scholarly journals Duodenal Decubitus Ulcer Caused by Percutaneous Endoscopic Transgastric Jejunostomy Tube

2020 ◽  
Vol 20 (4) ◽  
pp. 324-327
Author(s):  
Seokin Kang ◽  
Yuri Kim ◽  
Hee Kyong Na ◽  
Sun Ju Chung ◽  
Jeong Hoon Lee
Keyword(s):  
Weight Loss ◽  
Epigastric Pain ◽  
Rare Complication ◽  
Decubitus Ulcer ◽  
Feeding Tube ◽  
Jejunostomy Tube ◽  
Extension Tube ◽  
Endoscopic Gastrostomy ◽  
Surgical Gastrostomy

Percutaneous endoscopic gastrostomy (PEG) has substituted surgical gastrostomy for long-term enteral nutrition. Percutaneous endoscopic transgastric jejunostomy (PEG-J) entails placing a feeding tube into the jejunum through PEG. Unlike PEG, PEG-J is associated with complications caused by the jejunal extension tube. Herein, we report a rare complication of PEG-J. A 71-year-old woman who underwent PEG-J for the administration of carbidopa-levodopa, complained of epigastric pain, dyspepsia, and weight loss of more than 10% in 2 months. Esophagogastroduodenoscopy revealed a duodenal decubitus ulcer caused by the pressure from the jejunal extension tube. After removal of the PEG-J and a 4-week treatment with a proton pump inhibitor, the ulcer healed and the symptoms resolved.

scholarly journals A clinical course of a patient with anorexia nervosa receiving surgery for superior mesenteric artery syndrome

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ken Kurisu ◽  
Yukari Yamanaka ◽  
Tadahiro Yamazaki ◽  
Ryo Yoneda ◽  
Makoto Otani ◽  
...  
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Anorexia Nervosa ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Rare Complication ◽  
Nutrition Therapy ◽  
Psychological Status ◽  
Sma Syndrome

Abstract Background Superior mesenteric artery (SMA) syndrome is a well-known but relatively rare complication of anorexia nervosa. Although several reports have proposed surgery for SMA syndrome associated with anorexia nervosa, these have shown poor outcomes or did not reveal the long-term weight course. Thus, the long-term effectiveness of surgery for SMA syndrome in such cases remains unclear. This case report describes a patient with anorexia nervosa who underwent surgery for SMA syndrome. Case presentation An 18-year-old woman presented with anorexia nervosa when she was 16 years old. She also presented with SMA syndrome, which seemed to be caused by weight loss due to the eating disorder. Nutrition therapy initially improved her body weight, but she ceased treatment. She reported that symptoms related to SMA syndrome had led to her weight loss and desired to undergo surgery. Laparoscopic duodenojejunostomy was performed, but her body weight did not improve after the surgery. The patient eventually received conservative nutritional treatment along with psychological approaches, which led to an improvement in her body weight. Conclusions The case implies that surgery for SMA syndrome in patients with anorexia nervosa is ineffective for long-term weight recovery and that conservative treatment can sufficiently improve body weight; this is consistent with the lack of evidence on the topic and reports on potential complications of surgery. Due to difficulties in assessing psychological status, consultation with specialists on eating disorders is necessary for treating patients with severely low body weight.

scholarly journals SURGICAL GASTROSTOMY BASED ON ENDOSCOPIC CONCEPTS

2016 ◽  
Vol 29 (1) ◽  
pp. 50-52
Author(s):  
Emmanuel Conrado SOUZA
Keyword(s):  
Gastric Wall ◽  
Percutaneous Approach ◽  
Endoscopic Gastrostomy ◽  
Minimal Incision ◽  
Left Hypochondrium ◽  
Direct View ◽  
Anterior Gastric Wall ◽  
Enteral Access ◽  
Surgical Gastrostomy

