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Blashinsky ZA, Calafell JA. Malposition of Percutaneous Endoscopic Gastrostomy (PEG) Tube Through the Transverse Colon: A Novel Approach to Conservative Management. Cureus 2024; 16:e63908. [PMID: 39105023 PMCID: PMC11298332 DOI: 10.7759/cureus.63908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 07/03/2024] [Indexed: 08/07/2024] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is a common technique for enteral nutrition support. Complications range from skin injuries and leakage to more severe intraabdominal pathologies. This case report describes a patient with invasive right lateral pharyngeal wall squamous cell carcinoma who developed a gastrocolocutaneous fistula following PEG tube malpositioning in the transverse colon performed at an outside institution. Based on the patient's comorbidities and the associated high-risk nature of the surgery, a transverse colectomy and partial gastrectomy to resect the malpositioned tube followed by a new PEG tube was deemed invasive and would likely have a poor clinical outcome. Instead, the surgeon performed a laparoscopic-assisted PEG tube insertion in another portion of the stomach. The fistulous tract of the original PEG tube was completely sealed and fell out one week following surgery. The patient tolerated feeds through the new PEG tube site. Gastrocolocutaneous fistulas are rare complications of PEG tube insertion with a poorly understood pathophysiology. Here, we analyze the root cause of this condition, steps to mitigate it, and a proposed novel surgical approach for its conservative management.
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Affiliation(s)
- Zachary A Blashinsky
- Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
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Siu J, Fuller K, Nadler A, Pugash R, Cohen L, Deutsch K, Enepekides D, Karam I, Husain Z, Chan K, Singh S, Poon I, Higgins K, Xu B, Eskander A. Metastasis to gastrostomy sites from upper aerodigestive tract malignancies: a systematic review and meta-analysis. Gastrointest Endosc 2020; 91:1005-1014.e17. [PMID: 31926149 DOI: 10.1016/j.gie.2019.12.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/26/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Metastasis to the gastrostomy site in patients with upper aerodigestive tract (UADT) malignancies is a rare but devastating adverse event that has been poorly described. Our aim was to determine the overall incidence and clinicopathologic characteristics observed with development of gastrostomy site metastasis in patients with UADT cancers. METHODS This was a systematic review and meta-analysis of 6138 studies retrieved from Medline, EMBASE, CINAHL, and the Cochrane Register after being queried for studies including gastrostomy site metastasis in patients with UADT malignancies. RESULTS The final analysis included 121 studies. Pooled analysis showed an overall event rate gastrostomy site metastasis of .5% (95% confidence interval [CI], .4%-.7%). Subgroup analysis showed an event rate of .56% (95% CI, .40%-.79%) with the pull technique and .29% (95% CI, .15%-.55%) with the push technique. Clinicopathologic characteristics observed with gastrostomy site metastasis were late-stage disease (T3/T4) (57.8%), positive lymph node status (51.2%), and no evidence of systemic disease (M0) (62.8%) at initial presentation. The average time from gastrostomy placement to diagnosis of metastasis was 7.78 ± 4.9 months, average tumor size on detection was 4.65 cm (standard deviation, 2.02), and average length of survival was 7.26 months (standard deviation, 6.23). CONCLUSIONS Gastrostomy site metastasis is a rare but serious adverse event that occurs at an overall rate of .5%, particularly in patients with advanced-stage disease, and is observed with a very poor prognosis. These findings emphasize a need for clinical practice guidelines to include a regular assessment of the PEG site and highlight the importance of detection and management of gastrostomy site metastasis by the multidisciplinary care oncology team.
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Affiliation(s)
- Jennifer Siu
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kaitlin Fuller
- Gerstein Science Information Centre, University of Toronto Libraries, Toronto, Ontario, Canada
| | - Ashlie Nadler
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robyn Pugash
- Vascular/Interventional Radiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lawrence Cohen
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Konrado Deutsch
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada; Head & Neck Surgical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kelvin Chan
- Division of Medical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Canada
| | - Simron Singh
- Division of Medical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada; Head & Neck Surgical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada; Head & Neck Surgical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Otolaryngology-Head & Neck Surgery, Surgical Oncology, Michael Garron Hospital, Toronto, Ontario, Canada; Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Science, Toronto, Ontario, Canada
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Lee J, Kim J, Kim HI, Oh CR, Choi S, Noh S, Na HK, Jung HY. Gastrocolocutaneous Fistula: An Unusual Case of Gastrostomy Tube Malfunction with Diarrhea. Clin Endosc 2017; 51:196-200. [PMID: 28854775 PMCID: PMC5903073 DOI: 10.5946/ce.2017.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 01/14/2023] Open
Abstract
A gastrocolocutaneous fistula is a rare complication of percutaneous endoscopic gastrostomy (PEG). We report a case of a gastrocolocutaneous fistula presenting with intractable diarrhea and gastrostomy tube malfunction. A 62-year-old woman with a history of multiple system atrophy was referred to us because of PEG tube malfunction. Twenty days prior to presentation, the patient started developing sudden diarrhea within minutes after starting PEG feeding. Fluoroscopy revealed that the balloon of the PEG tube was located in the lumen of the transverse colon with the contrast material filling the colon. Subsequently, the PEG tube was removed and the opening of the gastric site was endoscopically closed using hemoclips. Clinicians should be aware of gastrocolocutaneous fistula as one of the complications of PEG insertion. Sudden onset of diarrhea, immediately after PEG feedings, might suggest this complication, which can be effectively treated with endoscopic closure.
