Gastrostomía endoscópica -through como dispositivo de instalación / Endoscopic gastrostomy using the pull through kit as installation device

Background: The pull-through method to install endoscopic gastrostomies is not devoid of complications. Aim: To describe and show the results of a trans-abdominal method to perform endoscopic gastrostomies using the accessories available in any endoscopic facility. material and methods: The technique consists in installing an exchange tube using the pull kit, which acts as a tube installer. We attempted the procedure in 14 patients whose ages ranged from 15 days to 83 years in a regional hospital. results: In 13 patients, the tube was correctly installed using the trans-abdominal pathway and they could be fed two hours later. Three months later, 11 patients were alive and did not experience complications associated with the gastrostomy. Conclusions: This preliminary experience supports the use of the described technique to install gastrostomies.

Objetivo: Para evitar las complicaciones de la gastrostomía endoscópica (GE) hemos desarrollado un método transabdominal empleando accesorios disponibles en cualquier unidad de endoscopia y una técnica con la cual los endoscopistas están familiarizados. Describimos el método y mostramos sus resultados. material y método: Esta técnica consiste en instalar una sonda de recambio con la ayuda del kit Pull que actúa como instalador de la sonda. Hemos intentado este procedimiento en 14 pacientes con edades entre 15 días y ochenta y tres años. Esta experiencia se realizó en el Hospital de Iquique. resultados: En 13 pacientes se logró instalar la sonda por vía transabdominal y alimentar dos horas después. A los 3 meses, once permanecían vivos y no habían tenido complicaciones mayores relacionadas a su gastrostomía. Conclusión: Aunque se trata de una experiencia inicial, creemos que esta técnica de gastrostomía combinada presenta una alternativa a otras técnicas endoscópicas de acceso transabdominal.

Perfil, critérios de indicação e desfecho da inserção de gastrostomia em um hospital pediátrico universitário / Profile, recommendation criteria, and outcome of gastrostomy tube insertions in a pediatric teaching hospital

Objetivo: Descrever o perfil dos pacientes submetidos à gastrostomia, os critérios de indicação e o desfecho dessa inserção em um hospital pediátrico universitário. Método: Estudo retrospectivo, quantitativo e descritivo, através de pesquisa em prontuários de pacientes submetidos à gastrostomia no período entre janeiro/2010 e dezembro/2012. Resultados: As doenças e condições de base mais frequentes foram: encefalopatia crônica da infância (77,5%), pneumonia (67,5%), crise convulsiva (57,5%) e desnutrição (42,5%). Apesar da maioria dos pacientes apresentar história de disfagia (62,5%), observou-se como via de nutrição mais frequente antes da inserção da gastrostomia a via oral (42,5%), seguida pela nasoenteral (40%). A introdução de dieta pela gastrostomia foi bem sucedida e ocorreu em média 2,82(± 1,19) dias após a sua inserção. Após seis meses de realização da gastrostomia, 80% dos pacientes permaneceram alimentando-se exclusivamente através desta via e somente 2,5% retirou a gastrostomia. 45% dos participantes apresentaram complicações da gastrostomia, sendo extravasamento do material gástrico (15%) e inflamação local (15%) as mais frequentes. Conclusão: O perfil dos pacientes submetidos à gastrostomia é de indivíduos, em sua maioria, com doença neurológica e respiratória, sem suporte respiratório, do sexo masculino e alimentando-se por via oral ou sonda nasoenteral por período prolongado. Os principais critérios de indicação foram doença neurológica e disfagia. Em relação ao desfecho, a introdução de dieta pela gastrostomia é bem sucedida, a maioria dos indivíduos permanece com este suporte nutricional a longo prazo e as complicações mais frequentes são extravasamento do material gástrico e inflamações na área da gastrostomia.

