Endoscopy 2018; 50(04): S163
DOI: 10.1055/s-0038-1637529
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

DIRECT PERCUTANEOUS GASTROSTOMY WITH GASTROPEXY

A Martínez-Alcalá García
1   Centro de Innovaciones Digestivas Martínez Alcalá (CIDMA), Endoscopic Unit, Seville, Spain
,
F Martínez-Alcalá García
1   Centro de Innovaciones Digestivas Martínez Alcalá (CIDMA), Endoscopic Unit, Seville, Spain
,
T Kröner
2   Mayo Clinic, Gastroenterology, Jacksonville, United States
,
K Mönkemüller
3   Frankenwald Klinik, Gastroenterology, Kronach, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

A 59-year old male with a hypopharyngeal carcinoma had persistent dysphagia and malnutrition despite adequate radiochemotherapy. A tight radiation-induced upper esophageal stenosis was present, which precluded the passage of a standard gastroscope. Passing a ultraslim, pediatric gastroscope was feasible. In order to provide nutrition a gastrostomy was indicated. However, placement of a traditional PEG tube using the pull-technique was not possible due to the tight stenosis. Therefore a gastroepexy gastrostomy wa performed.

In this teaching video, we want to focus on the technique to perform a direct percutaneous gastrostomy with gastropexy under direct endoscopic view with the Freka pexact system (Fresenius, Germany).

For this procedure, it was necessary to sedate the patient under deep sedation. Then we performed a an esophagogastroduodenoscopy using the an ultraslim gastroscope to discard any other pathological condition. After that, we followed these steps:

Localize the best point for the gastrostomy.

Proceed with the gastropexy using the double channel “needle with snare technique” (gastropexy is indeed the attachment of the stomach to the abdominal wall by any suturing method)

Two to three stitches using the needle with snare and nylon technique are usually necessary to firmly attach the stomach to the abdominal wall.

Incise the skin and subcutaneous tissue with a scalpel between the sutured area.

Insert the dilation catheter and peelable tubing into the stomach.

Insert the direct gastrostomy tube through the peelable tubing.

Inflate the balloon.

Peel off the tubing and remove, leaving the gastrostomy tube in the stomach

This teaching video demonstrates the key steps needed to understand and place a direct gastrostomy using the gastropexy technique. Gastropexy is an essential technique that should be mastered by the practicing endoscopist as it will be essential in cases where a traditional endoscopic gastrostomy with pull technique cannot or should not be performed.