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Percutaneous endoscopic gastrostomy for long term enteral nutrition.

BACKGROUND: Percutaneous endoscopic gastrostomy for long term enteral nutrition is often indicated in patients with head, neck and oesophageal cancer but despite its growing popularity elsewhere, it is not widely used in India. METHODS: Between March 1990 and July 1991, we performed percutaneous endoscopic gastrostomy in 54 patients. The primary sites of tumour were the hypopharynx (11), oral cavity (7), tongue (7), cricopharynx (7), oesophagus (16) and other sites (6). The indications were difficulty in swallowing following treatment (22), preoperative nutritional support (7) and terminal care (21). In 49 patients, it was performed by the 'pull' technique in the endoscopy room under local anaesthesia and mild sedation. Indigenously prepared tubes and blenderised foods were used. Fifteen patients underwent dilatation of the tumour prior to the gastrostomy. RESULTS: The procedure was successful in 50 (93%) patients. Three failures were caused by obstructing tumours and one by a previous gastric resection. Feeding was started 18 to 24 hours after the procedure in 48 patients. No major complications occurred but minor complications were seen in 11 (22%) patients. Fourteen patients had their gastrostomy tube removed after 2 to 6 months of use while 15 patients undergoing therapy or with persistent dysphagia were on gastrostomy feeds for 1 to 6 months. Of the 21 terminally ill patients, 8 died, 6 were lost to follow up and 7 were on feeds for 1 to 6 months. CONCLUSIONS: Percutaneous endoscopic gastrostomy is a simple, safe and effective method for long term enteral feeding. Indigenous tubes and home made blenderised foods are adequate substitutes for the more expensive commercial kits and enteral formulations.

Adolescent↗
PubMed1992

Gastrostomy buttons for feeding children on continuous cycling peritoneal dialysis.

The promotion of growth in infants and young children with chronic renal failure (CRF) requires an aggressive approach to feeding, often in combination with early dialysis. Supplementary feeding has usually involved the use of nasogastric tubes, but these can have many problems. We report our experience with a gastrostomy button device (Bard Ltd.) for long term feeding. Ten children (7 male) had an initial gastrostomy catheter inserted at a median age of 2.0 years (range 0.25-8.5 years). None of the children required an operation for gastrooesophageal reflux and 6 had placement of the gastrostomy catheter at the time of insertion of the Tenckhoff catheter for continuous cycling peritoneal dialysis (CCPD). The catheter is usually exchanged for a similar sized (18 gauge) button device after 4 weeks. All ten children received CCPD in addition to overnight feeding using an enteral feeding pump. The buttons have been in use for a mean of 12 months (range 2-33 months) and are only changed if the anti-reflux valves fail. Nutritional goals have been achieved and growth parameters maintained or improved in 9 children. The button has many advantages over nasogastric tubes or gastrostomy catheters. It has been welcomed by our families in reducing the stress of feeding these young children.

Catheters, Indwelling↗
PubMed1976

Urinary diversion: adjunctive tube gastrostomy.

A series of 98 patients who had undergone construction of ileal conduits is discusses. Of the 76 patients who had gastrostomy drainage 2 had complications related to the procedure. Complications occurred in 6 of the 22 patients who had nasogastric drainage. The advantages and disadvantages of postoperative gastric decompression by tube gastrostomy and the nasogastric tube are discussed. We conclude that the gastrostomy tube has a definite place in pediatric and adult urological cases in which postoperative ileus may be expected.

Adolescent↗
PubMed1977

[Value of gastrostomy in the prevention of food inhalation].

Gastrostomy can have both a preventive and curative effect for patients particularly exposed to food inhaling, especially the heavy casualties with loss of initial consciousness and prolonged intubation or tracheotomy. In these patients stopping the forcible feeding led to frequent mishaps and to recurrent pulmonary complications. Gastrostomy prevents them while enabling the seriously injured patients to receive 2.500 calories daily. These cases showed the different circumstances where gastrostomy done rapidly under L. A. and with assisted ventilation gave good results.

Aged↗
PubMed1976

[Temporary gastrostomy as an alternative procedure for nasogastric suction].

