??ade?

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• ??ade?µ??? e?d?s??p??? ?ast??st?µ?a
• Percutaneus endoscopic gastrostomy (PEG)
• ? ???????a?
• ??T ?G? ??a??????

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??sa????

• ? e?te???? d?at??f? ?????e?ta? µ?s? s?????? st?
  st?µa??-??te?? p?? t?p??et???ta? ?????ast????,
  d?ade?µ??? e?te ?e?????????
• ? PEG e?s???? t? 1980 ap? t??? Gauderer and
  Ponsky
• ??e? a?t??atast?se? t?? ?e??????????
  ?ast??st?µ?e? (Witzel, Stamm, Janeway) p?? ?????
  s?µa?t??? ?????te?? p?s?st? ep?p?????.
• ? e?????a e?t??es?? t?? µe??d?? ?a? ? µ????
  s????t?ta ep?p????? ????? a????e? s?µa?t??? t??
  e?de??e?? t?? µe??d??.

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??sa????

• S?µe?a e??a? ???st? ?t?
• ? as?t?a e??a? ?a?? a?e?t? ??a ???e? µ??e?
• ? p?e????t?ta t?? as?e??? µe ad??aµ?a s?t?s??
  µp??e? ?a ??ße? d?at??f? (st?µa???-??st?da) µ?s?
  levin
• ? µa????????a s?t?s? µ?s? levin s?s?et??eta? µe
  p????? ep?p????? ?a? a???µ??? f??t? e??as?a? t??
  p??s?p????

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?????ast????? vs PEG

• S?µf??a µe ta ap?te??sµata ap? a??et?? µe??te?
• ? PEG se s?????s? µe t?? ?????ast???? s????a
  s?s?et??eta?
• µ????te?? d?sa?e??a t?? as?e????
• ????te?e? ep?p????? (d?aß??se??, ????,
  a?µµ??a??a, ap?f?a??, ?a??asµ??? ??s?)
• µ????te?? p?s?st? ??s?fa????? a?a?????,
  p?e?µ???a?
• ?pe???? st?? ep?te??? d?at??f???? st????
• ße?t??s? t?? p???t?ta? ???? t?? as?e???

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(No Transcript)
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.khkh
S?µf??a µe t?? pa???sa ???s?, e?? a?aµ??eta? ?t?
? d?at??f? t?? as?e???? ?a e??a? a?epa???? ?a? ?a
??e???eta? e?te???? d?at??f? ??a ??????? d??st?µa
gt2-3 eßd?µ?de? p??pe? ?a p??t?µ?ta? ? d?at??f?
µ?s? PEG
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???????µ?? ??a ???s? st?? ??????? p???? s?et???
µe t?? ep????? t?? ?d?? ??a e?te???? d?at??f?
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NCJ Needle Catheter Jejunostomy PEJ
percutaneus Endoscopic Jejunostomy, JET_PEG
Jejunal Tube PEG
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??e??e???t??? NCJ Needle Catheter Jejunostomy

• ??? p??ß??peta? ? a????? µa????????a? e?te?????
  d?at??f?? µet? ap? ?e????????? ep?µßas?
  s???st?ta? ? d?e??e???t??? ??st?d?st?µ?a d?a
  ße?????
• ? µ???d?? ep?t??pe? t?? p???µ? e?te???? s?t?s? se
  as?e?e?? p?? ad??at??? ?a s?t?s???? epa???? ??a
  pa?atetaµ??? ??????? d??st?µa µete??e???t???

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??e??e???t??? ??st?d?st?µ?a
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??de??e?? PEG

• G?a t?? ap?fas? p??pe? ?a ??f???? ?p???
• ??????? ?at?stas?
• d?????s?-p?????s? ??s??
• a?aµe??µe?a ?f??? st?? p???t?ta ????
• ep???µ?e? t?? as?e????
• ? t?p???t?s? PEG de? p??pe? ?a ???eta? sa? te????
  ? s?µß????? µ?t?? se as?e?e?? µe µ???? p??sd???µ?
  ep?ß??s?? ? ßa??? ????a

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???ta?????? st???? e?te????? d?at??f?? PEG

• p?????? ap??e?a? ß?????
• ?p??at?stas? d?at??f???? e??e?µµ?t??
• ???d?t?s?
• ?e?t??s? p???t?ta? ???? ???? ad??aµ?a? s?t?s??

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??????????? as?e?e?? lt40 s??????

• ????? p?? p???a???? st???s? st?µat?f?????a
  a??te?? pept???
• ?p????? ?a ??????
• e?te pa??????t???
• e?te p??? t?? ep?µßas?- ??µe???e?ape?a
  - a?t???ß???a ?a? ?a afa??e???? µet? t??
  ap??at?stas?
• ?s?e?e?? p?? ?a ?p?ß?????? se ep??et???
  µa????????a ??µe??-a?t???ß???a

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?e?????????? as???e?e? gt50 pe??pt?se??

