COMMENTS (J. MARTÍN):

PEG PUSH system in a patient with esophageal carcinoma
46-year-old male patient. Connatal palsy cerebral. Admitted to the hospital by pneumonia. A CT scan shows traqueo-esophageal fistulae. An upper endoscopy and a PEG was solicited.
Methods: Sedation: Propofol managed by non-anesthesiologist Intervention in endoscopy room. Time prodedure: 30 minutes. Treatments: esophageal dilation ( boston Scientific CRE) Push Peg system( Kimberley Clark ).
Gastroscopy shows a neoplastic appearance at 1/3 upper esophagus. We dilate the stenosis up to 10 mm to pass the gastroscope to stomach. Then take bx of the stenosis. Once in the stomach by transillumination got a suitable area for the PEG. We put lidocaine on the area of skin where we will put the PEG. Now we introduce three plexias from outside to fix the cavity gastric to the skin in three points. Each plexia is externally attached to the tension required with a button. Now we introduce three plexias from outside to fix the cavity gastric to the skin in three points. Each plexia is externally attached to the tension required with a button. Each plexia is mounted in a needle. Once it is inserted in the gastric cavity is liberated, T-shaped, and is externally set according to the desired tension. With the three plexias set, we make an skin incision of 5-6 mm. Then we introduce a catheter to attach the Guide metal which will serve to insert the PEG kit push. The PEG push kit has three prpgressive diameters that facilitates the insertion of it. Then internal dilators are removed and we leave the more external part of the kit, through wich we will put the ball PEG chosen, in this case 16 G. Finally we make the local priests of the wound and adjust external plate of the PEG so that you have the proper tension and gastrocutaneous fistula is well formed.