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Benjamin M. Walter

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This video explains how to create a percutaneous endoscopic gastrostomy using the direct puncture technique after gastropexy.

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Various versions of the gastropexy device are available, but they all work in a similar way.

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The classic gastropexy device consists of two hollow needles. The needle with the blue head contains a curved loop. After the yellow inlay has been removed, the suture that is supplied can be inserted.

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The newer version, now widely used, also basically consists of two hollow needles. The loop can be extended by pressing on the blue part. To retract it, you press the red button.

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The suture can be inserted into the hollow needle using the yellow rotary knob.

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The sequence of steps is: insert the suture, extend the loop, advance the suture further, close the loop.

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The length of the hollow needles, and thus the distance from the skin, can be easily adjusted with both versions.

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After the diaphanoscopy has been checked, thorough disinfection of the planned puncture site is carried out. Local anesthesia is administered in the area after it has been covered with a fenestrated drape.

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First, the two hollow needles are advanced transcutaneously into the stomach. This is done with endoscopic monitoring. When the blue trigger is pressed, the loop is extended. When the yellow wheel is turned, the suture is advanced and passes through the open loop. The loop is closed again by pressing the red button. When the gastropexy device is removed, the suture caught in the loop is led out again transcutaneously.

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This creates the first gastropexy, which is tied off in the area of the abdominal wall using moderate traction.

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The second gastropexy suture is now created in the same way. The stomach is now attached to the abdominal wall and cannot shift away during the following steps.

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Next, a scalpel incision is made between the gastropexy sutures, in line with the tension lines (Langer lines). This makes it easier to insert the trocar. The trocar is advanced transcutaneously into the stomach in the area of the incision, with endoscopic monitoring. Injury to the stomach wall opposite the insertion site can be avoided by angulation. Once the trocar with the peel-off catheter has been advanced far enough into the stomach, the insertion aid is removed.

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A 15-Fr GastroTube is now advanced through the peel-off catheter into the stomach. It is important to ensure that the front part of the GastroTube with the balloon on it is inserted far enough into the stomach, so that it is outside of the white catheter. If necessary, the catheter can already be opened slightly using the red traction aids during insertion.

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The balloon now has to be filled with water to prevent the GastroTube from slipping out. The amount needed is marked on the GastroTube’s colored valve. In this case, it is 5 mL. After the balloon has been inflated, the peel-off catheter can be completely removed. The protruding suture threads on the gastropexy are cut off above the knots. The GastroTube is then fixed using moderate traction and a wound dressing is applied.

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