Objective: To describe the profile of patients undergoing a gastrostomy, the recommendations and outcome of this insertion in a Pediatric Teaching Hospital. Method: This was a retrospective, quantitative, and descriptive study that researched the records of patients who underwent a gastrostomy between January 2010 and December 2012. Results: The diseases and conditions most frequent were chronic infantile encephalopathy (77.5%), pneumonia (67.5%), seizures (57.5%), and malnutrition (42.5%). Although most patients presented a history of dysphagia (62.5%), oral feeding was observed most frequently as the most common form of nutrition, before the gastrostomy insertion (42.5%), followed by nasoenteric tube (40%). The introduction of nutrition by gastrostomy was successful and occurred an average of 2.82 (± 1.19) days after insertion. Six months after their gastrostomy, 80% of patients continued feeding only through this access tube and only 2.5% had removed the gastrostomy; 45% of the participants had gastrostomy complications, with extravasation of gastric material (15%) and local inflammation (15%) being the most frequent. Conclusion: The profile of patients undergoing gastrostomy is mostly of individuals with neurological and respiratory diseases, without respiratory support, of the male gender, and feeding by oral cavity or nasoenteric tube for a prolonged period. The main recommendation criteria were dysphagia and neurological diseases. Regarding the outcome, the introduction of nutrition by gastrostomy was successful; most individuals remained with this long-term nutritional support and the most common complications were gastric material extravasation and local inflammations.

Percutaneous Radiologic Gastrostomy Using the One-Anchor Technique in Patients after Partial Gastrectomy

OBJECTIVE: The purpose of our study was to assess the feasibility of performing percutaneous radiologic gastrostomy (PRG) in patients who had undergone partial gastrectomy and to evaluate factors associated with technical success. MATERIALS AND METHODS: Nineteen patients after partial gastrectomy, who were referred for PRG between April 2006 and April 2012, were retrospectively analyzed. The remnant stomach was punctured using a 21-gauge Chiba-needle. A single anchor was used for the gastropexy and a 12-Fr or 14-Fr gastrostomy tube was inserted. Data were collected regarding the technical success, procedure time, and presence of any complications. Univariable analyses were performed to determine the factors related to the technical success. RESULTS: Percutaneous radiologic gastrostomy was technically successful in 10 patients (53%), while a failed attempt and failure without an attempt were observed in 5 (26%) and 4 (21%) patients, respectively. Percutaneous radiologic jejunostomy was successfully performed in 9 patients who experienced technical failure. In the 10 successful PRG cases, the mean procedure time was 6.35 minutes. Major complications occurred in 2 patients, tube passage through the liver and pneumoperitonum in one and severe hemorrhage in the other. The technical success rate was higher in patients with Billroth I gastrectomy (100%, 6/6) than in patients with Billroth II gastrectomy (31%, 4/13) (p = 0.011). CONCLUSION: Percutaneous radiologic gastrostomy can be successfully performed using the one-anchor technique in approximately half of the patients after partial gastrectomy.

Gastrostomía en la nutrición enteral domiciliaria / Gastrostomy in home enteral nutrition

La gastrostomía es el acceso enteral más considerado cuando se requiere una sonda de alimentación a largo plazo. Las técnicas de implantación de la sonda de gastrostomía pueden ser percutánea y quirúrgica. La alimentación por gastrostomía es generalmente bien aceptada en niños y adultos. La gastrostomía es un acceso de gran utilidad y de gran importancia a nivel clínico en la alimentación enteral a largo plazo tanto de niños como adultos.

Access gastrostomy is considered when more enteral feeding tube requires long term. The technical implementation of the gastrostomy tube can be percutaneously and surgically. Gastrostomy feeding is generally well accepted in children and adults. The gastrostomy is a useful access and important at the clinical level in the long-term enteral feeding both children and adults.

Percutaneous endoscopic gastrostomy tube placement for end-stage palliation of malignant gastrointestinal obstructions

Decompression of malignant gastrointestinal obstructions is an uncommon indication for percutaneous endoscopic gastrostomy [PEG] tubes. The purpose of this study is to determine the efficacy of venting PEG tubes in relieving nausea and vomiting and assessing complications associated with tube placement. This study is a retrospective chart review of patients with PEG tubes placed to decompress malignant gastrointestinal obstructions between January 2005 and September 2010 by the gastroenterology service at our institute. Patient demographics, symptom relief, procedural complications, diet tolerability and home palliation were reviewed. Seven PEG tubes were inserted to decompress malignant gastrointestinal obstructions. The mean patient age was 62 years [range 37-82 years]. The underlying primary malignancies were small intestine [1], appendiceal [1], pancreatic [2], and colon [3] cancer. Gastric outlet obstruction was present in 3 [43%] patients while small bowel obstruction occurred in 4 [57%] patients. There was relief of nausea and vomiting in 6 [86%] patients. Procedural complications were present in 1 [14%] patient and involved superficial cellulitis followed by peristomal leakage. Patients with gastric outlet obstruction continued to have limited oral intake while patients with small bowel obstruction tolerated varying degrees of oral nutrition. Six [86%] patients were discharged home after PEG tube placement, but only 2 [33%] were able to undergo end-stage palliation at home without re-admission for hospital palliation. Venting PEG tubes significantly reduce the symptoms of nausea and vomiting in patients with metastatic gastrointestinal obstruction due to primary gastrointestinal malignancies. Complications associated with tube placement were minimal

