Perkütan Endoskopik Gastrostomi
Özet
Perkütan endoskopik gastrostomi (PEG), oral alımı yetersiz ancak gastrointestinal sistemi fonksiyonel olan hastalarda uzun süreli enteral beslenme sağlamak amacıyla endoskopi kılavuzluğunda midenin karın duvarına ağızlaştırılması işlemidir. İlk kez 1980 yılında tanımlanan bu minimal invaziv yöntem, nazogastrik tüplere kıyasla daha konforlu, cerrahi gastrostomiye göre ise daha düşük komplikasyon oranına sahiptir. Genellikle inme, ALS, demans gibi nörolojik hastalıklara bağlı disfajide ve üst gastrointestinal sistem tıkanıklıklarında enteral nütrisyon, hidrasyon ve ilaç uygulaması amacıyla tercih edilir. Ciddi koagülasyon bozuklukları, sepsis ve peritonit gibi durumlar işlemin mutlak kontrendikasyonları arasında yer alır. PEG güvenli bir prosedür olmasına rağmen, kanama, organ perforasyonu, gömülü tampon sendromu ve aspirasyon pnömonisi gibi majör; lokal yara enfeksiyonu, tüpün tıkanması veya yerinden çıkması gibi minör komplikasyonlar görülebilmektedir. İşlem öncesinde hastaya profilaktik antibiyotik uygulanmalı ve uygun açlık süresi sağlanmalıdır. Genellikle çekme (pull) tekniğiyle yerleştirilen tüpten beslenmeye işlemden 3-4 saat sonra başlanabilir. Günlük stoma bakımı ve tüpün düzenli yıkanması komplikasyonları önlemede kritiktir; işlevini tamamlayan tüpler ise "kes ve it" veya endoskopik yöntemlerle çıkarılmaktadır.
Percutaneous endoscopic gastrostomy (PEG), first defined in 1980, is a minimally invasive method used to provide long-term enteral nutrition, hydration, and medication delivery by percutaneously placing a feeding tube into the stomach under endoscopic guidance for patients with inadequate oral intake but a functional gastrointestinal system. Primarily indicated for dysphagia secondary to neurological disorders like stroke, ALS, and dementia, as well as upper gastrointestinal obstructions, PEG offers lower complication rates than surgical gastrostomy and greater advantages over nasogastric tubes. Absolute contraindications include severe coagulation disorders, active peptic ulcer bleeding, sepsis, and peritonitis. Although generally safe, PEG carries risks of major complications such as hemorrhage, internal organ perforation, necrotizing fasciitis, aspiration pneumonia, and buried bumper syndrome, alongside minor issues including local wound infections, peristomal leakage, tube displacement, and tube obstruction. Pre-procedural preparation requires necessary fasting, informed consent, and prophylactic antibiotic administration, mostly utilizing the "pull" technique under sterile conditions. Feeding can safely initiate 3-4 hours post-procedure, and maintaining long-term success relies heavily on daily stoma care, regular water flushing to prevent clogging, and proper tube removal techniques like the "cut and push" method or endoscopic extraction when the tube is no longer required.
Referanslar
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