及总结自1999年7月该院开展应用至今共25例资料，现报道如下。     

经皮内镜胃造瘘术

经皮内镜胃造瘘术山东医科大学附属医院（２５００１２）赵幼安Ｐｏｎｓｋｙ等创用经皮内镜胃造瘘术（Ｐｅｒｃｕｔａ－ｎｅｏｕｓＥｎｄｏｓｃｏｐｉｃＧａｓｔｒｏｓｔｏｍｙ，ＰＥＧ）以来，在欧洲、美国、日本等国家已广泛应用于临床。我国近年来也有类似报道。ＰＥＧ...     

Usefulness of percutaneous endoscopic gastrostomy for supportive therapy of advanced aerodigestive cancer

Aerodigestive cancer, like esophageal cancer or head and neck cancer, is well known to have a poor prognosis. It is often diagnosed in the late stages, with dysphagia being the major symptom. Insufficient nutrition and lack of stimulation of the intestinal mucosa may worsen immune compromise due to toxic side effects. A poor nutritional status is a significant prognostic factor for increased mortality. Therefore, it is most important to optimize enteral nutrition in patients with aerodigestive cancer before and during treatment, as well as during palliative treatment. Percutaneous endoscopic gastrostomy (PEG) may be useful for nutritional support. However, PEG tube placement is limited by digestive tract stenosis and is an invasive endoscopic procedure with a risk of complications. There are three PEG techniques. The pull/push and introducer methods have been established as standard techniques for PEG tube placement. The modified introducer method, namely the direct method, allows for direct placement of a larger button-bumper-type catheter device. PEG tube placement using the introducer method or the direct method may be a much safer alternative than the pull/push method. PEG may be recommended in patients with aerodigestive cancer because of the improved complication rate.     

经皮内镜胃造瘘患者的循证治疗

目的:探讨经皮内镜胃造瘘临床上常见问题,并为患者制定合理的治疗方案,以控制患者症状,降低死亡率.方法:在充分评估患者的情况后,提出临床问题,从Cochrane图书馆(1995-2010)、MEDLINE(1990-12/2010)、EMBase (1990-12/2010)、SCIE(1990-12/2010)、中国知...     

Complications of percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) has become the method of choice for mid-to long-term enteral feeding. The majority of complications that occur are minor, but the rare major complications may be life threatening. Some complications occur soon after tube placement, others develop later, when the gastrostomy tract has matured. Older patients with comorbidities and infections appear to be at a greater risk of developing complications. Apart from being aware of indications and contraindications, proper technique of PEG placement, including correct positioning of the external fixation device, and daily tube care are important preventive measures. Adequate management of anticoagulation and antithrombotic agents is important to prevent bleeding, and administration of broad spectrum antibiotics prior to the procedure helps prevent infectious complications. Early recognition of complications enables prompt diagnosis and effective therapy.     

经皮内镜下胃造瘘在治疗中风后患者中的应用进展

中风后很多患者都会出现吞咽困难,并且在短时间内无法恢复.经皮内镜下胃造瘘术(percutaneous endoscopic gastrostomy,PEG)可以为中风后吞咽功能障碍的患者提供长期的营养支持,与静脉营养以及传统的鼻胃管治疗相比有很多的优势,因此传统的观念认为PEG可以减少并发症,提高患者的生活质量,但是近年来的关于并发症和死亡率的研究有相反的结果.因此如何选择合适的患者,合适的时机,预测可能出现的各种并发症以及生存时间才能使患者从中获益.本文全面地分析了近年来的研究并对比了早期的研究,阐述了PEG在中风患者中的应用应该个体化综合分析的理念,为临床上PEG应用前提供参考依据.     

超细胃镜检查3844例临床分析

目的探讨超细胃镜检查的临床应用价值。方法 2004年5月至2012年5月间,应用FU-JINON公司生产的EG-470N5型上消化道超细电子胃镜（鼻胃镜）对3844例患者进行经鼻腔/口腔检查,其中常规内镜检查3786例,急诊内镜检查58例,并对72例患者进行了内镜下介入治疗及操作,包括止血、溶石术、息肉电切、异物取出、支架置入及放置螺旋型鼻肠管或辅助胶囊内镜检查。结果经鼻插镜3694例,经口150例,检出慢性胃炎2022例,消化性溃疡754例,食管炎310例,食管胃底静脉曲张、门脉高压性胃病184例,胃癌及残胃癌100例,Barrett食管64例,十二指肠球炎52例,上消化道息肉48例,残胃炎、吻合口溃疡及吻合口炎37例,食管癌29例等。因普通胃镜无法通过而经鼻胃镜检查明确诊断者16例,其中食管癌6例,胃癌4例,腐蚀性食管炎、贲门癌及球部溃疡并严重狭窄各2例。急诊内镜检查58例,54例明确诊断。镜下止血治疗29例,均获成功。活检594例次,诊断符合率94.2%。辅助螺旋型鼻肠管放置及胶囊内镜检查25例。溶石及息肉电切治疗各2例。10例因食管癌癌性狭窄患者均成功置入覆膜金属支架。成功取出嵌顿于食管的鱼刺4例。无消化道出血、穿孔等严重不良反应发生。结论超细胃镜检查痛苦小,患者易于接受,对常见上消化道疾病具有良好的诊断价值,通过超细胃镜尚可进行息肉电切、局部喷洒止血、支架置入及取出异物等内镜介入治疗,具有良好的临床应用前景。     

Complications and outcome of percutaneous endoscopic gastrostomy in a high-volume centre

Introduction: Percutaneous endoscopic gastrostomy (PEG) is the method of choice for long-term enteral feeding for patients with swallowing disorders and normal gut function. There is limited data regarding the demographics and clinical characteristics of patients from whom PEG was removed.