New "introducer" PEG-gastropexy with T fasteners: a pilot study / Gastrostomia endoscópica percutânea pela técnica de introdução com gastropexia com T-tags: um estudo piloto

CONTEXT: Enteral feeding is indicated for patients unable to maintain appropriate oral intake, and percutaneous endoscopic gastrostomy (PEG) is the most adequate long-term enteral access. Peristomal infections are the most common complications of PEG, occurring in up to 8 percent of patients, despite the use of prophylactic antibiotics. The "introducer" PEG-gastropexy technique avoids PEG tube passage through the oral cavity, preventing microorganisms' dislodgment to the peristomal site. OBJECTIVES: To compare the incidence of peristomal wound infection at 7-day post-procedure after conventional "pull" technique versus a new "introducer" PEG-gastropexy kit. Secondary outcomes included success rates, procedure time, and other complications. METHODS: Eighteen patients referred for PEG placement between June and December 2010 were randomly assigned to "pull" PEG with antibiotics or "introducer" PEG-gastropexy technique without antibiotics. RESULTS: Overall success rate for both methods was 100 percent, although mean procedure duration was higher in the "introducer" PEG-gastropexy group (12.6 versus 6.4 minutes, P = 0.0166). Infection scores were slightly higher in patients who underwent "pull" PEG with antibiotics compared with "introducer" PEG-gastropexy without antibiotics (1.33 ± 0.83 versus 0.75 ± 0.67, P = 0.29). CONCLUSION: Although procedure duration was longer in the "introducer" PEG-gastropexy, infection scores were marginally higher in the "pull" PEG technique.

CONTEXTO: A nutrição enteral está indicada para pacientes incapazes de manter aporte voluntário adequado e a gastrostomia endoscópica percutânea (GEP) é a via preferencial para acesso enteral de longa duração. As infecções periostomais são as principais complicações da GEP, ocorrendo em até 8 por cento dos pacientes, a despeito do uso de antibiótico profilático. A GEP pela técnica de introdução com gastropexia evita a passagem da sonda de gastrostomia pela cavidade oral, prevenindo contra o deslocamento de microorganismos ali presentes até o sítio da ostomia. OBJETIVO: Comparar a incidência de infecção periostomal no 7º dia após GEP por técnica de tração versus GEP pela técnica de introdução com gastropexia. Objetivos secundários incluíram: taxa de sucesso, tempo de procedimento e outras complicações. MÉTODOS: Dezoito pacientes encaminhados ao setor de endoscopia do Hospital Albert Einstein, São Paulo, SP, para realização de GEP entre junho e dezembro de 2010, foram randomizados para realização de gastrostomia pela técnica de tração com antibioticoterapia profilática ou pela técnica de introdução com gastropexia sem antibiótico profilaxia. RESULTADOS: A taxa de sucesso para ambos os métodos foi de 100 por cento, apesar do tempo do procedimento ter sido mais longo no grupo da técnica de introdução (12,6 versus 6,4 min, P = 0,0166). Os índices de infecção foram discretamente superiores no grupo de GEP por tração, com antibioticoterapia profilática, em comparação ao grupo GEP por introdução com gastropexia (1,33 ± 0,83 versus 0,75 ± 0,67, P = 0,29). CONCLUSÃO: Apesar da duração do procedimento ter sido mais longa no grupo GEP por introdução com gastropexia, a taxa de infecção foi discretamente mais elevada no grupo GEP por tração.

Acute buried bumper syndrome: An endoscopic buried bumper syndrome:approach.

Acute buried bumper syndrome is an uncommon complication of percutaneous endoscopic gastrostomy (PEG) tube placement. If not recognized and treated appropriately, it can lead to serious complications including death. We report a case of an acute buried bumper syndrome, successfully managed with PEG tube repositioning through the original tract, without the need of replacement.

