By Nib Soehendra, Kenneth F. Binmoeller, Hans Seifert, Hans Wilhelm Schreiber

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Additional resources for Therapeutic Endoscopy: Color Atlas of Operative Techniques for the Gastrointestinal Tract, 2nd ed

Sample text

Depending on the size of the fistula, sealing of the leak can be expected within a period of about 2 weeks. Covered expandable metal stents should not be used because they are likely to migrate in the absence of a stricture and are difficult or impossible to remove. Small fistulae communicating with the mediastinum can be treated with a two-component fibrin adhesive. Repeated treatment sessions are usually required to achieve a complete sealing (Fig. 40). A fistulous communication with the airway should be excluded, because the fibrin adhesive may spill into the lung.

The tapered end of the gastrostomy tube dilates the tract as the tube is pulled out through the abdominal wall. Fig. 51 A 15-French PEG tube usually does not require a skin incision to pass through the abdominal wall. A surgical grasping forceps can be used to pull the tube. 4 Fig. 52 Obese patients may require a small skin incision to facilitate pulling of the PEG tube through the abdominal wall. Percutaneous Endoscopic Gastrostomy (PEG) 43 44 4 Percutaneous Endoscopic Gastrostomy (PEG) Fig. 53a, b After placement, it is not always necessary to check the PEG tube endoscopically.

4 a Fig. 45a, b Stomach wall puncture with the sheathed needle. a Oriented perpendicular to the abdominal wall, the sheathed needle is first introduced into the abdominal wall. The needle must be held firmly within its sheath because there is a tendency for the needle to be pushed back during penetration. Percutaneous Endoscopic Gastrostomy (PEG) 37 b b Having penetrated the abdominal wall, the sheathed needle is gently advanced against the anterior wall of the stomach to produce a visible indentation.

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Therapeutic Endoscopy: Color Atlas of Operative Techniques by Nib Soehendra, Kenneth F. Binmoeller, Hans Seifert, Hans
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