Background: Until the early 1980s, Stamm technique was considered standard method to gastrostomy. After description of the endoscopic technique, due to its efficiency and speed, quickly became the method of choice for long-term enteral access. Aim: Describe a technique that combines direct view of the stomach from open surgery with the simplicity and less traumatic endoscopic gastrostomy method. Method: In patient supine under spinal anesthesia the technique stars with small epigastric incision to pull up the stomach. A 3 mm incision in the left hypochondrium is made to pass needle puncture to guidewire passage. The stomach is drilled, guidewire is seizured, connection to catheter and percutaneous approach is made with traction of the stomach to the abdominal wall. Purse suture on the anterior gastric wall is not needed. Results: Twenty-eight patients underwent gastrostomy using endoscopy devices; six had local minor complications without the need for re-intervention; there was no death. Conclusion: The surgical gastrostomy with minimal incision in the stomach to pull off the catheter using endoscopic gastrostomy devices, proved to be safe, easy to perform, less traumatic, quick, simple and elegant.

scholarly journals P-OGC58 Preoperative Enteral Feeding in Patients with Oesophagogastric Cancer

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Cathy White ◽  
Mayilone Arumugusamy ◽  
William Robb
Keyword(s):  
Weight Loss ◽  
Enteral Feeding ◽  
Patient Flow ◽  
Tube Feeding ◽  
Feeding Tube ◽  
Tube Insertion ◽  
Jejunostomy Tube ◽  
Curative Intent ◽  
Additional Support ◽  
The Impact

Abstract Background Patients with Oesophagogastric (OG) cancer undergoing multimodal treatment have a higher risk for progressive decline in their nutritional status. Our centre has seen increased numbers of patients using jejunostomy and gastrostomy tube feeding as an additional support during neoadjuvant chemotherapy and radiotherapy (nCRT).  This audit aimed to evaluate the processes surrounding and the impact of this intervention. Methods A retrospective review of 2019 medical records.  Patients with OG cancer for treatment with curative intent that underwent an elective feeding tube insertion for preoperative supplementary feeding were included. Results 14 patients were admitted for elective feeding tube insertion in 2019. On admission N = 10 patients (71%) had clinically severe weight loss (defined as ≥ 10% in 6 months, or ≥ 7.5% in 3 months or ≥ 5% in 1 month).  Four (29%) had a dietetic assessment pre admission, with 1 patient (7%) trained on home enteral nutrition pre admission. Conclusions This service is growing rapidly, patient numbers have more than doubled in 3 years. Enteral feeding is effective in preventing clinically significant weight loss in patients undergoing nCRT who progress to surgery. Short LOS: dietetic consult pre admission is essential to improve patient flow, education, preparation. Jejunostomy tube dislodged in 46% patients (n = 6), aim to improve strategies to avoid or best manage this.   For future work: Examine effect on body composition (CT: sarcopenia) and examine patient’s perspectives and quality of life.

Migrated PEG balloon causing acute pancreatitis

2021 ◽  
Vol 14 (4) ◽  
pp. e240605
Author(s):  
Muhammad Omar Saeed ◽  
Thomas Fleck ◽  
Ashish Awasthi ◽  
Chander Shekhar
Keyword(s):  
Acute Pancreatitis ◽  
Rare Complication ◽  
Feeding Tube ◽  
Gastrostomy Tube ◽  
Mr Cholangiopancreatography ◽  
Common Procedure ◽  
Oral Nutrition ◽  
Endoscopic Gastrostomy ◽  
Fixation Plate ◽  
Peg Tube

Percutaneous endoscopic gastrostomy (PEG) is a common procedure for an unsafe swallow or inability to maintain oral nutrition. When a PEG tube needs replacement, a balloon gastrostomy tube is usually placed through the same, well formed and mature tract without endoscopy. We present a patient with a rare complication related to the balloon gastrostomy tube, to raise awareness and minimise the risk of this complication in the future. A 67-year-old female patient presented to the emergency department with severe abdominal pain and vomiting. Her gastrostomy feeding tube displaced inwards, up to the feeding-balloon ports complex. After investigations, she was diagnosed with acute pancreatitis. MR cholangiopancreatography (MRCP) confirmed features of this and, interestingly, an inflated gastrostomy balloon could be seen abutting the major and minor ampullae. The patient confirmed that the PEG tube had been changed to a balloon gastrostomy tube some time ago, but the external fixation plate (external bumper) had been loose lately, with the tube repeatedly moving inwards. She admitted that, 1 day before admission, the PEG tube had receded into the stomach and could not be pulled out with a gentle tug. After reviewing the MRCP images, the balloon was deflated, and the tube retracted. Once correctly placed, the balloon was reinflated, and her symptoms improved over the next 2 days.