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Affiliation(s)
- Junghwan Lee
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jinyoung Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ha Il Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chung Ryul Oh
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sungim Choi
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soomin Noh
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hee Kyong Na
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hwoon-Yong Jung
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Friedmann R, Feldman H, Sonnenblick M. Misplacement of Percutaneously Inserted Gastrostomy Tube Into the Colon: Report of 6 Cases and Review of the Literature. JPEN J Parenter Enteral Nutr 2017; 31:469-76. [DOI: 10.1177/0148607107031006469] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Reuven Friedmann
- From the Department of Geriatrics, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated with the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; and the“ Neve Horim” Home for the Aged, Jerusalem, Israel
| | - Helena Feldman
- From the Department of Geriatrics, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated with the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; and the“ Neve Horim” Home for the Aged, Jerusalem, Israel
| | - Moshe Sonnenblick
- From the Department of Geriatrics, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated with the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; and the“ Neve Horim” Home for the Aged, Jerusalem, Israel
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Bohnker BK, Artman LE, Hoskins WJ. Narrow Bore Nasogastric Feeding Tube Complications. Nutr Clin Pract 2016. [DOI: 10.1177/088453368700200506] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Park WY, Lee TH, Lee JS, Hong SJ, Jeon SR, Kim HG, Cho JY, Kim JO, Cho JH, Lee SW, Cho YK. Reappraisal of Pneumoperitoneum After Percutaneous Endoscopic Gastrostomy. Intest Res 2015; 13:313-7. [PMID: 26576136 PMCID: PMC4641857 DOI: 10.5217/ir.2015.13.4.313] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 03/04/2015] [Accepted: 03/06/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND/AIMS Pneumoperitoneum is recognized as a benign and self-limiting finding after the insertion of a percutaneous endoscopic gastrostomy (PEG) tube, while complicated pneumoperitoneum is rarely reported. The aim of this study was to reappraise pneumoperitoneum following PEG. METHODS We retrospectively reviewed 193 patients who underwent PEG from May 2008 to May 2014. All patients had a follow-up upright chest or simple abdominal radiograph after PEG. Pneumoperitoneum was quantified by measuring the height of the air column under the diaphragm and graded as small (<2 cm), moderate (2-4 cm), or large (>4 cm). Clinically significant signs were defined as fever, abdominal tenderness or leukocytosis occurring after PEG insertion. RESULTS Of the 193 study patients, 9 (4.6%) had a pneumoperitoneum visualized by radiographic imaging, graded as small in 5 patients, moderate in 2 patients and large in 2 patients. Clinically significant signs were observed in 5 (55.5%) patients with fever reported in 4 patients, abdominal tenderness in 4 patients and leukocytosis in 4 patients. The time to resolution of free air was 2-18 days. Two patients (22.2%) with moderate or large pneumoperitoneum after PEG died from either pneumonia or septic shock. CONCLUSIONS The clinical course of pneumoperitoneum after PEG is not always benign and self-limiting. These findings suggest that clinicians should not neglect a moderate or large pneumoperitoneum, particularly in patients who have an altered mental status or received antibiotics, since peritoneal irritation cannot be observed under these circumstances.
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Affiliation(s)
- Won Young Park
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Tae Hee Lee
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Joon Seong Lee
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Su Jin Hong
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seong Ran Jeon
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Hyun Gun Kim
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Joo Young Cho
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Jin Oh Kim
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Jun Hyung Cho
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Sang Wook Lee
- Department of Internal medicine, Sungbuk Central Hospital, Seoul, Korea
| | - Young Kwan Cho
- Department of Internal Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
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Kato K, Taniguchi M, Iwasaki Y, Sasahara K, Nagase A, Onodera K, Matsuda M, Inaba Y, Kawakami T, Higuchi M, Kobashi Y, Furukawa H. Computed tomography-gastro-colonography for percutaneous endoscopic gastrostomy using a helical computed tomography. Am J Surg 2015; 210:374-381. [PMID: 25912624 DOI: 10.1016/j.amjsurg.2014.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/04/2014] [Accepted: 10/11/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. METHODS In total, 48 individuals underwent computed tomography-gastro-colonography (CT-GC)-guided PEG placement. Study end points included success of CT-GC, inability to thread the PEG tube, the eventual tube location, tube adjustments needed, adverse events, operating time, and PEG tube-related infection. RESULTS A successful CT-GC was achieved in all 48 patients (100%), and we successfully used a standard PEG technique to place the gastrostomy tube in 44 patients (92%). In 4 patients (8%), the laparoscopic-assisted PEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. The overall procedure-related minor complication rate was 8%. CONCLUSION CT-GC is an optional method for the estimation of intra-abdominal, anatomical orientations that may minimize the risk of complications before PEG placement.
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Affiliation(s)
- Kazuya Kato
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan.