Patients and methods: We performed a retrospective analysis of all consecutive adult patients who underwent first placement of PEG between 1 August 2013 and 31 December 2015 at Karolinska University Hospital in Stockholm, Sweden.

Results: In total, 495 PEG were inserted in 495 patients during the study period, 56% male, mean age at insertion 67 years (range 19–95). Most patients belonged to the neurologic group (52%), followed by the oncologic (32%), another diagnosis (9%) and trauma (7%). Major complications occurred in 10 (2.0%) patients. There were no differences in the age or BMI of patients with either minor or major complications but both parameters were risk factors in terms of survival. PEG was removed from 165 (33.3%) patients, most of them from the oncology group, due to the improvement of general status of patients after specific oncologic treatment.

Conclusion: Increased age and low BMI were identified as risk factors for mortality but did not correspond with the rate of complications. Antibiotic prophylaxis with sulfamethoxazole and trimethoprim provides good protection for patients with PEG.     

Bleeding risk with clopidogrel and percutaneous endoscopic gastrostomy

AIM To compare bleeding within 48 h in patients undergoing percutaneous endoscopic gastrostomy(PEG) with or without clopidogrel.METHODS After institutional review board approval, a retrospective study involving a single center was conducted on adult patients having PEG(1/08-1/14). Patients were divided into two groups: Clopidogrel group consisting of those patients taking clopidogrel within 5 d of PEG and the non-clopidogrel group including those patients not taking clopidogrel within 5 d of the PEG.RESULTS Three hundred and nineteen PEG patients were found. One hundred and sixty-eight males and 151 females with mean body mass index 28.47 ± 9.75 kg/m2 and mean age 65.03 ± 16.11 years were identified. Thirtythree patients were on clopidogrel prior to PEG with 286 patients not on clopidogrel. No patients in either group developed hematochezia, melena, or hematemesiswithin 48 h of percutaneous endoscopic gastrostomy(PEG). No statistical differences were observed between the two groups with 48 h for hemoglobin decrease of 2 g/dL(2 vs 5 patients; P = 0.16), blood transfusions(2 vs 7 patients; P = 0.24), and repeat endoscopy for possible gastrointestinal bleeding(no patients in either group). CONCLUSION Based on the results, no significant post-procedure bleeding was observed in patients undergoing PEG with recent use of clopidogrel.     

Laparoscopy-assisted percutaneous endoscopic gastrostomy enables enteral nutrition even in patients with distorted anatomy

AIM:To analyzed whether laparoscopy-assisted percutaneous endoscopic gastrostomy(PEG)could be a valuable option for patients with complicated anatomy.METHODS:A retrospective analysis of twelve patients(seven females,five males;six children,six young adults;mean age 19.2 years)with cerebral palsy,spastic quadriparesis,severe kyphoscoliosis and interposed organs and who required enteral nutrition(EN)due to starvation was performed.For all patients,standard PEG placement was impossible due to distorted anatomy.All the patients qualified for the laparoscopyassisted PEG procedure.RESULTS:In all twelve patients,the laparoscopy-assisted PEG was successful,and EN was introduced four to six hours after the PEG placement.There were no complications in the perioperative period,either technical or metabolic.All the patients were discharged from the hospital and were then effectively fed using bolus methods.CONCLUSION:Laparoscopy-assisted PEG should become the method of choice for gastrostomy tube placement and subsequent EN if PEG placement cannot be performed safely.     

Endoscopic ultrasound-guided percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) is the method of choice for feeding and nutritional support in patients with a normal gastrointestinal function who require long-term enteral nutrition. We report our experience regarding an alternative endoscopic ultrasound (EUS)-guided PEG technique. A retrospective clinical experience case series study was conducted from January 2019 to November 2019 at a tertiary center. Adult patients deemed unfit for conventional PEG due to absence of transillumination or previous gastric surgery were enrolled. An EUS target was created by filling a glove with saline and placing it in the abdomen. EUS was performed and the target identified from the stomach. The abdominal wall was punctured from the stomach and a guidewire was advanced. The guidewire was knotted to a string, which was passed into the stomach and drawn back through the mouth. The procedure was continued following the traditional technique. Four patients underwent EUS-PEG in our center during the study period. Mean age was 65 years and 50% were male. Two patients (50%) had a body mass index over 30. PEG indications were tongue malignancies (50%), cerebrovascular disease (25%) and dementia (25%). One patient had a Roux-en-Y gastric bypass and percutaneous endoscopic jejunostomy was performed. Technical success rate was 100% and no complications occurred. This case series shows that the EUS-guided PEG technique is a safe alternative in patients deemed unfit for conventional PEG.     

Survival of geriatric patients after percutaneous endoscopic gastrostomy in Japan

AIM: To examine the long term survival of geriatric patients treated with percutaneous endoscopic gastrostomy (PEG) in Japan. METHODS: We retrospectively included 46 Japanese community and tertiary hospitals to investigate 931 consecutive geriatric patients (≥ 65 years old) with swallowing difficulty and newly performed PEG between Jan 1st 2005 and Dec 31st 2008. We set death as an outcome and explored the associations among patient’s characteristics at PEG using log-rank tests and Cox proportional hazard m...