Info

The Big Heart Disease Lie

Natural Treatments for Cardiovascular Disease

Get Instant Access

Antegrade Gastrostomy 'Pull'

The intervention starts with an ultrasound exam of the upper abdomen to assess and mark the position of the liver and transverse colon. Thereafter a naso-

Fig. 7.2. a A 7-month-old girl with a previous history of congenital heart disease. She has oromotor feeding problems with failure to thrive. The image shows the abdomen in which a needle is positioned. The colon has been opacified with contrast medium (courtesy of Dr. B. Connolly, Image Guided Intervention, Hospital for Sick Children, Toronto, Canada). b A guidewire has been inserted into the stomach. Note the T-fastener used to stabilize the wall of the stomach. c A pigtail drain has been inserted in the stomach (all images are from Dr. B. Connoloy)

Fig. 7.2. a A 7-month-old girl with a previous history of congenital heart disease. She has oromotor feeding problems with failure to thrive. The image shows the abdomen in which a needle is positioned. The colon has been opacified with contrast medium (courtesy of Dr. B. Connolly, Image Guided Intervention, Hospital for Sick Children, Toronto, Canada). b A guidewire has been inserted into the stomach. Note the T-fastener used to stabilize the wall of the stomach. c A pigtail drain has been inserted in the stomach (all images are from Dr. B. Connoloy)

a b c gastric and an orogastric feeding tube are inserted into the stomach. A snare is passed through the orogastric tube and positioned in the stomach. With the snare in place, the stomach is inflated, displacing the transverse colon inferiorly, and punctured with a needle. Through the needle a long guidewire (260 cm) is inserted into the stomach and, under fluoroscopic guidance, grasped by the snare (Fig. 7.3a,b) to be subsequently pulled up the oesophagus and out of the mouth. This now means that the guidewire runs through the mouth into the stomach and out via the puncture site. Over this guidewire a gastrostomy tube with a fixed terminal retention disk is fitted and fed until the tip of the dilator is visible at the puncture site (Fig. 7.3c). It is important to keep in mind that the collapsed retention disk has a diameter of approximately 12 mm. The calibre of the oesophagus should be large enough to capacitate its passage. The tip of the gastrostomy tube dilator is grasped and pulled through the anterior abdominal wall. Care should be taken not to cause damage to teeth at the time when the retention disk enters the mouth.

The gastrostomy tube is fixed using the external stabilizer, which comes with the set. One should not place too much pressure on the abdominal wall when fixing the stabilizer, because pressure necrosis of gastric mucosa can occur. The post-procedural approach is identical to the 'push' technique.

The advantage of the 'pull' technique is the use of fixed retention disks allowing for a lower number of cases of gastrostomy tube dislodgement. Most authors state that when the time has arrived to remove the gastrostomy tube it suffices to cut the gastrostomy tube and push the retention disk into the stomach. This way it will leave the patient's body via the natural route. However, Kaye et al. (2000a) describe two complications of this approach and advocate the retrieval of the retention disk. The procedure entails passing a snare through the gastros-tomy tube and a guidewire down the oesophagus, the guidewire is grasped under fluoroscopy and pulled out of the stomach via the gastrostomy tube. A dilatation (PTA) balloon, with a sufficient balloon diameter, is passed antegrade and inflated when it

has passed the gastrostomy tube. The PTA balloon and gastrostomy tube are pulled into the stomach, where the PTA balloon is inflated further, and both the PTA balloon and gastrostomy tube are retrieved via the mouth.

Was this article helpful?

0 0
Your Heart and Nutrition

Your Heart and Nutrition

Prevention is better than a cure. Learn how to cherish your heart by taking the necessary means to keep it pumping healthily and steadily through your life.

Get My Free Ebook


Post a comment