| | - Masahiko Taniguchi
- Department of Surgery, Asahikawa Medical University, 1-1, 2-1, Midorigaoka, Asahikawa City 078-8510, Japan
| | - Yoshiaki Iwasaki
- Department of Gastroenterology and Hepatology, Okayama University, 2-5-1, Shikata Town, Okayama City, Okayama 700-8558, Japan
| | - Keita Sasahara
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan
| | - Atsushi Nagase
- Department of Surgery, Asahikawa Medical Center, 4048, 7 cyome, Hanasaki-cyo, Asahikawa City 070-8644, Japan
| | - Kazuhiko Onodera
- Department of Surgery, Hokuyu Hospital, 5-1, 6-6 Higashi-Sappro, Shiroishi-ku, Sapporo City 003-0006, Japan
| | - Minoru Matsuda
- Department of Surgery, Nihon University, 1-8-13 Surugadai Kanda, Chiyoda-ku, Tokyo 010-8309, Japan
| | - Yuhei Inaba
- Department of Internal Medicine, Asahikawa Medical University, 1-1, 2-1, Midorigaoka, Asahikawa City 078-8510, Japan
| | - Takako Kawakami
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan
| | - Mineko Higuchi
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan
| | - Yuko Kobashi
- Department of Radiology, Jikei University, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroyuki Furukawa
- Department of Surgery, Asahikawa Medical University, 1-1, 2-1, Midorigaoka, Asahikawa City 078-8510, Japan
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Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol 2014; 20:8505-8524. [PMID: 25024606 PMCID: PMC4093701 DOI: 10.3748/wjg.v20.i26.8505] [Citation(s) in RCA: 266] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 02/23/2014] [Accepted: 04/15/2014] [Indexed: 02/06/2023] Open
Abstract
Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction, and patients who are critically ill. However, despite the benefits and widespread use of enteral tube feeding, some patients experience complications. This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding, together with associated complications and special aspects. We conducted an extensive literature search on PubMed, Embase and Medline using index terms relating to enteral access, enteral feeding/nutrition, tube feeding, percutaneous endoscopic gastrostomy/jejunostomy, endoscopic nasoenteric tube, nasogastric tube, and refeeding syndrome. The literature showed common routes of enteral access to include nasoenteral tube, gastrostomy and jejunostomy, while complications fall into four major categories: mechanical, e.g., tube blockage or removal; gastrointestinal, e.g., diarrhea; infectious e.g., aspiration pneumonia, tube site infection; and metabolic, e.g., refeeding syndrome, hyperglycemia. Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route, gastrointestinal complications are without doubt the most common. Complications associated with enteral tube feeding can be reduced by careful observance of guidelines, including those related to food composition, administration rate, portion size, food temperature and patient supervision.
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Mortality after percutaneous endoscopic gastrostomy in patients with cirrhosis: a case series. Gastrointest Endosc 2010; 72:1072-5. [PMID: 20855067 DOI: 10.1016/j.gie.2010.06.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 06/14/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tube placement can improve the nutritional status and the ability of a patient with cirrhosis to recover from surgery such as orthotopic liver transplantation. However, cirrhosis has been considered a significant contraindication to PEG tube placement. OBJECTIVE Our aim in this study was to describe the mortality and complications in a series of cirrhotic patients who underwent PEG at our institution. DESIGN Retrospective, single-institution case series. PATIENTS This study involved 26 consecutive patients with cirrhosis who underwent PEG between 1995 and 2005. INTERVENTION PEG tube placement. MAIN OUTCOME MEASUREMENTS AND RESULTS The 30-day mortality of the series of patients was 10 of 26 (38.5%), whereas the 90-day mortality was 11 of 26 (42.3%). Nine of the 10 patients who died in the first 30 days had ascites at the time of PEG tube placement. Two patients died as a direct consequence of complications from the PEG procedure, whereas the other deaths were related to progression of liver disease or factors not directly related to the PEG. LIMITATIONS The patients in this case series had varying levels of illness and reasons for PEG tube placement such that a generalization of outcomes may not be possible. CONCLUSIONS The overall mortality of patients with cirrhosis who underwent PEG is high. Although there is an increased risk, PEG tube placement in cirrhotic patients without ascites may be less risky. The benefits of PEG tube placement in patients with cirrhosis should be weighed heavily against the risks.
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Melmed GY, Kar S, Geft I, Lo SK. A new method for endoscopic closure of gastrocolonic fistula: novel application of a cardiac septal defect closure device (with video). Gastrointest Endosc 2009; 70:542-5. [PMID: 19699982 DOI: 10.1016/j.gie.2009.03.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 03/11/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastrocolonic fistula after percutaneous endoscopic gastrostomy PEG tube placement is an uncommon but serious complication. These fistulous tracts are often fibrotic and frequently require surgical intervention. OBJECTIVE To describe a novel endoscopic treatment for gastrocolonic fistula. DESIGN Case report. SETTING Inpatient hospital setting. PATIENT An 82-year-old woman was seen 1 year after PEG placement with feculent vomiting; imaging studies showed a gastrocolonic fistula. Cardiopulmonary comorbidities posed an unacceptable surgical risk. Endoscopic attempts at fistula closure with hemoclip placement and biodegradable plug were unsuccessful. Total parenteral nutrition resulted in multiple metabolic and infectious complications. INTERVENTION Gastrocolonic fistula closure was performed twice by using cardiac septal defect closure devices. The first closure was achieved by using the Amplatzer double-disk nitinol wire mesh atrial septal defect closure device, which was deployed under endoscopic and fluoroscopic guidance across the fistula tract. The proximal disk was then injected with cyanoacrylate glue to create a watertight seal. The second closure, performed 4 months later after collapse of the initial device, was performed by using the CardioSEAL septal repair implant. This was secured in place with hemoclips and similarly injected with cyanoacrylate glue to create a watertight seal. MAIN OUTCOME MEASUREMENTS Fistula closure, as determined by contrast gastrogram through a PEG tube and gastrograffin enema. RESULTS Successful fistula closure was achieved for 4 months after initial device placement. After the second device was placed, the patient remained clinically well until her demise 18 months later from unrelated causes. LIMITATIONS These procedures were performed on only one subject. CONCLUSIONS Successful endoscopic closure of gastrocolonic fistula can be achieved, even with long-standing, fibrotic fistulous tracts by using a novel endoscopic approach.