The Ethics of Medically Assisted Nutrition and Hydration at the End of Life

2016 ◽  
Author(s):  
Daniel Sulmasy
Keyword(s):  
Tube Feeding ◽  
Nutritional Therapy ◽  
Treatment Modalities ◽  
Percutaneous Endoscopic Gastrostomy Tube ◽  
Jejunostomy Tube ◽  
Endoscopic Gastrostomy ◽  
Dying Patients ◽  
Intravenous Hydration ◽  
Nutrition And Hydration ◽  
Surgical Gastrostomy

This chapter examines the ethics of medically supplying nutrition and hydration to dying patients. It first considers the available treatment modalities for patients who are unable to eat or drink, including nasogastric tube feeding, percutaneous endoscopic gastrostomy tube feeding, surgical gastrostomy or jejunostomy tube feeding, proctoclysis, intravenous hydration and nutrition, total or partial parenteral nutrition, and hypodermoclysis. Before discussing the ethics of their use in palliative medicine, the medical aspects of these techniques as well as their risks and benefits are outlined. The author then proposes a classification of four critical decisional junctures along the trajectory of disease progression and highlights a number of disabling, chronic, progressive, and eventually fatal diagnoses with differing trajectories toward death. Finally, it looks at a number of ethical controversies surrounding medically assisted nutrition and hydration, including the issue of religion and the moral and psychological aspects of stopping and starting nutritional therapy.

Endoscopic and Surgical Gastrostomy and Jejunostomy Tube Placement

2018 ◽  
Vol 02 (01) ◽  
pp. 053-061
Author(s):  
Kevin El-Hayek ◽  
Marita Bauman
Keyword(s):  
Minimally Invasive ◽  
Surgical Techniques ◽  
Tube Placement ◽  
Percutaneous Endoscopic Gastrostomy Tube ◽  
Jejunostomy Tube ◽  
Endoscopic Gastrostomy ◽  
Enteral Access ◽  
Surgical Gastrostomy ◽  
Tools And Techniques ◽  
Invasive Techniques

AbstractEnteral access is a common request for consulting surgeons and interventionists. Prior to the 1980s, such a consultation often necessitated open surgical intervention whereas today, enteral access is often performed via several minimally invasive methods. Tools and techniques for minimally invasive enteral access have changed drastically due to advancements in the fields of endoscopy, laparoscopy, and interventional radiology. Percutaneous endoscopic gastrostomy tube placement is one such advancement. Since its first development, its basic principles have been applied to other minimally invasive techniques, which have resulted in an expansion of techniques for establishment of enteral access. In this article, we outline various endoscopic and surgical techniques for gastric and jejunal access.

scholarly journals Direct percutaneous endoscopic jejunostomy performed with gastroscope

2013 ◽  
Vol 04 (03) ◽  
pp. 090-092
Author(s):  
Ajay P. Choksi ◽  
Keyur C. Shah ◽  
Harshad K. Parekh
Keyword(s):  
Small Bowel ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Enteral Feeding ◽  
Nutritional Support ◽  
Feeding Tube ◽  
Endoscopic Gastrostomy ◽  
Gastric Feeding ◽  
Endoscopic Placement ◽  
Percutaneous Endoscopic Jejunostomy

