Percutaneous endoscopic gastrostomy (Percutaneous Endoscopic Gastrostomy referred to as PEG) in the endoscopic guided percutaneous gastrosto
Percutaneous endoscopic gastrostomy (Percutaneous Endoscopic Gastrostomy referred to as PEG) in the endoscopic guided percutaneous gastrostomy tube placement, nutrient solution direct infusion into the stomach through the feeding tube to reach PEG, gastrointestinal nutrition and other therapeutic purposes, PEG provides an effective way for the establishment of long-term safety, enteral nutrition channel. At present, it is widely used in developed countries, and its application is very limited. Since the introduction of this technology in our hospital in 2004, nearly 30 patients have been performed endoscopic gastrostomy, and achieved good results, and this technology to Dali, Lincang, Wenshan and other hospitals to promote.
Due to various causes of dysphagia or dysphagia patients often encountered in clinical practice, in order to meet the nutritional needs of the body, in the past often take a nasogastric tube or gastrostomy surgery. However, these two methods have a lot of drawbacks. Long term indwelling nasogastric tube, not only make the patient feel nasopharyngeal discomfort, long-term intubation caused by nasopharyngeal and esophageal mucosal erosion, bleeding and stenosis, but also easy to be pulled out by patients themselves. The operation of fistula should be carried out in operation room, and the procedure of anesthesia and operation is complicated. PEG is a practical endoscopic therapy. Compared with the traditional laparotomy gastrostomy, PEG has small trauma, simple operation, short operation time, safe, economic, easy to postoperative nursing, and complication and mortality rate decreased obviously, has replaced the traditional surgical gastric fistula. PEG tube indwelling time, the longest more than 4 years. The utility model has the advantages that the self feeding is convenient, and the PEG tube can be fixed on the abdominal wall when not used normally, and the patient can maintain the appearance dignity without being exposed. PEG was originally designed for long-term enteral nutrition in patients with normal gastrointestinal function but not oral feeding. Now, PEG indications continue to expand, has been applied to burn, esophageal cancer, head and neck cancer and other people, and even severe maxillofacial trauma patients can benefit from PEG.
PEG is the premise of a variety of reasons leading to oral feeding disorders, but the normal gastrointestinal function, the need for long-term (2 to more than 3 weeks) tube feeding nutritional support or long-term gastrointestinal decompression. Specific indications are as follows: central nervous system diseases cause swallowing disorders (such as stroke, brain trauma, vegetative state); head and neck neoplasms (nasopharynx, oral) before and after radiotherapy or surgery; esophageal perforation of esophagus and esophageal fistula, extensive scar formation; inadequate intake (such as burns, AIDS, anorexia, bone marrow transplant); biliary fistula, biliary drainage; severe acute pancreatitis, pancreatic cyst, gastric emptying disorder (jejunal tube); due to various reasons, for intractable vomiting (tumor chemotherapy). PEG is also contraindicated, divided into absolute contraindications and relative contraindications. Absolute contraindications include: coagulopathy, peritonitis and peritoneal dialysis, gastric varices, gastric and any gastroscopy disease. Relative contraindications such as a large number of ascites, PEG can not see the light from the abdominal wall in patients, usually because the other structure between morbid obesity or stomach and abdominal wall. Endoscopic and abdominal ultrasound, CT scan can be used to check that there is no other tissue structure, and under the guidance of the puncture operation. Obese patients can cut the skin and subcutaneous tissue under local anesthesia, and then you can safely perform PEG operations.
PEG not only can play the role of long-term enteral nutrition, but also can be used in the perioperative period of some special patients, gastrointestinal decompression can also play a role.
The fistula should be promptly replaced and removed. Many patients due to the condition improved, can independently by eating without going through the fistula tube feeding, can be directly extracted from the fistula in vitro. But after extubation in sinus formation, usually at least in more than 28 days after implantation.
The incision infection was more common in PEG patients, and the complications were minor and severe complications. Minor complications including incision infection, fistula spondylolisthesis shift, parastomal fistula blockage, leakage and incision hematoma. Serious complications include hemorrhage, aspiration, peritonitis, internal pad syndrome, gastric fistula and so on. Through the prevention of infection, aseptic operation, strict compliance with operating procedures, postoperative care can effectively avoid the occurrence of complications.
Intermittent feeding can be carried out after the placement of PEG tube, which has the advantages of easy implementation, good tolerance and physiological compliance. Each time the amount of enteral nutrition should be injected to avoid a large number of infusion of gastroesophageal reflux. In addition, the patient should maintain a semi recumbent position to reduce the risk of aspiration. Patients discharged from the hospital, at home can continue to enteral nutrition support by PEG, maintain the normal nutritional status, such as the emergence of the fistula surrounding skin swelling and pain or fistula obstruction of the abnormal situation, should be timely to the hospital.