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Affiliation(s)
- Gil Y Melmed
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California, Los Angeles, California 90048, USA.
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Hepworth CC, Gong F, Kadirkamanathan SS, Swain CP, Rogers J. Operating gastrostomy tubes: Insertion and removal for minimally invasive transgastric ulcer surgery. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709809152882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Prunet B, Meaudre E, Lacroix G, Lamblin G, Goutorbe P. [Misplacement of percutaneous endoscopic gastrostomy into the colon in an intensive care unit]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2008; 27:763-765. [PMID: 18760893 DOI: 10.1016/j.annfar.2008.07.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Alley JB, Corneille MG, Stewart RM, Dent DL. Pneumoperitoneum after Percutaneous Endoscopic Gastrostomy in Patients in the Intensive Care Unit. Am Surg 2007. [DOI: 10.1177/000313480707300806] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Percutaneous endoscopic gastrostomy (PEG) has been associated with up to a 55 per cent incidence of pneumoperitoneum in the literature. A review was conducted of 120 consecutive PEG tube insertions in patients in the intensive care unit (ICU) to determine the incidence and significance of postprocedural pneumoperitoneum in this population. One hundred twenty consecutive PEG insertions in patients in the ICU were retrospectively reviewed. Chest radiographs were reviewed for 48 hours postprocedure, noting if any pneumoperitoneum was apparent on radiologic examination. If present, the time to resolution was noted. Documented PEG complications were also examined. Post-PEG pneumoperitoneum was detected in 6.7 per cent of patients in the ICU. Mean time to resolution was 2.7 days. The complication rate was 10.8 per cent, including dislodgement requiring laparotomy, transcolonic placement, and upper gastrointestinal bleeding. There were no complications resulting from PEG placement in patients with postprocedural pneumoperitoneum. Two transcolonic PEGs were undetected by postprocedure chest radiographs. The incidence of post-PEG pneumoperitoneum in our ICU population was 6.7 per cent. We believe that this incidence, although lower than historical rates, accurately reflects the current rate of detectable pneumoperitoneum in patients in the ICU. PEG-related complications were not associated with postprocedure pneumoperitoneum.
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Affiliation(s)
- Joshua B. Alley
- Department of Surgery, University of Texas Health Science Center at San Antonio, University Hospital, San Antonio, Texas
| | - Michael G. Corneille
- Department of Surgery, University of Texas Health Science Center at San Antonio, University Hospital, San Antonio, Texas
| | - Ronald M. Stewart
- Department of Surgery, University of Texas Health Science Center at San Antonio, University Hospital, San Antonio, Texas
| | - Daniel L. Dent
- Department of Surgery, University of Texas Health Science Center at San Antonio, University Hospital, San Antonio, Texas
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Abstract
A patient sustained deep dermal burns from contact with gastric contents following disconnection of his percutaneous endoscopic gastrostomy (PEG) tube. We discuss the complications of gastrostomies and add this as a rare complication, which may be prevented by a modification to the outlet control of a PEG tube.
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Affiliation(s)
- R Alvi
- Mersey Plastic Surgery and Burns Centre, Whiston Hospital, Merseyside, UK
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Abstract
BACKGROUND Although most gastrointestinal endoscopic procedures are performed by gastroenterologists, surgeons often assist in the management of patients with complications. This review provides an introduction to the incidence, prevention, and treatment of complications that may occur after upper endoscopy, colonoscopy, percutaneous endoscopic gastrostomy, and endoscopic retrograde cholangiopancreatography. METHODS Systematic review of the literature. RESULTS Preprocedural complications include medication effects and adverse effects of bowel preparation. Major procedural complications consist primarily of perforation and hemorrhage. Percutaneous endoscopic gastrostomy tube placement may be complicated by fistula and obstruction. There is also a risk of infectious disease transmission, both to and from the patient. CONCLUSIONS Endoscopy, like all invasive procedures, carries significant potential risks for the patient. In practiced hands, and with awareness of the problems that may arise, many complications may be avoided and others successfully managed.
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Affiliation(s)
- S M Kavic
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Kimber CP, Khattak IU, Kiely EM, Spitz L. Peritonitis following percutaneous gastrostomy in children: management guidelines. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1998; 68:268-70. [PMID: 9572335 DOI: 10.1111/j.1445-2197.1998.tb02079.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To establish the incidence, timing and outcome of peritonitis following percutaneous gastrostomy (PEG) insertion in children. METHODS Patients developing peritonitis after PEG insertion during a 5-year period (1990-95) were identified. Variables analysed included clinical presentation, management, operative findings and outcome. RESULTS One hundred and twenty paediatric patients received 130 PEG in the 5-year period. Eight children developed peritonitis: 4 within 24 h of PEG insertion and 4 following routine PEG tube change (3-18 months later). All four patients developing early peritonitis underwent laparotomy in whom three had sustained major damage to adjacent viscera. The fourth patient had a negative laparotomy, but died from continued overwhelming sepsis. All four patients who developed peritonitis after a routine tube change underwent a tube contrast study. In two children a gastrocolic fistula was identified and surgically repaired. Contrast studies in two patients detected an intraperitoneal leak. This problem resolved with conservative management in both cases. CONCLUSIONS Peritonitis immediately following PEG insertion is rarely due to the air leakage during insertion (benign pneumoperitoneum) and warrants early laparotomy to identify and correct the likely associated visceral trauma. Following PEG tube change peritonitis may result from stomal separation or tube malposition and an urgent study is indicated to identify the cause.
