Q: How many techniques for PEG tube placement?
A: The peroral pull technique (Ponsky), the peroral push technique (Sacks-Vine), and the direct percutaneous procedure (Russell) are the three methods for placing PEG tubes; the first method is the most frequently utilized. These methods all start with the same stages. Following the previously described preparation, the stomach is transilluminated and insufflated, and the endoscope is inserted through the mouth. Lidocaine is injected into the designated location, which is roughly 2 cm below the xiphoid process and 2 cm medial to the costal border. Using the No. 11 blade, a small incision is formed. A 14–18 gauge needle is then inserted through the incision and recognized by the endoscopic camera.
Q: What is Russell Technique?
A: Russell method is not often applied. Following the aforementioned setup, the needle is removed and the guidewire is inserted through it to be recognized by the camera inside the stomach. Once the dilator is visible in the stomach, it is passed over the sheath and guide wire. The feeding tube is then inserted into the stomach through the sheath, and after it is visible, the tube's balloon is inflated inside the stomach. The tube is then brought to the anterior abdomen and percutaneously severed using a skin disc. Notable are the tube's tightness and length at skin level (about 3 to 4 cm).
Q: What is Sacks-Vine Technique?
A: The guidewire is inserted through the needle and caught in a snare that is inserted through the endoscope in the Sacks-Vine procedure (preoral push). The endoscope with the snare and guide wire is taken out of the mouth once the wire has been safely ensnared. The needle is then removed. The feeding tube is placed over the guide wire and forced down through the mouth once there is sufficient of it visible. As the feeding tube emerges through the skin, its tapering end is grasped and withdrawn to a distance of about 3 to 4 cm from the anterior abdominal wall. In order to make sure the feeding tube is positioned correctly, the guide wire is then removed and the endoscope is put back into the stomach. The feeding tube is held in place by the skin disc, which is fastened over it. The tightness and length of the tube are recorded.
Q: Which method is most commonly used?
A: Ponsky technique (preoral pull) is the most commonly used and is similar to the Sacks-Vine technique.
