gastrostomie percutanee sous scopie
DESCRIPTION
GastrostomtyTRANSCRIPT
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PERCUTANEOUS GASTROSTOMY
Dr. H. NegilaParis
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-Patients who need prolonged nutritional support include:
*Head, Neck and esophageal carcinoma
*Bowel decompression
*Some neurologic disease
*Swallowing disorders and esophageal strictures
*Chronic conditions such as cystic fibrosis and congenital heart disease
PERCUTANEOUS GASTROSTOMY INDICATIONS
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ABSOLUTE: RELATIVE:
Gastric varices Ascites
Total gastrectomy Partial gastrectomy
Uncorrectable coagulopathy Coagulopathy
Overlying colon
Inability to pass a
nasogastric tube
PERCUTANEOUS GASTROSTOMY CONTRE INDICATIONS
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• Informed consent
• NG tube placement
• 300 ml oral barium in the evening
• Intravenous access
• Analgesia
• Glucagon
PERCUTANEOUS GASTROSTOMY PREPARATION
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•Major:
-Major infection and septicemia -Perforation
-Hemorrhage -Aspiration -Dislodgement of the tube
.Minor:
-Wound infection
-Dislodged or leaking tube
PERCUTANEOUS GASTROSTOMY COMPLICATIONS
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PERCUTANEOUS GASTROSTOMY T-fasteners
• T-fasteners
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• Mark the position of left hepatic lobe by ultrasound and injection of 1 mg of glucagon
PERCUTANEOUS GASTROSTOMY FIRST STEP
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• Gastric distension by injection of air in the NG tube
PERCUTANEOUS GASTROSTOMY SECOND STEP
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PERCUTANEOUS GASTROSTOMY THIRD STEP
• Gastroplexy using the T-fastener
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• Injection of contrast to ensure the right position of the needle inside the stomach
PERCUTANEOUS GASTROSTOMY VERIFICATION
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• Using a guidewire to introduce inside the needle
PERCUTANEOUS GASTROSTOMY Seldinger Technique
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• Of the orifice by guide( 9F, 14F, 16F ) or using of Baloon
PERCUTANEOUS GASTROSTOMY DILATATION
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• Control the position of umbrella
PERCUTANEOUS GASTROSTOMY AT THE END