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Affiliation(s)
- C P Kimber
- Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom
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18
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Lowe JB, Page CP, Schwesinger WH, Gaskill HV, Stauffer JS. Percutaneous endoscopic gastrostomy tube placement in a surgical training program. Am J Surg 1997; 174:624-7; discussion 627-8. [PMID: 9409586 DOI: 10.1016/s0002-9610(97)00177-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study examines the patterns of use of percutaneous endoscopic gastrostomy (PEG) and primary open gastrostomy (Gtube) performed in a residency training program in surgery. METHODS A retrospective cohort study that assesses the indications and outcomes of 317 PEGs and 75 isolated Gtubes used for gastric access between 1987 and 1997. RESULTS The demographics and risk factors of the patients receiving Gtube and PEG were comparable. The mean number of PEGs performed per resident is currently 13 per year (mean 5 over 10 years) with a 97% PEG success rate; an 88% success rate is demonstrated for placement of jejunal extensions. CONCLUSIONS PEGs are generally preferable to Gtubes as primary procedures. Surgical residents should become competent in PEG placement by performing adequate numbers of procedures with fully trained staff.
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Affiliation(s)
- J B Lowe
- Department of Surgery, University of Texas Health Science Center at San Antonio, 78284, USA
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19
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Abstract
During a 30-month period, 28 children aged 6 months-15 years underwent fashioning of a laparoscopic gastrostomy. Indications for operation included: feeding difficulties and failure to thrive in neurologically impaired children (13); chronic renal failure (9); and others (6). There were 17 conventional tube and 11 button gastrostomies. Twelve children had insertion of a gastrostomy alone; the others underwent a concomitant laparoscopic Nissen fundoplication (NFP). The average operation time for gastrostomy alone was 65 min (range 35-104) and for gastrostomy plus NFP 155 min (range 130-246). There were no specific laparoscopic complications. Two patients who required large volumes of eternal drugs and peritoneal dialysis from the 1st post-operative day developed minor external leaks from their stomas. It appears that laparoscopy provides for safe and precise positioning of any standard balloon or button gastrostomy. It is a particularly attractive technique for use in patients already undergoing a laparoscopic fundoplication and those in whom other minimally invasive techniques are contraindicated or fail.
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Affiliation(s)
- G M Humphrey
- Department of Paediatric Surgery, St. James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
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20
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Madan AK, Batra AK. Percutaneous endoscopic gastrostomy in the elderly: complications (review). JOURNAL OF NUTRITION FOR THE ELDERLY 1996; 15:39-49. [PMID: 8949018 DOI: 10.1300/j052v15n04_04] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Due to varying disease processes, the elderly may have limited oral access to their otherwise intact gastrointestinal tract. In such individuals, the intact gastrointestinal tract must be accessed in other ways. Until the early 1980s, choices were limited to temporary solutions such as the nasogastric tube or to long operative procedures such as the operative gastrostomy tube. The introduction of percutaneous endoscopic gastrostomy (PEG) allowed a quick, safe, and cheap procedure as an option. While PEG tubes have been used to help many of the elderly with their nutritional needs, they are not without risks. Below is a review of the literature concerning PEG complications in the elderly.
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21
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22
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Kealey WD, McCallion WA, Boston VE. Tension pneumoperitoneum: a potentially life-threatening complication of percutaneous endoscopic gastrojejunostomy. J Pediatr Gastroenterol Nutr 1996; 22:334-5. [PMID: 8708893 DOI: 10.1097/00005176-199604000-00021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- W D Kealey
- Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Northern Ireland
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23
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Kirby DF, Delegge MH, Fleming CR. American Gastroenterological Association technical review on tube feeding for enteral nutrition. Gastroenterology 1995; 108:1282-301. [PMID: 7698596 DOI: 10.1016/0016-5085(95)90231-7] [Citation(s) in RCA: 209] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- D F Kirby
- Division of Gastroenterology, Medical College of Virginia, Richmond
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24
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25
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Kadakia SC, Cassaday M, Shaffer RT. Comparison of Foley catheter as a replacement gastrostomy tube with commercial replacement gastrostomy tube: a prospective randomized trial. Gastrointest Endosc 1994; 40:188-93. [PMID: 8013820 DOI: 10.1016/s0016-5107(94)70165-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Percutaneous endoscopic gastrostomy (PEG) provides a non-surgical alternative to long-term enteral feeding. The gastrostomy tube, however, may deteriorate, malfunction, or be accidentally expelled, requiring replacement. A commercial gastrostomy tube is commonly used for replacement. However, a commercial replacement gastrostomy tube is many times more expensive than a Foley catheter, and the two have never been compared. We compared the efficacy and safety of an all-silicone Foley catheter used as a replacement feeding gastrostomy tube with the effectiveness of a commercial replacement gastrostomy tube in 46 patients undergoing long-term enteral feedings per gastrostomy. Twenty-four patients were randomized to the Foley group and 22 patients to the commercial replacement gastrostomy tube group. The Foley catheter functioned well without need for replacement in 16 (66%) patients for 27.4 +/- 14.8 (mean +/- SD) weeks; the commercial replacement gastrostomy tube functioned in 13 (59%) patients for 24.5 +/- 13.6 weeks (p > 0.05, NS). The Foley catheter needed to be replaced because of malfunction in 8 (34%) patients and the commercial replacement gastrostomy tube in 9 (41%) patients after 21.6 +/- 11.5 weeks and 19.3 +/- 9.3 weeks, respectively (p > 0.05, NS). Neither the Foley catheter nor the commercial replacement gastrostomy tube migrated; this was the most striking finding, in contrast to case reports in the literature. Our data suggest that the Foley catheter can be safely used as a replacement gastrostomy tube; it is considerably cheaper than the commercial replacement gastrostomy tube, and its efficacy and complication rates are similar to those of the commercial replacement gastrostomy tube.
