DATE OF PROCEDURE: MM/DD/YYYY
DIAGNOSES:
1. Displaced gastrostomy tube.
2. Traumatic brain injury.
PROCEDURE PERFORMED: Esophagogastroduodenoscopy (EGD) with replacement of gastrostomy tube.
SURGEON: John Doe, MD
ANESTHESIA: Monitored anesthesia care.
INDICATIONS FOR PROCEDURE: This is a (XX)-year-old African-American male who suffered a severe brain injury in a car crash. Subsequently, he has required feedings via gastrostomy due to poor swallowing. Gastrostomy tube was noted to have a leak around it, and an attempt to replace the tube directly met resistance and inability to pass a new gastrostomy tube.
ENDOSCOPY FINDINGS: Normal-appearing pharynx and larynx with the gastroesophageal junction at 39 cm from the incisors. The gastric mucosa appeared normal through fundus, body, and antrum. The pylorus was wide open, and the duodenal bulb and descending duodenum appeared normal. In the distal body of the stomach, the gastrostomy site was noted to be open, and with initial pressure on the externally introduced gastrostomy tube, the edge of the tube was visible through the mucosal opening and was eventually introduced with external manipulation.
DESCRIPTION OF PROCEDURE: After obtaining informed consent and identification of the patient, the patient was transported to the operating room where monitoring and sedation was provided by the anesthesia service. With the patient supine, a video upper endoscope was introduced orally and advanced through the posterior pharynx into the esophagus and then through the esophagus into the stomach. The stomach was distended with air, and the endoscope advanced through the stomach and pylorus into duodenum and well into the descending duodenum. The endoscope was slowly withdrawn carefully inspecting mucosal surfaces. As the scope was withdrawn within the stomach, a retroflexed view was obtained and then the body of the stomach was visualized, and the previous gastrostomy site was evident and visualized by noting a mucosal opening. A 20 French MIC gastrostomy tube was placed within the external wound of the previous gastrostomy, and as this was introduced, the edge of the end of the gastrostomy tube was visible through the hole in the mucosa with the endoscope, but seemed to be slightly off to the side and so would not enter the stomach easily. Observing with the endoscope, the gastrostomy tube was then manipulated, and with some gentle pressure and twisting, the end of the gastrostomy tube entered the stomach. The balloon on the gastrostomy tube was then inflated and pulled back to have the flange or the balloon up against the mucosa. The external flange of the tube was then secured against the skin with the flange at approximately the 5 cm mark on the tube. Dressing was placed over the gastrostomy entry site. The gastroscope was then slowly withdrawn, carefully inspecting the mucosal surfaces of the esophagus as the scope was withdrawn. On complete withdrawal of the scope, the patient was then transported to the recovery room in stable condition.
