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Percutaneous endoscopic gastrostomy
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==Techniques== [[Image:PEG tube kit.jpg|thumb|right|200px|PEG tube, cannula and guidewire (Pull Technique)]] Two major techniques for placing PEGs have been described in the literature. The Gauderer-Ponsky technique involves performing a [[gastroscopy]] to evaluate the [[anatomy]] of the [[stomach]]. The anterior stomach wall is identified and techniques are used to ensure that there is no [[organ (anatomy)|organ]] between the wall and the [[skin]]: * digital pressure is applied to the abdominal wall, which can be seen indenting the anterior gastric wall by the endoscopist. * transillumination (diaphanoscopy): the light emitted from the endoscope within the stomach can be seen through the abdominal wall. * a small (21G, 40mm) needle is passed into the stomach before the larger cannula is passed. An [[catheter|angiocath]] is used to puncture the abdominal wall through a small [[Surgical incision|incision]], and a soft guidewire is inserted through this and pulled out of the [[mouth]]. The feeding tube is attached to the guidewire and pulled through the mouth, esophagus, stomach, and out of the incision.<ref name=Gauderer01/> In the Russell introducer technique, the [[Seldinger technique]] is used to place a wire into the stomach, and a series of dilators are used to increase the size of the [[gastrostomy]]. The tube is then pushed in over the wire.<ref name="pmid3349370">{{cite journal |vauthors=Deitel M, Bendago M, Spratt EH, Burul CJ, To TB |title=Percutaneous endoscopic gastrostomy by the "pull" and "introducer" methods |journal=Can J Surg |volume=31 |issue=2 |pages=102β4 |year=1988 |pmid=3349370 }}</ref>
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