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Affiliation(s)
- S C Kadakia
- Gastroenterology Service, Brooke Army Medical Center, San Antonio, Texas 78234-6200
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26
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Abstract
Percutaneous endoscopic gastrostomy (PEG) by the "pull" technique is the standard method in pediatric patients. Modifications have been reported for adults but few in children. Problems with the "pull" technique including pericatheter infection due to contamination of the tube tract with oral flora, repeated insertion of the endoscope, potential esophageal injury from the catheter, and the possible need for another endoscopy for catheter removal, prompted our interest in a simpler technique. The "push" technique requires insertion of the endoscope only once to insufflate and visualize the insertion site. A modified Seldinger technique is used to insert a 14F acrylic Foley catheter. We have used this technique to place PEG tubes in 8 children age 6 weeks to 17 years (mean, 6 years), for failure to thrive due to cystic fibrosis (3), neurological impairment (4), and undetermined cause (1). Operative time averaged 15 minutes. All PEGs were used within 24 hours. This "push" technique of PEG insertion is safe, simple, quick, and obviates many of the potential risks inherent in the "pull" technique. The "push" technique deserves a more widespread application in children.
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Affiliation(s)
- T M Crombleholme
- Division of Pediatric Surgery, Tufts University School of Medicine, Boston, MA
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27
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Grant JP. Percutaneous endoscopic gastrostomy. Initial placement by single endoscopic technique and long-term follow-up. Ann Surg 1993; 217:168-74. [PMID: 8439214 PMCID: PMC1242756 DOI: 10.1097/00000658-199302000-00011] [Citation(s) in RCA: 147] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Of 598 patients, 595 underwent placement of a percutaneous endoscopic gastrostomy (PEG) tube using a single endoscopy technique and a polyurethane gastrostomy tube. Primary indications were altered mental status and dysphagia. All procedures were performed in the operating room, with 74 patients receiving general anesthesia and 524 intravenous sedatives with or without topical anesthesia. Average operating room time was 34 minutes. Of 208 patients with prior intra-abdominal surgery, 207 underwent successful placement. The overall complication rate was 4.9%, with a major complication rate of 1.3%. One death occurred from presumed leakage at the gastrostomy site with peritonitis. One hundred twenty patients subsequently died of causes unrelated to the gastrostomy tube after 75 +/- 164 days (range, 1 to 972). One hundred fifty-four patients recovered an adequate oral diet and had the PEG removed after 169 +/- 244 days (range, 6 to 1337). The remaining 319 patients continued to use their gastrostomy tube for 1532 +/- 411 days (range, 134 to 2251). The polyurethane gastrostomy tube has been very durable; none has required replacement because of deterioration.
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Affiliation(s)
- J P Grant
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710
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28
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Abstract
Contrary to total parenteral nutrition with its relatively recent introduction into modern clinical medicine, enteral nutrition has a long and colorful history. Prior to development of fiberoptic endoscopy, physicians attempting to feed patients who could not or would not eat were limited to the blind placement of intestinal tubes or radiologically assisted placement of these devices. Previous to these modern attempts, the use of nutrient enemas was attempted for which there was evidence of occasional success. With the introduction of fiberoptic flexible endoscopy, guidance of tubes into the upper intestinal tract under direct vision became feasible. The manner in which tubes were positioned, advanced, or manipulated are myriad and attest to the ingenuity of clinicians. A revolution in endoscopic intervention occurred with the introduction of the percutaneous endoscopic gastrostomy in 1980. This provided secure access to the stomach without a laparotomy. This technique was also modified to allow decompression of the stomach with feeding distally into the small intestine and also direct puncture and placement of tubes into the small intestine. The most recent advance in enteral nutrition is taking place at the present time with the introduction of laparoscopic techniques in the creation of gastrostomies and jejunostomies.
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Affiliation(s)
- T A Stellato
- Department of Surgery, Case Western Reserve University, Cleveland, Ohio
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29
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Wicks C, Gimson A, Vlavianos P, Lombard M, Panos M, Macmathuna P, Tudor M, Andrews K, Westaby D. Assessment of the percutaneous endoscopic gastrostomy feeding tube as part of an integrated approach to enteral feeding. Gut 1992; 33:613-6. [PMID: 1612476 PMCID: PMC1379288 DOI: 10.1136/gut.33.5.613] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The insertion of percutaneous endoscopic gastrostomy has been well documented. The possible benefits for patient nutrition and nursing practice have, however, not been assessed. We report a study of enteral feeding by percutaneous endoscopic gastrostomy in 30 patients, the majority with a persistent vegetative state. All patients had previously been fed through a nasogastric tube using manual administration and a dietitian assessed protein calorie intake. Based upon body mass index (weight/height2), midarm circumference and triceps skinfold thickness, 20 (67%) were malnourished, with 10 patients having a body mass index less than 17 (severe malnutrition); attributed to high rates of both tube displacement and feed regurgitation. Patients were observed over six to 12 months after percutaneous endoscopic gastrostomy insertion combined with overnight continuous pump feeding. All patients attained a body mass index greater than 17, and 17 (56%) of the total number achieved the normal range with no change in protein-calorie intake (pre: 2110 kcal, post: 1880 kcal). Complications of percutaneous endoscopic gastrostomy in the study group included peritonitis (one), tube site infection (two) and displacement (two); all without serious sequelae. As part of an integrated approach percutaneous endoscopic gastrostomy proved a safe and efficient method of enteral feeding and justifies wider consideration in the United Kingdom.