• ??a???e??efa????? ?a??se?? (pa?atetaµ??? ??µa)
• ??? µe d?ata?a??? s??e?d?s??-?at?p?s??
• ????? e??ef????
• Parkinsons disease
• amyotrophic lateral sclerosis

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???e? ?atast?se??

• ?a?e??a se as?e?e?? µe AIDS
• S??d??µ? ß?a???? e?t????
• ?peµß?se?? a?a?atas?e??? p??s?p???? ??a????
  ?a?atetaµ??? ??µa
• ????t?a?µat?e?
• ??s?? t?? Crohn
• ?a?e??a se ??st??? ???s?, ?????a ?ef????
  a?ep???e?a
• S???e?e?? a??µa??e? (t?a?e??s?fa???? s??????a,
  ?t?)

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?a???? pas???te? as?e?e??

• ?s?e?e?? µe s?ßa?? ????s? ?efa???, µ???µ? f?t???
  ?at?stas? ? ß?ade?a ap??at?stas? ap? s?ßa?? ??s?,
  ßa??? ?e???p??e?a t?? µ???da?, s?ßa?? s?pt???
  e??efa??p??e?a.
• Se a?t??? t??? as?e?e?? t??? as?e?e?? ? ???a???
  t?p???t?s? t?? PEG e?asfa???e? t?? d?at??f???
  ?p?st????? ????? ta p??ß??µata t?? ?????ast?????
  s????a.
• Se pe??pt?s? ap??at?stas?? ?a? epa????? s?t?s??
  ap? t? st?µa ? PEG µp??e? e????a ?a afa??e?e?

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??te?de??e??

• ??ata?a??? p??t???? µ??a??sµ??
• (INRgt1.5, aPTT gt50 sec, PLTlt 50000)
• ?a?eµß??? ??????? (?pa?, pa?? ??te??)
• Ge???e?µ??? ?a?????µ?t?s? ?????a?.
• ?e???? as??t??? s??????
• ?e??t???t?da, ?e????e??? a???e??a, ????s?
• ????? p??sd???µ? ep?ß??s??
• ? ap??s?a ??at?? f?t?? t?? e?d?s??p??? de?
  ap?te?e? a?t??de??? (d???µas?a pa?a???t?s??)
• ? PEG ???eta? s?µe?a ??eta se as?e?e?? µe
  ?ast?e?t?µ?, ?e?p?as?e? st?µ????, ? pe??t??a???
  a?µ????a?s?

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???et??µas?a f???t?da PEG
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?p?p?????

• S??????? ??µa????ta? µeta?? 8-30
• S?ßa??? p?? ??e?????ta? pa??µßas? 1-4
• ?a??te?e? (d??t??s?, e?d??. ??µ???a??a,
  pe??t???t?da) µe ?e????????? pa??µßas? lt0.5
• St? 15 pa?at??e?ta? pe??st?µat??? f?e?µ???
• St? 50 pa?at??e?ta? p?e?µ?pe??t??a??, (?????
  ??????? s?µas?a)

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???µe? ep?p?????

• ?p?f?a?? s????a ap? t??f??
• ?p??e?a e?ast???t?ta? s????a ?a? ???µ?? st?
  t????µa
• ?p???p? s????a
• ??tta??t?da p???? t?? st?µat??
• ?e??st?µat??? a??pt??? ??????d??? ?st??
• ??taf?asµ?? t?? es?te????? p?µat?? st? ?????a??
  t????µa

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?fa??es? s?st?µat?? PEG

• ?f?s?? ?? e?de??e?? t?? PEG s???? e??a? ??a
  s???e???µ??? ??????? d??st?µa ? a????? ??a
  afa??es? e??a? s????
• ??af??eta? p?s?st? afa??es?? 20-30
• ????? ap?? e??a? ? ap???p? t?? e??te???? ?a? ?
  ap?ß??? t?? es?te????? p?µat?? µe t?? af?de?s?
• S????te?a ?µ?? ???eta? afa??es? t?? es?te?????
  tµ?µat?? e?d?s??p???
• ?e? ep?t??peta? ? afa??es? p??? t?? 10 ?µ??a ap?
  t?? e?te?es? t??

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??t??at?stas? PEG?

• ?a s??????a ????? ?atas?e??? t?? s?st?µ?t?? PEG
  ep?t??p??? t?? pa?aµ??? ??a µe???? ???????
  d??st?µa p?? µp??e? ?a ft?se? ta 10 ?????a
• ?e? ??????? a??a??? e?t?? e?? pa???s??s???
  d?s?e?t?????a

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S?µpe??sµata

• Se as?e?e?? µe µa????????a ad??aµ?a s?t?s??
• ??µa
• ßa???? p?s???te?
• ???, ?e?????????? ??s??
• s?pt??? e??efa??p??e?a
• ?e?p?as?e? ?p? a????
• ? s?t?s? µ?s? ?ast??st?µ?a? ap?te?e? t?? µ???d?
  e?????? af?? ep?t?????e? ?a??te?a d?at??f???
  ap?te??sµata µe ????te?e? ep?p?????

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• e??a??st?