Percutaneous Endoscopic Gastrojejunostomy in Patients with Delayed Gastric Emptying

經皮內視鏡胃空腸造瘻術運用於胃排空遲緩的病人

李忠憲(Chung-Hsien Li) ； 張維國(Wei-Kuo Chang) ； 邱志龍(Chih-Lung Chou) ； 朱恆成(Heng-Cheng Chu) ； 趙有誠(You-Chen Chao) ； 謝財源(Tsai-Yuan Hsieh)

《臺灣消化醫學雜誌》 25卷1期 (2008/03) Pp. 1-5

https://doi.org/10.6557/GJT.200803_25(1).0001

摘要

目的：經皮內視鏡胃空腸造瘻術已廣泛應用在長期管灌餵食之病患，尤其是胃排空遲緩病患。我們報告本院在經皮內視鏡胃空腸造瘻術的操作經驗。
方法：從2000年至2006年，我們收集145個病患接受經皮內視鏡胃造瘻術，胃造瘻管完成後24小時便開始灌食，經過大約一年的灌食後，有13個病患有胃排空遲緩問題，其中部分患者反復發生吸入性肺炎。因此這13個病患陸續接受胃空腸造瘻管置放術。首先將插入導線的灌食管經胃造瘻管送至胃，用內視鏡鉗子夾住灌食管前端的縫線，在內視鏡操作下，經由鉗子將灌食管送至十二指腸，最後將插入導線的灌食管儘可能推到空腸的遠端，再藉由X光檢查儀確認灌食管最後位置。所有病患經由灌食機連續灌食。住院期間，每日觀察病患灌食情況。
結果：13個病人中，總共放了三十七次灌食管，其中有三十三次都是一次成功，成功率爲百分之八十九，最後所有病患皆項利完成經皮內視鏡胃空腸造瘻術且灌食良好。經皮內視鏡胃造瘻術大約耗時二十分鐘而經皮內視鏡胃空腸造瘻術大約十分鐘。胃空腸造瘻管完成後隔天便開始灌食。所有病患皆獲得良好腸道灌食，有十個病患在開始灌食後第四天，達到我們預期的營養目標。這些病患接受經皮內視鏡胃空腸造瘻管灌食平均六十八天。這些病患在灌食的過程中，有1人併發吸入性肺炎。其中只有2位病患發生造瘻口感染，有2位因造瘻管阻塞、扭結或位置移位需要多次更換灌食管。但並沒有任何病患死於胃空腸造瘻術的併發症。
結論：經皮內視鏡胃空腸造瘻術提供一個長期管灌餵食的很好方式，尤其針對胃排空遲緩病患。現在這項技術與過去胃空腸造瘻術的技術相比，安全性佳，併發症又少，可以減少吸入性肺炎發生的機會，提供一個很好的腸道營養方式。

關鍵字

經皮內視鏡胃空腸造瘻術 ； 經皮內視鏡胃造瘻術 ； 腸道營養

並列摘要

Objective: Percutaneous endoscopic gastrojejunostomy (PEGJ) has become the method of choice to achieve an enteral access route in patients who require long-term enteral nutrition, especially in patients with delayed gastric emptying. Here, we discuss a successful approach for PEGJ used in our hospital.
Materials and Methods: Thirteen of 145 percutaneous endoscopic gastrostomy patients (9%) with delayed gastric emptying had indications for PEGJ, which was performed in two steps. Percutaneous endoscopic gastrostomy (PEG) was performed first, and feeding was started through the PEG tube 24 hours later. PEG was converted to PEGJ because of delayed gastric emptying. Under fluoroscopic guidance to confirm the tube position, a stiffened jejunal tube was passed through the PEG tube and pushed downward as deep as possible to the jejunum. Feeding was accomplished by continuous infusion using a feeding pump in all patients. A daily follow-up of the patients was carried out during the hospitalization period.
Result Thirteen PEG patients underwent 37 attempts at feeding tube placement. Thirty-three initial procedures were successful and eventually all procedures succeeded in these patients. Therefore, there was a successful rate in initial placement of feeding tubes of 89% (33/37) in these patients. The average time was about 20 minutes for the PEG placement and about 10 minutes for the PEGJ placement. Enteral nutrition with a polymeric diet was initiated the day after the PEGJ placement. All patients obtained good enteral feeding through the PEGJ, and 10 patients achieved the nutrition goal four days later. The average duration of enteral nutrition through the PEGJ was 68 days. Only one patient developed aspiration pneumonia. There were some minor complications including peristomal infection in two patients and gastrojejunostomy tube replacements in two patients. No death resulted from a PEGJ-related complication.
Conclusion: PEGJ provides a better choice for a long-term nutritional support, especially in patients with delayed gastric emptying. PEGJ shows good efficacy and safety when combined with good enteral nutrition support, can reduce aspiration pneumonia, and has a low complication rate compared with previously described methods.

並列關鍵字

percutaneous endoscopic gastrojejunostomy ； percutaneous endoscopic gastrostomy ； enteral nutrition