Anestesia em criança com síndrome de Guillain-Barré após vacina de sarampo: relato de caso / Anesthesia in children with Guillain-Barré syndrome after measles vaccination: case report

JUSTIFICATIVA E OBJETIVOS: A síndrome de Guillain-Barré após vacina de sarampo é rara. O diagnóstico muitas vezes é tardio, o que leva a um aumento da morbidade. O presente relato apresenta um caso avançado e os cuidados especiais exigidos durante a anestesia. RELATO DO CASO: Paciente do sexo masculino, com quatro anos de idade com síndrome de Guillain-Barré desde um ano de idade, foi submetido a gastrostomia sob anestesia geral sem intercorrências, com sevoflurano e sem bloqueadores neuromusculares. CONCLUSÕES: O caso ilustra a raridade etiológica de uma síndrome importante na prática anestésica assim como os eventos adversos pós-vacinação, a melhor escolha para a equipe anestésica e as complicações da síndrome de Guillain-Barré na infância.

Percutaneous endoscopic gastrostomy: Nine years experience in a tertiary care centre in Pakistan

To review the experience of percutaneous endoscopic gastrostomy [PEG] tube placement and its management in the last nine years, at a tertiary care center in Pakistan. All patients who underwent percutaneous endoscopic gastrostomy from January 1995 to January 2004 at Shifa International Hospital, Islamabad, were included in this study. The indications, technique, complications and follow up were reviewed. A total of 182 persons underwent this procedure. There were 118 [65.0%] males and 64 [35.0%] females. Age ranged from 55-86 years. One hundred seventy five [96.0%] patients had cerebro-vascular accident, five [2.75%] had Parkinson's disease and two [1.25%] malignancy. More than 99% procedures were successful and no procedure related mortality was noted. Mild PEG site infections were encountered in eighteen [9.8%] patients which were manageable with local treatment and oral antibiotics. Four [2.2%] patients had severe tube site infection and needed parenteral antibiotics. Tube dislodgement took place in five [2.75%] patients and had to be removed and reinserted. Thirty days follow up was uneventful with regard to the tube. Longest follow up was 736 days. Percutaneous endoscopic gastrostomy had proved a viable means of enteral nutrition in patients with neurological impairment. Complications were insignificant. However, patient and care giver's education could be improved for more effective tube management, and prevention of PEG insertion site infection

Percutaneous endoscopic gastrostomy in porcines performed with standard medical instruments used in a general hospital routine

PURPOSE: To perform a endoscopic gastrostomy by the introducer method with routine instruments used in a general hospital, without special instruments of special kits.METHODS: This procedure was performed in pigs (Sus scrofa domesticus) under observation for seven days and then submitted to euthanasia. The technique was evaluated for macroscopic and histologic parameters. RESULTS: All animals had a good evolution without major complications. Some minor complications ocurred like a rupture of Foley catheter balloon and subcutaneous space abscess.CONCLUSION: The percutaneous gastrostomy with routine general hospital instruments is sucessful performed, is safe, cheap and must be performed by skilled endoscopists.

Gastrostomía endoscópica percutánea. Una variante de alimentación enteral / Percutaneous endoscópic Gastrosctoy. An enteral nutrition variable

Presentamos un estudio de gastrostomía endoscópica percutánea (GEP), realizada en 26 pacientes, que requieren este procedimiento en el Centro de Cirugía Endoscópica del Hospital Universitairo Central Calixto García, La Habana Cuba. La indicación más frecuente, 62 por ciento fue debida a lesiones tumorales malignas del esófago, correspondiendo el resto a afecciones benignas que provocaban disfagia. La duración promedio del procedimiento fue de 10 minutos. Se presentaron 2 complicaciones tardías, una por ruptura del balón de la sonda y un absceso de pared. No hubieron fallecidos.

Comparison between mushroom-type and balloon-type gastrostomy buttons.

The gastrostomy button has been improved rapidly over the last ten years. The gastrostomy button was divided into two groups. The first group had a mushroom tip and, in this study, the Bard button represented this group. The other had a balloon as an internal stabilizer and the Mic-key button represented this group. The authors retrospectively studied all buttons inserted at the Royal Children's Hospital, Brisbane between 1988 and 1995. The average longevity of Bard and Mic-key buttons were 378.82 and 259.62 days respectively. Valve incompetence was the most common cause of removal of the Bard button (38%), whereas, balloon rupture was the major cause of removal of Mic-key button (44%). Each type of gastrostomy button had its own advantages and disadvantages and these special characteristics will be discussed.

Primary gastrostomy button: a means of long-term enteral feeding in children.

