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Git peg bmj.

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BMJ: PEG.

BMJ: PEG.

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    Git peg bmj. Git peg bmj. Presentation Transcript

    • Prepared by: Dr.Mohammad Shekhani. CABM-FRCP
    • Introduction:
      • PEG feeding, introduced into clinical practice in 1980,
      • It is now an efective way of providing enteral feeding to patients who have functionally normal GIT but who cannot meet their nutritional needs because of inadequate oral intake.
      • It is the preferred method of feeding when nutritional intake is likely to be inadequate for more than four to six weeks& when enteral feeding is likely to prevent further weight loss, correct nutritional defciencies& stop the decline in quality of life in patients caused by insufcient nutritional intake.
      • The benefcial efects of gastrostomy feeding on morbidity& mortality have been described only in certain subgroups.
      • RTs in stroke shown improved nutritional outcomes, higher likelihood of survival& earlier discharge.
      • But gastrostomy tubes are increasingly being requested& inserted for indications where long term outcomes are uncertain.
    • The procedure:
      • It is a procedure for placing a feeding tube directly into the stomach via a small incision through the abdominal wall.
      • After aseptic prep of the abd wall&prophylactic antibiotics, an endoscope is passed via the oesophagus into the stomach.
      • A powerful light source within the endoscope& insufation of air allows the position of the endoscope to be identifed through the abdominal wall.
      • Use of a fnger invagination technique may also help identify the optimal site.
      • After LA infltration, a needle is inserted through the abd wall into the stomach, along with a guide wire which is grasped using a snare via the endoscope
      • The guide wire, the snare& the endoscope are then retracted.
      • The guide wire is attached to the end of a gastrostomy tube, pulled back down through the oesophagus& stomach& brought out through the hole in the abdominal wall& end of the PEG tube is retained within the stomach cavity, by a wide internal bumper
      • An external bumper is then fxed to the tube to prevent the internal bumper from moving distally in the alimentary canal.
    • The procedure:
      • The procedure is usually performed under sedation& takes about 15-20 mins.
      • Gastrostomy feeding tubes may also be placed using radiological or surgical methods, depending on technical considerations or local availability
    • C/I s to PEG:
      • Absolute:
      • Haemodynamic compromise
      • Sepsis
      • Perforated viscus
      • Relative:
      • Plateletes < 50,000.
      • Ascites.
      • Peritonitis.
      • GOO.
      • Crohns.
      • Gastric surgery.
    • Complication requiring admission:
      • The “buried bumper” syndrome is a rare but serious complication in 1.5-1.9%.
      • The internal bumper migrates from the gastric wall towards the skin, anywhere along the PEG tract, as a consequence of excessive tension between the internal/ external bumper.
      • Symptoms may include pain on feeding, retrograde leakage of feed on to the skin&rarely gastric perforation.
      • Correction is achieved through removing& re-siting the internal bumper endoscopically or by surgical intervention.
    • Complication requiring admission:
      • Serious complications such as peritonitis or gastric outlet obstruction may present with symptoms of acute or chronic abdominal pain.
      • Red fag signs that should prompt emergency admission are pain on feeding, external leakage of gastric contents, or bleeding within or around the gastrostomy tube.
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