Based on personal experience with 70 cases of temporary tube gastrostomy - used as an alternative procedure to nasogastric suction in 50 cases and as a double-purpose tube in 20 cases of radical esophagectomy - pertinent problems concerning indication, technique, advantages, and possible complications are presented. The results indicate that temporary gastrostomy is a safe procedure, reduces cardiopulmonary disorders, and increases the patient's comfort. The procedure is therefore strongly recommended for patients with poor cardiopulmonary reserve and for the age group above 60 years. Temporary gastrostomy is also indicated in younger patients, if prolonged gastric distension with the necessity of decompression is anticipated.

Adult↗
PubMed1975

The permanent gastrostomy. Use of the gastrointestinal anastomotic stapler.

A permanent feeding gastrostomy was quickly and simply constructed in 29 patients with low operative risk using the gastrointestinal anastomotic stapler. The technique consisted of a simple application of this stapler on a carefully selected section of the stomach to form a Janeway type of gastrostomy. Activation of the device placed two double rows of staples and cut between them. This left the mucosa in approximation both in the tube and in the body of the stomach. A few additional Lembert sutures was all that was necessary. There were no suture line leaks nor other complications peculiar to the method.

Adolescent↗
PubMed1975

[Valvular tube gastrostomy].

Valvular tube gastrostomy was performed on 90 patients whose lesions necessitated permanent alimentary gastrostomy. 60 were cases of cancer of the oesophagus where the tumor could not be removed, and 30 were cancers of the oropharynx. 10 (11 p.cent) died within one month of surgery, but slackening of the sutures was an attributable cause in none of these cases. 4 succumbed to their cancer before the sixth month. The functional results of those surviving more than 6 months were examined: -- 75 p.cent had very good results; -- 17 p.cent had mediocre results, but feeding was still possible; -- 8 p.cent had bad results and a second operation was necessary.

Aged↗
PubMed1975

[G.S. Toprover's gastrostomy].

Based on the analysis of 76 case reports of esophageal cancer (55 patients), cancer of the cardiac portion of the stomach (15 patients) and other organs, in which the G.S. Toprover gastrostomy was performed, the main drawbacks of the operation were revealed, and the causes of lethal issues following the operation after this technic are analysed. It is emphasized that putting in circular sutures on the gastrostome conus results in their cutting through with subsequent impairment of the fistula hermeticity, and some modified more improved methods of gastrostomy are recommended.

Adult↗
PubMed1992

[Percutaneous endoscopic gastrostomy].

Although percutaneous endoscopic gastrostomy (PEG) for feeding purposes has been in use for the past 10-12 years, many practitioners are unaware of this option. We describe 10 patients who underwent PEG with only 1 major, but nonfatal, complication. We stress that PEG is indicated for those who cannot swallow, and is safe, easy to perform, and a relatively cheap procedure. It is therefore a useful substitute for surgical gastrostomy.

Adult↗
PubMed1992

[Our experience with percutaneous endoscopic gastrostomy in pharyngo-laryngeal surgery].

Percutaneous endoscopic gastrostomy (PEG), is an enteral feeding procedure, easy to tolerate and simple to perform. PEG appears to be an alternative to surgical gastrostomy. Used in ten patients with E.N.T. cancer, we only observe two minor complications. Advisable in a first time for the feeding of patients with palliative treatment, we propose PEG for patients in position to have a long and difficult rehabilitation of swallowing.

Adult↗
PubMed1976

Primary repair of esophageal atresia without staging or preliminary gastrostomy.

Twenty-two neonates with esophageal atresia and a distal tracheoesophageal fistula were treated by primary repair. Only if an anastomotic leak was demonstrated was a tube gastrostomy for decompression with trangastric placement of a duodenal tube for feeding performed. Twelve newborns were classified as high-risk by the presence of prematurity with low birth weight (less than 2,250 gm), significant pneumonia, or obvious significant associated anomalies. There was one operative death and 1 late death. Three babies required a tube gastrotomy and duodenal tube for anastomotic leaks. All 20 survivors are symptom free and thriving. Progress in perioperative management of neonates with esophageal atresia may obviate the need for routine gastrostomy and for staging of high-risk newborns.

Abnormalities, Multiple↗
PubMed1977

A reversed jejunal segment interposition as feeding gastrostomy.

