Percutaneous gastrostomy under enhanced X-ray

The article was professionally consulted by Specialist Doctor I Vo Cong Hien - Radiologist - Radiology Department - Vinmec Nha Trang International General Hospital.

Gastric tube placement is a common technique in feeding and giving medication to patients who have lost the ability to eat by mouth. There are two methods of nasogastric tube placement: inserting the catheter into the gastrointestinal tract through the natural route from the nose or mouth and opening the stomach through the skin. In particular, percutaneous gastrostomy under bright X-ray is a minimally invasive and safe gastric bypass technique for patients.

Gastric bypass is a procedure to create a hole directly from the outside to the inside of the stomach to nourish the patient or to suck to relieve pressure in the stomach. This is a common indication in clinical practice, applied to patients with normal absorption from the gastrointestinal tract but unable to eat or drink through the mouth - esophagus due to many different reasons. Percutaneous gastrostomy under flexible endoscopic guidance is widely used. However, this is a highly invasive technique, especially in situations where the patient is often exhausted or uncooperative or requires general anesthesia during endoscopy. Therefore, many centers now apply the technique of percutaneous gastrostomy under enhanced X-ray, this is a minimally invasive, safe and effective gastric bypass technique, without the need for general anesthesia. .

Swallowing disorders due to neuropathy : Including cerebrovascular accident, brain degeneration (Alzheimer's dementia), neurotoxicity. There is a large tumor in the face and neck, esophagus, and mediastinum, which obstructs the swallowing tract. The patient is exhausted: hydrocephalus, brain death, congenital heart disease, acquired late stage. Secondary malabsorption: chronic enteritis, small bowel inflammation after irradiation. Mental disorders (inability to feed themselves).

Anatomical variation of the transverse colon located between the stomach and the anterior abdominal wall. Patients who have undergone gastric bypass surgery have a high degree of free fluid in the abdominal cavity. The soft part of the anterior abdominal wall at the opening of the septum (epigastric) is inflamed and infected. Gastric varices, portal hypertension, and peritoneal dialysis (filtration) peritoneal artificial blood). Severe coagulopathy (INR < 1.5, platelet count < 8 G/l).

Before the procedure, the patient will be thoroughly explained about the procedure to coordinate with the doctor, the patient also needs to fast before 6 hours. Can drink no more than 50ml of water.
The steps to carry out the procedure are as follows:
Dilatation of the stomach. Install a monitoring system to monitor basic parameters such as electrocardiogram, blood pressure, SpO2 oxygen saturation, breathing rate. Disinfect the skin of the abdominal wall with povidone - iodine solution, then cover with a sterile cloth with holes. Gastric distension: Use a 50ml syringe to inflate continuously through the nasogastric tube. Reduce gastric motility with glucagon or Buscopan. Gastric suspension to the anterior abdominal wall Local anesthetic layer by layer with lidocaine around the gastric opening site. Use a needle to pierce the abdominal wall into the stomach. Once the needle tip is located in the gastric lumen, insert the barrel containing the T-fastener into the needle and push it into the stomach with a syringe containing physiological saline. Continue performing gastric suspension with subsequent T-fasteners. Usually stitches hang 3 triangular positions. Gastrostomy Use a knife to make a skin incision in the center of the T-fastener that has hung the stomach. Pierce the skin incision site into the stomach lumen with an 18G needle. Insert the rigid 0.035 conductor into the gastric lumen through the 18G needle. Withdraw the 18G needle, and then pass the dilatation tubes one by one through the rigid lead.

Insertion of a nasogastric tube Insert the catheter into the stomach lumen through a wire. Fixing the catheter tip in the gastric lumen Withdraw the lead and fix the catheter to the skin surface of the anterior abdominal wall with the buckle and threads of the T-fastener. Use contrast medium to check the position and circulation of the catheter End the procedure.

Inflammation at the catheterization site Catheter slippage Stomach bleeding Septicemia Intestinal perforation, peritonitis . Gastric bypass under enhanced X-ray is a technique that requires a high level of experience of the doctor and the perfect coordination of the patient. To achieve high diagnostic efficiency, patients need to choose reputable addresses with x-ray machines and modern and standard medical equipment.
Vinmec International General Hospital is a hospital with a full convergence of general and specialized doctors to perform, examine, operate, diagnose and treat diseases. In particular, at Vinmec, there is also a nasogastric tube opening technique to bring optimal treatment results to customers.
BSCK I Vo Cong Hien has many years of experience in the field of imaging, especially in diagnostic ultrasound for general abdominal diseases, advanced cardiac - vascular, obstetrics and gynecology. Doctor Vo Cong Hien used to work at the Imaging Department of the University of Medicine and Pharmacy Hospital - Hoang Anh Gia Lai before working at the Imaging Department of Vinmec Nha Trang International General Hospital.
Customers can directly go to Vinmec Health system nationwide to visit or contact the hotline here for support.