Pull Technique

The original method described in 1980 by Ponsky and colleagues was a "Pull" technique for PEG placement (Safadi et al, 1998). In this method (after placing the patient in a supine position and starting IV sedation) the endoscope is advanced to complete the upper examination (esophagus, stomach, and duodenum). The stomach is fully inflated. The gastric inflation not only brings the gastric wall closer to the anterior abdominal wall but also helps to displace the left lobe of the liver in cephalad direction and the colon towards the pelvis. Transillumination and movement of the stomach wall during ballottement ensures that the gastric wall will be in close proximity to the anterior abdominal wall and that there are no intervening viscera. A fluid filled syringe is then advanced through the abdominal wall at the spot selected for PEG placement; any air aspirated prior to reaching the stomach suggests interposing bowel and an alternative site should be chosen. The skin is anesthetized with lidocaine and a 1 cm horizontal incision is made. The puncturing cannula is inserted through the abdominal wall into the stomach. A guidewire is passed through the cannula and grasped with a snare. The endoscope is then pulled out along with the snare. Subsequently, the dilating part of the PEG tube is attached to the wire and pulled from the abdominal wall, hence it is called the Pull technique. After several inches are extended, a gastroscope is reintroduced to check the position of the bolster inside the stomach wall. On the outer tube, a crossbar is applied to prevent migration of the tube.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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