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Gastrostomie percutanee sous scopie

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Gastrostomty

Gastrostomty

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      Gastrostomie percutanee sous scopie Gastrostomie percutanee sous scopie Presentation Transcript

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