1. THE RESULTS OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN TEN CASES OF
INTERNATIONAL CONFERENCE SURGERY ACCESS IN TROPICAL AREAS AND UPDATES IN ONCOLOGY THANH NHAN HOSPITAL
THE RESULTS OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN TEN CASES OF
THANH NHAN HOSPITAL
Dao Quang Minh et al
Hai Phong, 11/2017

2. Introduction Percutaneous Endoscopic Gastrostomy (PEG)
less invasive surgery
Minimum penetration
Reducing complications
The world: Gauderer & Ponsky (1980).
Vietnam: 1990s Bach Mai hospital, Cho Ray hospital…
Thanh Nhan hospital: traiditional open sugery, Laparoscopic, PEG.
Objects:
Introduce ten case studies which treated by PEG

3. Case study 1 Patient: Male Age: 29 Symptoms Imaging findings:
fluid-containing adnexal mass
Case study 1
Patient: Male Age: 29
Symptoms
Sore throat, fever, chill, purulent discharge from tonsillitis
Imaging findings:
ENT endoscopy: Abcess tonsils
MRI: fluid-containing adnexal mass cạnh khí quản,
Diagnosis: peritonsillar abscess / Oropharyngeal dysphagia
Treatment:
Drainage of Pus from an Abscess+antibiotic theory+ painkiller
Perform DEG
Sugery time:
Oral feeding: after sugery 24h
Withdraw the sonde: after 6 weeks

4. Case study 2 Patient: male age: 65 years
Diagnostic at hospital admission :
Neck-discharge/partial thyroidectomy.
Imaging findings:
Esophagoscopy: Tracheoesophageal Fistula
MRI: Tracheoesophageal Fistula
Diagnostic: Tracheoesophageal Fistula/ a Partial Thyroidectomy
Treatment:
PEG performance
Esophageal stent procedure.
Sugery time: 25 mins
Oral feeding: after sugery 24h
Withdraw the sonde: after 5 weeks

5. Case study 3 Patient male age: 56 Reason of hospitalization :
Dysphagia, weight loss
Testing findings
Esophagoscopy : tumor at lower third esophagus
CT-scanner 64 dãy: Tumor in lower third of esophagus invasive visceral peritoneum.
Pathnology: Moderate epithelial carcinoma of esophagus
Diagnostic : lower third esophageal cancer
Treament: PEG
Time of procedure: 23 mins
Feeding after 24h
Keep the sonde permanently

6. Case study4 Patient female age: 78 Reason of Hospitalization :
Dysphagia, hiccup
Tetsing findinh
Esophagoscopy : tumor at lower third esophagus
64-slice CT scanners: tumor at lower third esophagus destructs visceral peritoneum
Pathnothology: Moderate epithelial carcinoma of esophagus
Diagnostic: lower third esophageal cancer
Treatment: PEG
Time of procedure: 20 mins
Feeding: after 24h
Keep the sonde permanently

7. Case study 5 Patient male eag: 56 Reason of hospitalization:
Hiccup, hoarsing
Testing findings
Esophagoscopy : tumor at lower third esophagus
64-slice CT scanners : tumor at lower third esophagus invasive mucosa
Pathonology: Low-grade epithelial carcinoma of esophagus
Diagnostic : Lower third esophageal cancer
Treatment: PEG
Time of the procedure: 18 mins
Feeding: after 24h
Keep the sonde permanently

8. Case study 6 Patient male age: 60 Reason for hospitalization:
Dysphagia , hiccup
Tetsing finding:
Esophagoscopy: suspect laryngopharyngeal cancer
Pathonology: Moderate epithelial carcinoma of throat
Diagnostic: Laryngopharyngeal cancer
Tratment: PEG procedure
Time of the procedure: 18 mins
Feeding after 24hours
Keep the sonde permenantly

9. Case study 7 Patient male age: 62 Hospitalization : Tetsing findings:
Disphagia, hiccup
Tetsing findings:
ENT endoscopy: suspect laryngopharyngeal cancer
Pathology: Moderate epithelial carcinoma of esophagus
Diagnostic: Laryngopharyngeal cancer
Treatment: PEG
Time of procedure: 15 mins
Feeding after 24h
Keeps the sonde permanently

10. Case study 8 Patient female age: 58 Reason for hospitalization
Hiccup
Testing findings:
ENT endoscopy: suspect laryngopharyngeal cancer
Pathology: low-grade squamous carcinoma of throat
Diagnostic: laryngopharyngeal cancer
Treatment: PEG procedure
Time of proceduring: 14 mins
Feeding: 24 hours
Keep the sonde permenantly

11. Case study 9 Patient male age: 70 Reason for hospitalization:
Dysphagia
Testing findings:
ENT endoscopy: suspect middle third Esophagus cancer
Pathology: Moderate Epithelial carcinoma of esophagus
Diagnostic: middle third Esophagus cancer
Treatment: PEG procedure
Time of procedure: 16 mins
Feeding: after 24 hours
Keep the sonde permanently

