title: Combined endoscopic gastrostomy ("Pull-Introducer Technique"): a new less traumatic technique for preterm and small for gestational age patients.
abstract: BACKGROUND
  The most common endoscopic gastrostomy technique is the "Pull-Through" or Gauderer-Ponsky technique. This is a transoral technique in which the internal bumper of the tube goes in through the esophagus. However this has been shown to be traumatic and often impossible in newborns and small for gestational age (SGA) patients, therefore a transabdominal technique must be used in this cases. We have developed a new transabdominal technique which combines two classical methods. This technique avoids the inconvenience of passing the internal bumper through the esophagus.
  
  
  METHODS
  We have used this combined technique in five SGA patients. The technique consists of inserting a replacement tube using a Pull kit as installation device.
  
  
  RESULTS
  There were no complications during these five procedures and the patients were fed 2 hours later.
  
  
  CONCLUSIONS
  The main advantage of this technique is the use of kits that are already found in endoscopy units and endoscopists are familiar with. The disadvantage is the use of a balloon tube that can break or deflate.
authors.affiliation: Endoscopy Center, Regional Hospital of Iquique, Iquique, Chile. Electronic address: akirberg@gmail.com.
authors.forename: Arturo
authors.initials: A
authors.lastname: Kirberg
authors.affiliation: Endoscopy Center, Regional Hospital of Arica, Arica, Chile.
authors.forename: Biffret
authors.initials: B
authors.lastname: Diaz
authors.affiliation: Endoscopy Center, Regional Hospital of Iquique, Iquique, Chile.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Flores
authors.affiliation: Endoscopy Center, Regional Hospital of Iquique, Iquique, Chile.
authors.forename: Jorge
authors.initials: J
authors.lastname: Romeroa
authors.affiliation: Pediatric ICU, Regional Hospital of Iquique, Iquique, Chile.
authors.forename: Marcela
authors.initials: M
authors.lastname: Varas
authors.affiliation: Neonatology, Regional Hospital of Iquique, Iquique, Chile.
authors.forename: Karla
authors.initials: K
authors.lastname: Contreras
mesh_terms: D003680:Deglutition Disorders / Q000601:surgery*; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000295:instrumentation / Q000379:methods*; D005774:Gastrostomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D017063:Outcome Assessment, Health Care
keywords: Combined gastrostomy; Endoscopic gastrostomy; Gastrostomy in newborns; Pediatric endoscopy