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percutaneous endoscopic gastrostomy

PEG Tube. 18F to 28FSilicone or polyurethaneAverage longevity of 1

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percutaneous endoscopic gastrostomy

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    1. Percutaneous Endoscopic Gastrostomy Dr. Bruno Salena Division of Gastroenterology Hamilton Health Sciences McMaster University

    2. PEG Tube 18F to 28F Silicone or polyurethane Average longevity of 1 2 years

    3. PEG Tube ( low profile)

    4. PEG vs. Surgical Gastrostomy Lower cost Shorter procedure time Lower complications

    5. PEG - Indications For nutrition where patient cannot consume sufficient calories to meet metabolic needs Impaired swallowing (neurologic, neuro-muscular, obstructive neoplasms) NG tube associated aspiration Gastric decompression

    6. PEG - Contraindications Inability to bring the anterior gastric wall in apposition to the anterior abdominal wall (prior subtotal gastrectomy, ascites, marked hepatomegaly) Severe obesity Small bowel fistula Infiltrative gastric diseases Obstructing esophageal tumour Incorrectable coagulopathy

    7. PEG - Technique Pull method (Gauderer & Ponsky, 1980) Push method (Russell) Radiologic method

    8. PEG Technique (Basic elements) Gastric insufflation and trans-illumination Percutaneous placement of tapered cannula into stomach Passage of suture or guidewire into stomach Placement of gastrostomy tube Verification of proper position

    9. PEG Technique (Transillumination)

    10. PEG Technique (Anesthesia)

    11. PEG Technique ( Advance cannula and snare)

    12. PEG Technique (guidewire)

    13. PEG Technique (confirm position)

    14. PEG - Technique

    15. PEG - Complications Wound infection Peritonitis Septicemia Peristomal leakage Tube dislodgement Aspiration Bowel perforation Gastro-colic fistula

    16. PEG - Complications Pneumo-peritioneum is common wound infection risk 5% Morbidity 3 6% Mortality 0.3 1%

    17. PEG Post-operative Care Antibiotics x 48 hrs Feeds can start in 8 hours Water flush of tube Daily wash of site with soap and water after wound healing Wound management (leakage, silver nitrate for proud flesh)

    18. Percutaneous Endoscopic Jejunostomy Severe GERD Gastric emptying disorders Joint feeding/aspiration

    19. PEG Summary & Questions Safe, efficient and effective Acceptable morbidity Longer-term feeding Ethics

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