Mohandas K M, Dave U R, Santhi Swaroop V, Desai D C, Dhir V, Pradhan S A, Bathena H M, Kavarana N M
Department of Gastroenterology, Tata Memorial Hospital, Parel, Bombay, Maharashtra, India.
Natl Med J India. 1992 Mar-Apr;5(2):52-5.
Percutaneous endoscopic gastrostomy for long term enteral nutrition is often indicated in patients with head, neck and oesophageal cancer but despite its growing popularity elsewhere, it is not widely used in India.
Between March 1990 and July 1991, we performed percutaneous endoscopic gastrostomy in 54 patients. The primary sites of tumour were the hypopharynx (11), oral cavity (7), tongue (7), cricopharynx (7), oesophagus (16) and other sites (6). The indications were difficulty in swallowing following treatment (22), preoperative nutritional support (7) and terminal care (21). In 49 patients, it was performed by the 'pull' technique in the endoscopy room under local anaesthesia and mild sedation. Indigenously prepared tubes and blenderised foods were used. Fifteen patients underwent dilatation of the tumour prior to the gastrostomy.
The procedure was successful in 50 (93%) patients. Three failures were caused by obstructing tumours and one by a previous gastric resection. Feeding was started 18 to 24 hours after the procedure in 48 patients. No major complications occurred but minor complications were seen in 11 (22%) patients. Fourteen patients had their gastrostomy tube removed after 2 to 6 months of use while 15 patients undergoing therapy or with persistent dysphagia were on gastrostomy feeds for 1 to 6 months. Of the 21 terminally ill patients, 8 died, 6 were lost to follow up and 7 were on feeds for 1 to 6 months.
Percutaneous endoscopic gastrostomy is a simple, safe and effective method for long term enteral feeding. Indigenous tubes and home made blenderised foods are adequate substitutes for the more expensive commercial kits and enteral formulations.
经皮内镜下胃造口术用于长期肠内营养常用于头颈部及食管癌患者，但尽管该技术在其他地方越来越受欢迎，在印度却未得到广泛应用。
1990年3月至1991年7月，我们对54例患者实施了经皮内镜下胃造口术。肿瘤的主要部位为下咽（11例）、口腔（7例）、舌（7例）、环咽（7例）、食管（16例）及其他部位（6例）。适应证为治疗后吞咽困难（22例）、术前营养支持（7例）及终末期护理（21例）。49例患者在局部麻醉和轻度镇静下于内镜室采用“牵拉”技术进行手术。使用了自制的管子和搅拌食物。15例患者在胃造口术前进行了肿瘤扩张。
50例（93%）患者手术成功。3例失败是由于肿瘤阻塞，1例是由于既往胃切除术。48例患者术后18至24小时开始喂养。未发生重大并发症，但11例（22%）患者出现轻微并发症。14例患者在使用胃造口管2至6个月后拔除，15例接受治疗或持续吞咽困难的患者接受胃造口喂养1至6个月。21例晚期患者中，8例死亡，6例失访，7例接受喂养1至6个月。
经皮内镜下胃造口术是一种简单、安全、有效的长期肠内喂养方法。自制的管子和自制的搅拌食物足以替代更昂贵的商业套件和肠内制剂。