AbstractWhile percutaneous endoscopic gastrostomy (PEG) is a well-known approach for achieving enteral feeding, direct percutaneous endoscopic jejunostomy (DPEJ) is a technique that allows endoscopic placement of percutaneous/transabdominal feeding tube directly into the jejunum. It offers a non-surgical alternative for postpyloric enteral feeding for long-term nutritional support when gastric feeding is not technically possible or is inappriopriate. Conventionally DPEJ is done with pediatric colonoscope or small bowel enteroscope. Here, we report a case where DPEJ was accomplished with gastroscope.

scholarly journals Percutaneous transcatheter bariatric embolotherapy for weight loss in obesity: two year data from a prospective RCT

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V.Y Reddy ◽  
M Fried ◽  
P Neuzil ◽  
R Rosen ◽  
P Sramkova ◽  
...  
Keyword(s):  
Weight Loss ◽  
Epigastric Pain ◽  
Clinical Status ◽  
Case Series ◽  
Initial Study ◽  
Gastric Fundus ◽  
Funding Source ◽  
Private Company ◽  
Double Blind

Abstract Background/Introduction Obesity is an important risk factor associated with poor cardiovascular and metabolic outcomes. Dietary, medical, and surgical weight loss strategies are often unsuccessful, unsustainable or accompanied by risks. Pre-clinical and early case series reported that transcatheter bariatric embolotherapy (TBE) of the left gastric artery reduces weight, by reducing “hunger” hormones from the gastric fundus. We studied TBE in a double-blind, sham procedure, first in human RCT of patients (pts) with obesity, and following completion of the initial study we asked subjects to return after 2 years post-embolization for further evaluation. Purpose The purpose of this extension study was to assess the long-term weight loss and other outcomes in subjects who underwent TBE for weight loss. Methods In the initial RCT subjects were randomized 1:1 to either a Sham (skin nick & 1 hr wait) or TBE following IV Propofol sedation. All pts received Lifestyle Therapy (behavioral and diet education); these staff following the pts were also blinded to treatment. Subjects completed the initial study when reaching the 1 year-follow-up visit. Subjects were then invited to return to the weight loss clinic at 2 years post-embolization for further evaluation on weight loss, blood pressure, pre-diabetic clinical status, satiety, and quality of life. Results A total of 44 pts (age 45.5±9.8; 36/8 M/F; BMI 39.6±3.8) were enrolled, of which 40 pts were randomized equally to groups, with no major complications. Mild, transient epigastric pain was seen, but EGDs showed no major abnormalities. Weight loss was improved with TBE by 6 mo, and maintained over the full 12 mo by both intention-to-treat and per-protocol analyses. At 2 years post-embolization, subjects treated with TBE demonstrated a mean 9% TBWL and 25% EBWL. Conclusion(s) Bariatric embolization is safe and when used along with lifestyle therapy, results in clinically significant weight loss. Long-term data demonstrates evidence that subjects treated with TBE continue to maintain their weight loss up to 2 years post-treatment. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Endobar Solutions LLC

scholarly journals Revisiting the Use of Percutaneous Endoscopic Gastrostomy Tubes in Patients with Advanced Dementia

2009 ◽  
Vol 3 ◽  
pp. PCRT.S2169
Author(s):  
Ayesha K. Shaikh ◽  
Eric L. Hamilton ◽  
Parag Bharadwaj ◽  
Katherine T. Ward
Keyword(s):  
Weight Loss ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Decubitus Ulcer ◽  
Nursing Home Patient ◽  
Advanced Dementia ◽  
Advantages And Disadvantages ◽  
The Past ◽  
Endoscopic Gastrostomy ◽  
Gastrostomy Tubes ◽  
Peg Tube

Mr. Smith is an 85-year-old nursing home patient who has suffered from dementia for the past eight years. He has been bed bound and uncommunicative for the last six months. He was admitted with aspiration pneumonia three times in the past year. Over the last few months he has lost weight due to poor dietary intake and has developed a decubitus ulcer. Mr. Smith's family inquires about the advantages and disadvantages of the placement of a percutaneous endoscopic gastrostomy (PEG) tube to help improve his weight loss.

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