Purpose: To evaluate a new technique whereby the endoscopist can easily reinsert the gastroscope to evaluate and confirm the position of the PEG button in the stomach. Method: The standard PEG procedure is well described in the literature. The final stage of the procedure is to reinsert the gastroscope and confirm the position and tension of the PEG button in the stomach wall. Once the gastroscope is in the stomach a PEJ tube can be inserted through the PEG tube and then dragged into the jejunum if necessary. We have found that intubation of the esophagus is often difficult and cumbersome especially in patients who require PEG placement, who are often neurologically impaired or have head and neck cancer. We propose an easy modification to this part of the procedure. The same snare that is used in the first part of the procedure to bring the wire out of the stomach through the mouth is attached around one half of the round button, while the gastroscope is outside the patient. If the propeller type of button is used then the snare is attached to only one blade so that it can easily be removed. It is important to attach the snare to the button prior to applying any form of lubrication to avoid the snare slipping off the button. Then as a single unit the gastroscope and the PEG button are guided through the mouth and into the esophagus where the snare acts as a guide wire for the gastroscope, when the PEG is pulled from outside toward the abdominal wall. Once the gastroscope is advanced to 40cm from the incisors the snare is opened and removed, the button is then pulled up against the stomach wall in the usual fashion. The gastroscope is then easily advanced into the stomach to evaluate and confirm the position and tension of the PEG button. Conclusion: We have performed this simple modification in a series of 50 patients and have found it to be a simple technique which greatly reduces endoscopy time especially in patients were introducing the gastroscope into the esophagus is cumbersome. The snare is readily and can be attached to any brand of PEG button.
|Original language||English (US)|
|State||Published - Dec 1 1998|
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging