경피 내시경하 위루술의 삽입과 관리 - CE

1 The Korean Journal of Gastrointestinal Endoscopy Review Vol. 39, No. 3 September, 2009 (119-124)119 Table and Contraindication of percutaneous En-doscopic GastrostomyIndicationDysphagia Neoplasm of pharynx and esophagusNeurologic disorder including cerebrovascular attackFacial injuryContraindicationAbsolute No passage of gastrofiberscope into the stomachIncorrectable coagulapathyPeritonitis Intestinal obstructionRelative Massive ascites Large gastric varixExtensive laparotomy Severe obesity Neoplasm of stomach Technique, Management and Complications of percutaneous endoscopic gastrostomy Yun Jeong Lim, and Chang Heon Yang, of Internal Medicine, Dongguk University College of Medicine, Gyeongju, KoreaPercutaneous endoscopic gastrostomy (PEG)

2 Is a widely used method for introducing a gastrostomy tube endoscopically to enable enteral feeding in patients who are unable to eat but have a normally functioning gut. The endsopist trained in the techniques for enteral access should be equally acquired the knowledge for monitoring patients and managing the complications arising from the initial gastrostomy procedure. Optimal endoscopic technique, proper monitor, early recognition of impending complication and quick management are important because most of these patients are elderly, debilitated, and chronically ill. In this review, general information about insertion and management of PEG was described based on the our experience of PEG and review of literatures. (Korean J Gastrointest Endosc 2009;39:119-124)Key Words: Enteral feeding, percutaneous endoscopic gastrostomy , Complication.

3 (780-714), 707 : 054-770-8206 : 054-770-2826 : . 2009 8 23 . 2009 9 24 ( percutaneous endoscopic gastrostomy , PEG) .1,2 PEG 1980 Gauderer Ponsky 3,4 . , PEG PEG PEG . 1. PEG PEG .5-7 PEG ( , , ), , , , (Table 1).

4 8-14 (Levin tube) 120 The Korean Journal of Gastrointestinal EndoscopyFigure of percuta-neous endoscopic gas-trostomy (pull type). (A) Digital indentation is seenin the insufflated stomach. (B) Needle is passed th-rough the nearest site of abdominal wall. (C) Gui-dewire is being grasped with snare. (D) Internal bolster of PEG is fixated in the stomach. , , , PEG .5,6 PEG , . PEG , PEG.

5 PEG , , , , , .5,14 , (Table 1). , PEG PEG .15-192. PEG PEG , , , , 3 5 .1,5 (Proton pump inhibitor, PPI), (H2 blocker) PEG.

6 , PPI PEG , (internal bump) , . PEG 30 1 ( 1 cephalosporine ) .20-22 PEG Kit (push type, Ponsky-Gauderer ), (introducer type, Russell ), (pull type, Sacks-Vine ) .5,23 Vol. 39, No. 3 September, 2009 (119-124)121 Table 2. Prevention and Complication of percutaneous endoscopic GastrostomyComplicationPrevention Treatment PEG site infection IV antibiotic before PEG IV antibiotic Incision & Drainage, if pus is accumulated Removal of PEG, if it is intractableExcessive leakageProper skin incision during PEG NPO & IV PPI Consider completely removal of PEG or, naso-gastric tube feeding, conversion to PEG-jejunostomy, if it is intractable Aspiration pneumoniaAvoid rapid infusion rate of enteral IV antibiotic feeding, semifowler position for Convert to PEG-jejunostomy if recurrent 30 minutes after feeding.

7 Periodic aspiration pneumonia occurs check-up of gastric residual volume PEG tube displacementSuspect tube displacement if infusion of Promptly manual correction of tube feeding is interrupted displacement Re-insertion of new feeding tube Buried bumper syndromeAvoid excessive tension of fixation of tubeSurgical removal of bumpPeritonitisIV antibiotics, surgeryNecrotizing fascitis Surgical approach Enterocutaneous fistulaLaparotomyPneumoperitoneumObserva tionGI bleeding PPI, endoscopic treatment . povidone iodine.

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9 24,25 Intermittent feeding 3 6 30 60 continuous feeding 12 24 . Bolus feeding 15 30 , , . 120 mL/hr .18 flushing . 2 200 mL PEG 122 The Korean Journal of Gastrointestinal Endoscopy .18 2 . Intermi-ttent feeding 4 5 ( 50 mL ) 200 mL Treitz.

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