Combined endoscopic gastrostomy ("Pull-Introducer Technique"): a new less traumatic technique for preterm and small for gestational age patients

Abstract

Introduction: The most common endoscopic gastrostomy technique is the "Pull-Through" or Gauderer-Ponsky technique. This is a transoral technique in which the internal bumper of the tube goes in through the esophagus. However this has been shown to be traumatic and often impossible in newborns and small for gestational age (SGA) patients, therefore a transabdominal technique must be used in this cases. We have developed a new transabdominal technique which combines two classical methods. This technique avoids the inconvenience of passing the internal bumper through the esophagus.

Patients and methods: We have used this combined technique in five SGA patients. The technique consists of inserting a replacement tube using a Pull kit as installation device.

Results: There were no complications during these five procedures and the patients were fed 2 hours later.

Discussion: The main advantage of this technique is the use of kits that are already found in endoscopy units and endoscopists are familiar with. The disadvantage is the use of a balloon tube that can break or deflate.

Keywords: Combined gastrostomy; Endoscopic gastrostomy; Gastrostomy in newborns; Pediatric endoscopy.