This document discusses percutaneous gastrostomy, a procedure to place a feeding tube directly into the stomach through the abdominal wall. It notes several conditions that may require long-term nutritional support via gastrostomy tube, including various cancers, neurological diseases, and swallowing disorders. The document outlines the indications, contraindications, and complications of the percutaneous gastrostomy procedure. It then describes the step-by-step process of performing the procedure, including patient preparation, ultrasound guidance, gastric distension, gastroplexy using T-fasteners, verification of tube placement, and securing the tube.

1. PERCUTANEOUS GASTROSTOMY
Dr. H. Negila
Paris

2. -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

3. ABSOLUTE: RELATIVE:
Gastric varices Ascites
Total gastrectomy Partial gastrectomy
Uncorrectable coagulopathy Coagulopathy
Overlying colon
Inability to pass a
nasogastric tube
PERCUTANEOUS GASTROSTOMY
CONTREINDICATIONS

4. • Informed consent
• NG tube placement
• 300 ml oral barium in the evening
• Intravenous access
• Analgesia
• Glucagon
PERCUTANEOUS GASTROSTOMY
PREPARATION

5. •Major:
-Major infection and septicemia -Perforation
-Hemorrhage -Aspiration -Dislodgement of the tube
.Minor:
-Wound infection
-Dislodged or leaking tube
PERCUTANEOUS GASTROSTOMY
COMPLICATIONS

6. PERCUTANEOUS GASTROSTOMY
T-fasteners
• T-fasteners

7. • Mark the position of left
hepatic lobe by ultrasound
and injection of 1 mg of
glucagon
PERCUTANEOUS GASTROSTOMY
FIRST STEP

8. • Gastric distension by
injection of air in the NG
tube
PERCUTANEOUS GASTROSTOMY
SECOND STEP

9. PERCUTANEOUS GASTROSTOMY
THIRD STEP
• Gastroplexy using the T-
fastener

10. • Injection of contrast to
ensure the right position of
the needle inside the
stomach
PERCUTANEOUS GASTROSTOMY
VERIFICATION

11. • Using a guidewire to
introduce inside the needle
PERCUTANEOUS GASTROSTOMY
Seldinger Technique

12. • Of the orifice by guide( 9F,
14F, 16F ) or using of
Baloon
PERCUTANEOUS GASTROSTOMY
DILATATION

13. • Control the position of
umbrella
PERCUTANEOUS GASTROSTOMY
AT THE END