Permanent feeding gastrostomies are needed for prolonged alimentation in some patients with foregut obstruction. The usual gastric flap or tube may be limited in patients with previous gastric surgery or with a small stomach. In these patients, interposition of a short, vascularized jejunal segment between the anterior wall of the stomach and the outside may be valuable. Periodic intubation is easy. Tested initially in dogs and then applied to selected patients, we have not seen ulcers, regurgitation, soiling, pain, or other complications.

Animals↗
PubMed1976

Retrograde oesophagoscopy via gastrostomy.

The following case-report shows that oesophagoscopy can be performed by introducing a flexible fiberscope through a gastrostomy. Conditions and indications for this unusual procedure are discussed. Applying this method of oesophagoscopy the natural form of the cardia can be observed, and the so-called cardiac lip well known to any endoscopist is shown to be an artefact.

Aged↗
PubMed1975

[Reconstruction of the oesophagus after scarring due to swalled alkali and 22 years of gastrostomy feeding (author's transl)].

The unusual life history of a man (now 24 years old) is reported who, at two years of age, swallowed an alkaline solution which caused severe oesophageal stricture due to scarring. It required feeding by gastrostomy exclusively for 22 years. Reconstruction of the oesophagus was then performed by interposing the colon (splenic flexure). Since secondary malignant degeneration is to be expected in this form of oesophageal stricture, removal of the residual oesophagus is recommended.

Adult↗
PubMed1992

Feeding via nasogastric tube or percutaneous endoscopic gastrostomy. A comparison.

When a patient needs enteral feeding, there are two methods to administer the nutrition. The method most used is the nasogastric tube (NGT), although in the literature little is published about the advantages and complications of the NGT. The second method is percutaneous endoscopic gastrostomy (PEG). A prospective randomized trial was started, and so far 90 patients have entered the study (46 NGT and 44 PEG). In four patients it was not possible to insert the NGT, and in three patients it was impossible to place the PEG. In both groups 6.5% aspiration was found. Nasal decubitus and swallowing problems were seen in 13% and 17%, respectively, in the NGT group. Intraperitoneal bleeding and abdominal pain were found in 2% and 11%, respectively, in the PEG group. Fixation of the patients was needed in 7% of the PEG and 22% in the NGT group. In eight patients in the NGT group the feeding had to be stopped owing to problems; in none of the PEG group was this necessary. The nursing staff awarded marks to each patient on a scale of 5 for the convenience of care (very good, 1; very bad, 5). This resulted in a mean score of 2.6 in the NGT and 2.0 in the PEG group. The score given by the patients was 2.3 in the NGT and 1.8 in the PEG group. There seems to be a clear preference for the PEG as a method for enteral nutrition.

Aged↗
PubMed1977

A chronic gastrostomy and test system for evaluation of gastric secretions in rhesus monkeys.

We have developed a test system for the evaluation of gastric secretion in the rhesus monkey on a chronic basis that does not require the usual restraining techniques. The system is characterized by ease of animal maintenance and handling, reliability in introducing test substances into the stomach, and long term postsurgical stability. The system comprises a surgical preparation whereby the gastrostomy tube is inserted permanently in the stomach, is passed subcutaneously up the back, and is exteriorized at the top of the skull, and a training procedure that conditions the monkeys so as to facilitate easy handling during the administration of test substances and the collection of gastric controls. Values for pH, volume, total acid, and acid concentration appear reasonably consistent under base-line (no test substance) conditions as well as after the intragastric administration of water or the subcutaneous injection of Histalog.

Animals↗
PubMed1979

[Gastrostomy and esophagoplasty with a pedicle graft from the greater curvature of the stomach as stages in surgical and combined treatment of cancer of the thoracic esophagus].

Not infrequently cancer of the middle and lower thirds of the esophagus metastasizes into the subfrenic lymph nodes, which justifies a revisional laparotomy for completing the diagnosis of the tumor process spreading. A peduncular gastrostomy is carried out at the revisional laparotomy. A one-stage operation of extirpation and plasty of the esophagus with a stomach tube, housed in the bed of ablated esophagus, involves a great risk and is followed by a high fatality rate.

Esophageal Neoplasms↗