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Gastrostomie percutanee sous scopie


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Gastrostomie percutanee sous scopie

  2. 2. 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
  3. 3. PERCUTANEOUS GASTROSTOMY CONTRE INDICATIONSABSOLUTE: RELATIVE:Gastric varices AscitesTotal gastrectomy Partial gastrectomyUncorrectable coagulopathy Coagulopathy Overlying colon Inability to pass a nasogastric tube
  4. 4. PERCUTANEOUS GASTROSTOMY PREPARATION• Informed consent• NG tube placement• 300 ml oral barium in the evening• Intravenous access• Analgesia• Glucagon
  5. 5. PERCUTANEOUS GASTROSTOMY COMPLICATIONS•Major:-Major infection and septicemia -Perforation-Hemorrhage -Aspiration -Dislodgement of the tube.Minor:-Wound infection-Dislodged or leaking tube
  6. 6. PERCUTANEOUS GASTROSTOMY T-fasteners• T-fasteners
  7. 7. PERCUTANEOUS GASTROSTOMY FIRST STEP• Mark the position of left hepatic lobe by ultrasound and injection of 1 mg of glucagon
  8. 8. PERCUTANEOUS GASTROSTOMY SECOND STEP• Gastric distension by injection of air in the NG tube
  9. 9. PERCUTANEOUS GASTROSTOMY THIRD STEP• Gastroplexy using the T- fastener
  10. 10. PERCUTANEOUS GASTROSTOMY VERIFICATION• Injection of contrast to ensure the right position of the needle inside the stomach
  11. 11. PERCUTANEOUS GASTROSTOMY Seldinger Technique• Using a guidewire to introduce inside the needle
  12. 12. PERCUTANEOUS GASTROSTOMY DILATATION• Of the orifice by guide( 9F, 14F, 16F ) or using of Baloon
  13. 13. PERCUTANEOUS GASTROSTOMY AT THE END• Control the position of umbrella