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Affiliation(s)
- C Wicks
- Institute of Liver Studies, King's College Hospital, London
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30
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Pidala MJ, Slezak FA, Porter JA. Pneumoperitoneum following percutaneous endoscopic gastrostomy. Does the timing of panendoscopy matter? Surg Endosc 1992; 6:128-9. [PMID: 1502680 DOI: 10.1007/bf02309084] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Percutaneous endoscopic gastrostomy (PEG) has had a significant impact on enteral alimentation in patients unable to maintain adequate oral caloric intake. PEG avoids the morbidity and mortality associated with the traditional feeding gastrostomies placed by celiotomy. Several authors have documented benign, self-limiting pneumoperitoneum following PEG placement. No study has addressed whether the timing of panendoscopy in relation to gastric puncture has an effect on the incidence of post-PEG pneumoperitoneum. The authors prospectively studied 30 patients undergoing PEG. Panendoscopy was either performed before or after gastric puncture, and each patient then had abdominal radiographs to determine the presence of pneumoperitoneum. Four of 16 patients (25%) having panendoscopy prior to gastric puncture had radiographic evidence of pneumoperitoneum compared to three of 14 patients (23%) having panendoscopy following gastric puncture. The authors conclude that the timing of panendoscopy in relation to gastric puncture does not significantly effect the incidence of post-PEG pneumoperitoneum.
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Affiliation(s)
- M J Pidala
- Department of Surgery, Akron City Hospital, OH 44309
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31
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Abstract
Percutaneous endoscopic gastrostomy (PEG) is clearly better than operative gastrostomy performed under general anesthesia. Whether or not PEG offers any significant advantage over operative gastrostomy performed using local anesthesia remains to be proved. Operative gastrotomy performed with local anesthesia seems comparable to nonoperative techniques.
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Affiliation(s)
- D A Rogers
- Department of Surgery, Medical College of Georgia, Augusta
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32
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Affiliation(s)
- L Bushnell
- University of Utah School of Medicine, Department of Surgery, Salt Lake City 84132
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33
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Murphy S, Pulliam TJ, Lindsay J. Delayed gastrocolic fistula following percutaneous endoscopic gastrostomy (PEG). J Am Geriatr Soc 1991; 39:532-3. [PMID: 2022806 DOI: 10.1111/j.1532-5415.1991.tb02503.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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34
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35
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Stiegmann GV, Goff JS, Silas D, Pearlman N, Sun J, Norton L. Endoscopic versus operative gastrostomy: final results of a prospective randomized trial. Gastrointest Endosc 1990; 36:1-5. [PMID: 2107116 DOI: 10.1016/s0016-5107(90)70911-x] [Citation(s) in RCA: 170] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study compared operative gastrostomy (OG) (by surgeons) with endoscopic gastrostomy (PEG) (by physicians) in a prospective randomized fashion to determine whether one technique was superior. PEG (Sachs-Vine) and OG (Stamm) were done using local anesthesia. Patients were assessed for complications, mortality, tube function, and cost. Groups were equally matched for indications and underlying disease. Fifty-seven had OG and 64 had attempted PEG. Complications occurred in 26% of OG patients and 9% died. Complications occurred in 25% of PEG patients and 12% died. Tube feeding was initiated in both groups within a mean of 29 (24 to 72) hours of the gastrostomy placement. OG cost $1675 and PEG $979 to perform. Twenty-one PEG patients required endoscopic tube change which raised their total cost to $1574. We conclude there is no difference between OG (using local anesthesia) and PEG with regard to morbidity, mortality, or tube function. The endoscopic technique does appear to have economic advantage.
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Affiliation(s)
- G V Stiegmann
- Department of Surgery (Gastrointestinal/Tumor), University of Colorado, Denver
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36
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Abstract
This is a report of a patient who developed a previously undescribed gastrostomy tube complication, namely, fatal aortogastric fistula.
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Affiliation(s)
- R Ware
- Department of Pediatrics, Duke University Medical Center, Durham, NC
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37
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Abstract
Percutaneous endoscopic gastrotomy tubes have been inserted in 50 patients with no mortality and minimal morbidity. The principal indications for their insertion were an inability to swallow (39 patients), a need for nutritional support (eight patients) and venting (three patients). The most common complication was peristomal wound infection (14 patients), the incidence of which was reduced significantly by the use of single-dose prophylactic antibiotic therapy. Percutaneous gastrostomies provide adequate nutrition with minimal morbidity in an acceptable way to both patients and those who care for them.
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38
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Fernandes ET, Hollabaugh R, Hixon SD, Whitington G. Late presentation of gastrocolic fistula after percutaneous gastrostomy. Gastrointest Endosc 1988; 34:368-9. [PMID: 3410257 DOI: 10.1016/s0016-5107(88)71385-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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39
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Deschner K, Fleischer D, Cattau E. The clinical significance of a prominent falciform ligament in the setting of a pneumoperitoneum (the air-line sign). Gastrointest Endosc 1988; 34:290-2. [PMID: 3391396 DOI: 10.1016/s0016-5107(88)71346-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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40
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41
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Abstract
A modified Gauderer-Ponsky technique of percutaneous endoscopic gastrostomy has been described. The major advantage is elimination of a second insertion of the endoscope, as well as unnecessary traversing of the esophagus by snares and strings. The result achieved is equal to what has been achieved with the original technique, but the single-pass technique is more expeditious and less uncomfortable for the patient. In addition, it can easily be modified to insert both draining gastrostomy and feeding jejunostomy tubes at the same time, using only one pass of the endoscope.
