Surgical Gastrostomy Research Articles

Percutaneous gastrostomy and gastro-jejunostomy.

Percutaneous gastrostomy and gastro-jejunostomy are new techniques which may be used instead of surgical or endoscopic gastrostomy to feed patients with an intact small bowel. We have successfully performed 72 gastrostomies on 67 patients who had had unsuccessful procedures and required surgery. Two patients developed peritonitis when their catheter dislodged into the peritoneal space.

Percutaneous gastrostomy

Enteral feeding is the preferred method of nutritional management in malnourished patients with intact gastrointestinal function. Although the surgical gastrostomy is usually effective, its morbidity and mortality is still not negligible. Recently, alternative percutaneous method for placement of gastrostomy tube have been developed and several large series have been published in the English literatures. Since May 1986 we have performed percutaneous gastrostomy on over 30 patients and there were only one major morbidity but no procedure-related mortalities. The purpose of this paper is to describe our experience and to discuss its potential problems.

613 PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN YOUNG CHILDREN

Three children, ages 7 to 48 months, with severe neurological deficits, incapable of adequate oral intake, received percutaneous gastrostomies assisted by endoscopy. This recently developed technique has yet to receive notice in the pediatric literature. This procedure which we have used in patients at risk for surgery and general anesthesia, is well tolerated and easily mastered by a trained endoscopist. Endoscopy was first performed to be certain that there were no obstructive lesions. The stomach was then inflated with air and at the point of maximum transillumination on the anterior abdominal wall, (which had been surgically prepped) lidocaine was injected. A plastic Medicut catheter was plunged through the wall and into the stomach. A long nylon thread was passed through the sheath into the stomach and was grasped by the endoscopic forceps. The thread was then pulled out of the mouth, leaving one end still emerging from the abdominal wall. The end from the mouth was tied to a specially prepared Malecot catheter which was then pulled in retrograde fashion, into the stomach so that the end of it emerged from the abdominal wall. The gastrostomy was used the following day. The procedure averaged 11 minutes, compared to 57 minutes with the standard surgical gastrostomy. We believe this technique may be used by our pediatric colleagues who manage such patients.

Percutaneous gastrostomy: further experience.

Percutaneous gastrostomy was performed in nine patients, bringing to 17 the total number of such procedures now performed in the authors' department. As a result of this additional experience, the authors have further refined the technique and have had the opportunity to follow a number of patients for extended periods. Percutaneous gastrostomy appears to be an effective alternative to surgical gastrostomy.