12. Case study 10 Patient female age: 67 Reason for hoitalization:
Weight loss , hiccup
Imaging findings:
ENT endoscopy: suspect middle third Esophagus cancer
Pathology: Low-grade epithelial carcinoma
Diagnostic: Middle third Esophagus cancer
Treatment: PEG procedure
Time of procedure: 18 mins
Feeding: 24 hours
Keep the sonde permanently

13. SUBJECT AND METHODOLOGY
Case reports
Evaluation criteria : gender, age, indication, operation time, complications before and after surgery, result after sugery.
Patient preparation
Before surgery
Position: lie face upwards
Anesthesia: intravenous anesthesia
Materials
Gastrointestinal scanner with 2.8 mm channel, light source. PEG kit
Personnel
A surgeon, an endoscopic doctor, an anesthesiologist.
An endoscopic technician, an anesthetic technician

14. Step 1: determine position for procedure
Step 2: fixed stitching
Bước 1: Xác định vị trí mở thông: Sau khi tiến hành soi dạ dày thám sát toàn bộ dạ dày và hành tá tràng, DII tá tràng. Tiến hành bơm căng dạ dày sát thành bụng. Vị trí mở thông là vị trí đèn soi hiện lên thành bụng sáng nhất.
Bước 2: Sau khi xác định được vị trí mở thông tiến hành gây tê tại chỗ
Bước 3:
Step 3: place Trocar
Step 4: place PEG kit

15. PEG KIT PS Needle (endoscopic trocar) LoopFixture II.
Bước 1: Xác định vị trí mở thông: Sau khi tiến hành soi dạ dày thám sát toàn bộ dạ dày và hành tá tràng, DII tá tràng. Tiến hành bơm căng dạ dày sát thành bụng. Vị trí mở thông là vị trí đèn soi hiện lên thành bụng sáng nhất.
Bước 2: Sau khi xác định được vị trí mở thông tiến hành gây tê tại chỗ
Bước 3:
The tool supports the placement the sonde
The sonde set in the patients

16. PEG KIT The sonde (longitudinal section) Feeding wire and bag
Bước 1: Xác định vị trí mở thông: Sau khi tiến hành soi dạ dày thám sát toàn bộ dạ dày và hành tá tràng, DII tá tràng. Tiến hành bơm căng dạ dày sát thành bụng. Vị trí mở thông là vị trí đèn soi hiện lên thành bụng sáng nhất.
Bước 2: Sau khi xác định được vị trí mở thông tiến hành gây tê tại chỗ
Bước 3:
Connecting sonde and feeding sonde
Feeding instruction

17. RESULTS AND DISCUSSION
Indications
Dysfunction of swallowing.
Nutrition through the tube over 4 weeks.
Indications N
Peritonsillar abscess 01
Tracheoesophageal Fistula
laryngopharyngeal cancer 03
Middle third Esophagus cancer 02
Lower third Esophagus cancer

18. RESULTS AND DISCUSSION
Time of procedure
After procedure
Time
Minimum
Maximum
Average
Mins 12 30
21.7
Criteria
Minimum
Maximum
Average
Passing gas (hours) 3 12
5.9
Painkiller after procedure (dosage) 1 2
1.1
Hospitalized time
2.1

19. RESULTS AND DISCUSSION
Gauderer & Ponsky (1980):
Developing quickly
support the digestive tract.
Time feeding
ESPGHAN: 4-6 weeks
MOH > 4 weeks
Our study:
08 cases feeding permanently
01 case: withdraw the sonde after 5 weeks (peritonsillar abscess case)
01 case: after 6 weeks (Tracheoesophageal Fistula case).
Complications:
Lynch R. (2004): Hemorrhage ( %), infection (1.6%), colon perforation ( %), ulcerlation tube’s position ( %).
Our study: no complication case
Braegger C, Decsi T, Dias JA, Hartman C, Kolacek S, Koletzko B, Mihatsch W, Moreno L, Puntis J, Shamir R, Szajewska H, Turck D, van Goudoever J. ESPGHAN Committee on Nutrition: Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr. 2010;51(1):110–22.

20. RESULTS AND DISCUSSION
Time of procedure
Lynch R. (2004) (19.7 mins)
Other method: endoscopic operation, traditional open surgery.
Time for oral feeding:
After 24h
After procedure
Passing gas (5.9 hours)
painkiller (1.1 dosage)
Recovering time (2.1 days)
Heuschkel RB, Gottrand F, Devarajan K, Poole H, Callan J, Dias JA, Karkelis S, Papadopoulou A, Husby S, Ruemmele F, Schäppi MG, Wilschanski M, Lionetti P, Orel R, Tovar J, Thapar N, Vandenplas Y. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; ESPGHAN position paper on management of percutaneous endoscopic gastrostomy in children and adolescents. J Pediatr Gastroenterol Nutr ;60(1):131–41.

21. CONCLUSION
PEG is a procedure to provide enteral nutrition for critically ill patients.
Safe, effective .
Early oral feeding
Reducing complications in abdominal surgery and post operation
Less invasive than traditional technologies

22. Pictures After setting the tube Gastric examination Check the tube
Inside head tube
Outside head tube
check the circulation