Percutaneous approaches to enteral alimentation

doi:10.1016/S0002-9610(85)80017-9

The American Journal of Surgery

Volume 149, Issue 1, January 1985, Pages 102-105

https://doi.org/10.1016/S0002-9610(85)80017-9 Get rights and content

Summary

Feeding gastrostomy and jejunostomy provide effective access for long-term enteral nutrition. Traditional operative techniques for the performance of these procedures requires laparotomy and often, general anesthesia. This report describes our experience with two relatively new methods, percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy. Results of percutaneous gastrostomy and jejunostomy to date in 323 cases include a morbidity of 5.9 percent and a 0.3 percent operative mortality. Percutaneous endoscopic gastrostomy and jejunostomy should become the procedures of choice for the establishment of enteral access in patients requiring long-term enteral alimentation.

References (9)

GaudererMWL et al.
Gastrostomy without laparotomy: a percutaneous endoscopic technique
J Pediatr Surg
(1980)
PonskyJL et al.
Percutaneous endoscopic gastrostomy: a nonoperative technique for feeding gastrostomy
Gastrointest Endosc
(1981)
GaudererMWL et al.
A simplified technique for constructing a tube feeding gastrostomy
Surg Gynecol Obstst
(1981)
PonskyJL et al.
Percutaneous endoscopic gastrostomy: review of 150 cases
Arch Surg
(1983)

There are more references available in the full text version of this article.

Cited by (170)

Surgical procedures in the surgical intensive care unit
2023, Current Therapy of Trauma and Surgical Critical Care
Bedside procedures are an integral part of the surgical care delivered to critically ill patients. Whether performed for diagnostic or therapeutic purposes, bedside procedures require adequate preparation, knowledge, and expertise in surgical techniques and anticipation of complications in order to be performed safely. They can carry a higher risk of complications because they are performed urgently, on critically ill patients, and outside the operating room. With older and sicker patients surviving their injury and ongoing pressure for more effective utilization of the operating rooms, bedside procedures in the intensive care unit have become more common.
Enteral and parenteral nutrition
2023, Encyclopedia of Human Nutrition: Volume 1-4, Fourth Edition
Nutritional support refers to the provision of nutrients to individuals who are unable to maintain adequate nutritional status due to derangements in nutritional intake, malabsorption, or altered metabolism. The nutrition assessment process is a critical step in identifying patients who are at nutritional risk. It incorporates both subjective (medical and nutrition histories) as well as objective (physical examination, anthropometric measurements, laboratory tests, etc.) parameters to determine those in whom nutritional support would be beneficial. Nutritional support can be in the form of oral, enteral, or parenteral administration of nutrients.
Enteral Nutrition (EN) is the preferred method of feeding patients who cannot eat, absorb, or use a normal diet in the presence of a useable GI tract. The route of delivery of EN varies from nasogastric, nasoenteric, gastrostomy or jejunostomy. A wide selection of EN formulas is commercially available depending on the needs of the patient. Enteral feedings are administered via pump assist devices or using gravity drip or manual bolus (syringe). If managed properly, enteral feeding is associated with improved clinical outcomes and reduced infectious complications and is the preferred form of nutritional support.
Parenteral nutrition (PN), which is a compounded formulation of crystalline amino acids, dextrose, fats, electrolytes, vitamins, and minerals, is utilized in situations where the gastrointestinal tract is not functioning or cannot be accessed or in those cases where adequate nutrition cannot be attained by enteral or oral means alone. The advent of parenteral nutrition has revolutionized the management of very ill patients who are unable to maintain adequate nutritional intake.
Computed tomography-gastro-colonography for percutaneous endoscopic gastrostomy using a helical computed tomography
2015, American Journal of Surgery
Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula.
In total, 48 individuals underwent computed tomography-gastro-colonography (CT-GC)-guided PEG placement. Study end points included success of CT-GC, inability to thread the PEG tube, the eventual tube location, tube adjustments needed, adverse events, operating time, and PEG tube-related infection.
A successful CT-GC was achieved in all 48 patients (100%), and we successfully used a standard PEG technique to place the gastrostomy tube in 44 patients (92%). In 4 patients (8%), the laparoscopic-assisted PEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. The overall procedure-related minor complication rate was 8%.
CT-GC is an optional method for the estimation of intra-abdominal, anatomical orientations that may minimize the risk of complications before PEG placement.
Gastrointestinal Devices, Procedures, and Imaging
2012, Emergency Medicine: Clinical Essentials, SECOND EDITION
Laparoscopy-assisted percutaneous endoscopic gastrostomy
2008, Asian Journal of Surgery
Percutaneous endoscopic gastrostomy (PEG) placement is associated with considerable complications. We added laparoscopic monitoring to improve outcome.
Thirty-four patients who had laparoscopy-assisted PEG (LAP-PEG) were reviewed. A 5 mm supraumbilical trocar and two 5 mm working ports were required for LAP-PEG. A needle was placed percutaneously into the stomach under laparoscopic and gastroscopic control. A wire was placed through the needle, encircled with a snare, and the PEG completed. The anterior wall of the stomach was then anchored to the abdominal wall.
Thirty-one subjects had cerebral palsy. Age at LAP-PEG ranged from 5 months to 25 years (mean, 8.1 years). Weight ranged from 4.7 kg to 25.9 kg (mean, 12.2 kg). In 23 patients, LAP-PEG was performed with laparoscopic Nissen fundoplication. In 11 patients, it was performed for reasons such as gastric volvulus and nutritional supplementation. Mean operating time was 67 minutes, and all procedures were performed safely without intra- or postoperative complications.
LAP-PEG is our method of choice for gastrostomy because it allows the first and last parts of a conventional PEG procedure to be well controlled and safe instead of being blind.
Surgical Procedures in the Surgical Intensive Care Unit
2008, Current Therapy of Trauma and Surgical Critical Care

View all citing articles on Scopus

^*: Presented at the 25th Annual Meeting of the Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 22–23, 1984.

View full text

Percutaneous approaches to enteral alimentation*

Summary

J Pediatr Surg

Gastrointest Endosc

A simplified technique for constructing a tube feeding gastrostomy

Surg Gynecol Obstst

Percutaneous endoscopic gastrostomy: review of 150 cases

Arch Surg