Between June 1992 and December 1997, forty-two patients (M 19, F 23) received 94 primary gastrostomy buttons due to 22 intellectual handicap, 7 cystic fibrosis, 4 severe gastrooesophageal reflux, 2 bronchopulmonary dysplasia, 2 tumours in the neck region and 5 miscellaneous causes. Open fundoplication concomitant with primary button, primary open button and laparoscopic fundoplication concomitant with primary button were performed in 20, 15 and 7 patients respectively. The average longevity +/- standard deviation of all buttons was 388.36 +/- 360.35 days. The average longevity of the buttons of the laparoscopic fundoplication group was significantly lower than the others. The major causes of removal of Bard buttons were valve incompetence and flap damage, whereas, balloon leakage was the major cause of removal of the Mic-key button. There were merely minor stomal complications and no gastric separation and peritonitis. Because of the acceptable longevity of the buttons and minimal complications, we concluded that the primary gastrostomy button was the preferable method of long term enteral feeding in children.

La técnica segura para la gastronomía endoscópica percutánea en niños / Safe technique for percutaneous endoscopic gastrostomy (PEG)

La Gastrotomía Endoscópica Percutánea (GEP) tiene ventajas sobre la gastronomía a cielo abierto. La experiencia con 79 niños durante un período dee 4 años nos permitió identificar una serie de poblemas técnicos asociados a la inserción del tubo percutáneo y otras complicaciones del procedimiento que incluyen: infección en la herida, desgarro esofágico durante la extracción de la guía de alambre, perforación del colon, desplazamiento del retén interno, erosión de la mucosa gástrica y reflujo gastroesofágico sintomático subsiguiente a la GEP. Muchas de estas complicaciones pueden ser evitadas siguiendo una técnica precisa de inserción

Gastrostomía endoscópica percutánea (GEP): una alternativa para alimentación enteral prolongada / Percutaneous endoscopic gastrostomy: an alternative for long enteral feeding

La gastrostomía percutánea bajo control endoscópico, desde su descripción inicial en 1980 en pacientes pediátricos, es el método de elección para alimentación artificial en pacientes con trastornos de la deglución prolongada, ya sea pasajera o definitiva. En su gran mayoría, los pacientes beneficiados con este método son aquellos con patología neurológica o tumores hipofaríngeos, laríngeos o esofágicos. Algunos factores, como el menor costo, baja morbimortalidad y excelente tolerancia por el paciente, han desplazado las alternativas quirúrgicas clásicas por este método mínimamente invasivo. El adecuado conocimiento del procedimiento, sus indicaciones y contraindicaciones, así como la prevención y precoz detección y tratamiento de las complicaciones permitirán su uso rutinario en pacientes que lo requieran

Sondas de alimentación enteral colocadas percutáneamente por endoscopia / Enteral feeding tubes percutaneously placed by endoscopy

En el presente artículo se hace una revisión de algunos aspectos de las técnicas de la Gastrostomía Endoscópica Percutánea (GEP) y Yeyunostomía Endoscópica Percutánea (YEP). Las sondas de gastrostomía y yeyunostomía endoscópica percutánea son métodos seguros ya comprobados con un costo-beneficio adecuado para proporcionar nutrición a los pacientes que tienen un intestino funcional y no pueden ingerir alimentos. Estas técnicas han demostrado ser procedimiento que ofrecen ventajas al paciente, evitándole los riesgos quirúrgico y anestésico. La selección apropiada de pacientes es importante para obtener mejores resultados. La GEP y YEP son métodos eficientes, rápidos, aceptados mundialmente, porque pueden realizarse en la cama del paciente, con mínima morbilidad, bajo costo e insignificante mortalidad

La gastrostomía laparoscópica como una alternativa a la gastrostomía endoscópica percutánea / Laparoscopic gastrostomy as alternative to percutaneous endoscopic gastrostomy

Introducción: La gastronomía endoscópica percutánea (GEP) es actualmente la técnica de elección cuando se requiere de una gastronomía para alimentación enteral. Sin embargo, en algunos casos no es posible realizar la GEP por diversas razones técnicas. Objetivo: Presentar la gastronomía laparoscópica (GL) como una alternativa a la GEP. Diseño: Caso clínico. Lugar: Un centro oncológico de referencia en México, D.F. material clínico: En este trabajo se describe un caso de falla de la GEP por existir obstrucción esofágica completa. Se realizó exitosamente una GL. Comentario: Se describe la técnica de este procedimiento como una alternativa a la GEP la GL es un procedimiento sencillo, de bajo costo y probablemente baja morbimortalidad