Plate 10
###### Figure 7

The usual indications for gastrostomy include the need for feeding, decompression, or gastric access. In feeding situations, the gastrointestinal tract must be functional and the need for enteral feeding must be for a prolonged interval. Stamm gastrostomies are most commonly performed at the conclusion of some other major gastrointestinal procedure while the abdomen is open, However, the percutaneous endoscopic gastrostomy (PEG) allows the placement of a gastrostomy in adults and children without laparotomy. This technique depends upon the safe passage of an endoscope into the stomach, which can be dilated with air. Inability to pass the endoscope safely or inability to identify the transabdominal lumination of the lighted endoscope tip within the dilated stomach are contraindications to the procedure. Ascites, partially corrected coagulopathy, and intra-abdominal infection are relative contraindications to the PEG method.

The indications for the gastrostomy dictate the extent and type of preoperative preparation. Passage of a nasogastric tube for gastric decompression is usually not needed if the patient has been nothing by mouth (NPO) for several hours. A single dose of intravenous antibiotic is given within 1 hour prior to the procedure because the peroral passage of the special catheter may contaminate the abdominal wall tract created as the catheter is brought out through the stomach.

A topical anesthesia for the oropharynx is needed for passage of the endoscope, and local anesthesia is used at the abdominal site where the special catheter will be placed. An intravenous needle or catheter is positioned for administration of sedatives.

The patient is usually supine while the topical anesthetic is sprayed into the oropharynx. He or she is allowed to gargle, swallow, or spit into a basin. After satisfactory anesthesia is obtained, the patient is positioned supine on the table with the head slightly elevated.

In adults as well as children, the smallest possible gastroscope is used. After the endoscope is passed safely into the stomach, the skin of the abdomen and lower chest is prepared with antiseptic solutions in the usual manner. Sterile drapes are applied.

During the placement of the gastroscope, any pathology may be evaluated. The stomach is fully inflated with air. This displaces ...

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

## Subscription Options

### AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.