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Affiliation(s)
- R S Chung
- Department of Surgery, Syracuse Veterans Administration Medical Center, New York
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42
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Fischer LS, Bonello JC, Greenberg E. Gastrostomy tube migration and gastric outlet obstruction following percutaneous endoscopic gastrostomy. Gastrointest Endosc 1987; 33:381-2. [PMID: 3315831 DOI: 10.1016/s0016-5107(87)71646-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- L S Fischer
- Department of Medicine, University of Illinois College of Medicine at Urbana-Champaign
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43
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Paul A, Vestweber KH, Bode C, Eypasch E. Percutaneous endoscopic duodenostomy (PED). Case report. Surg Endosc 1987; 1:123-6. [PMID: 2459790 DOI: 10.1007/bf00312700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Surgeons are increasingly using endoscopy to place transabdominal feeding tubes for enteral nutrition or gastric decompression. A possible extension for the application of this new technique is the direct placement of the feeding tube into the duodenal bulb. Two patients are presented in whom percutaneous endoscopic duodenostomy was successfully performed, although percutaneous endoscopic gastrostomy was not possible. It shows that this new method is technically possible. In both patients the positive influence of this technique on the patient's quality of life could be shown using the Spitzer Quality of Life Index and the Karnofsky Performance Status. Enteral nutrition was maintained for more than 6 weeks.
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Affiliation(s)
- A Paul
- Chirurgischer Lehrstuhl der Universität zu Köln, Federal Republic of Germany
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44
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Schnall HA, Falkenstein DB, Raicht RF. Persistent pneumoperitoneum after percutaneous endoscopic gastrostomy. Gastrointest Endosc 1987; 33:248-50. [PMID: 3109994 DOI: 10.1016/s0016-5107(87)71573-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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45
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Podrasky P, Rudzinski HM. Percutaneous endoscopic gastrostomy. An alternative to laparotomy. AORN J 1987; 45:1403-11. [PMID: 3109318 DOI: 10.1016/s0001-2092(07)70319-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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46
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Vestrup JA. Nutrition in the surgical patient. Can J Anaesth 1987; 34 Suppl 1:S16-20. [PMID: 20640732 DOI: 10.1007/bf03009892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- J A Vestrup
- Department of Surgery, University of British Columbia, Intensive Care Unit, Vancouver General Hospital, 855 West 12th Avenue, V5Z 4E3, Vancouver, British Columbia
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47
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Abstract
A retrospective review of 78 patients who had undergone endoscopic gastrostomy and 22 patients who had undergone Stamm gastrostomy was carried out. The mean operative time for the Stamm gastrostomy group was 63 min, while that for the endoscopic gastrostomy group was 26 min. One operative complication--bleeding--requiring reoperation occurred in the Stamm gastrostomy group. The incidences of aspiration, pneumonia, wound infection, and mortality were significantly higher in the Stamm gastrostomy group. We conclude that percutaneous endoscopic gastrostomy is the preferred technique for long-term enteral nutrition.
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Affiliation(s)
- H S Himal
- Department of Surgery, Toronto Western Hospital, Ontario, Canada
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48
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Nah YH, Chae SI, Song JH, Choi IT, Kim HJ, Park S, Cho WS. Percutaneous endoscopic gastrostomy for enteral nutrition. Korean J Intern Med 1987; 2:66-73. [PMID: 3155323 PMCID: PMC4534918 DOI: 10.3904/kjim.1987.2.1.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
From January to October, 1986, at Wonkwang University Hospital in Iri, percutaneous endoscopic gastrostomy(PEG) was attempted in 26 patients and was successful in 24. This study was designed to review the technique and to evaluate the efficacy of PEG. The mean operation time was 22 minutes (range: 14 to 42 minutes). After feeding started, early positive nitrogen balance was achieved in all patients. All gastrostomies functioned well throughout the patient’s survival with the longest functioning at 10 month. There were no procedure-related deaths, and morbidity was lower and less severe as compared with large-bore nasogastric tube feeding. Complications included minor wound infection in two patients, stomal growth in one patient, leaks around the tube in two patients, and intraperitoneal leak in one patient. No patient developed aspiration pneumonia or required laparotomy for complications from PEG. The gastrostomy tube was easily removed endoscopically when treatment was completed. Feeding via a large-bore tube increased the risk of aspiration pneumonia (72%) and the feeding cost via a small-bore tube with elemental diet exceeded that of PEG by more than tenfold. This author’s experience with these 26 patients has led to the conclusion that PEG is safe, easy to perform, and effective means of creating feeding gastrostomy without laparotomy or general anesthesia. The authors suggest that PEG be the preferred route of alimentation in those patients who are unable to swallow for prolonged periods of time.
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49
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Abstract
Operative gastrostomy (OG) for gastrointestinal decompression or feeding has stood the test of time. Nevertheless, this procedure is often associated with significant morbidity and occasional mortality. Furthermore, although it is often performed under local anesthesia, general anesthesia is frequently necessary. A recent alternative to OG is percutaneous endoscopic gastrostomy (PEG). The purpose of this study is to describe our experience with 100 consecutive PEGs in 98 patients. There were no complications, and no patient died as a result of PEG. Furthermore, PEG never required general anesthesia and was rapid and less costly than OG. Since PEG is so simple to perform, it may be employed earlier in the patient's course, thus avoiding nasogastric feedings or parenteral alimentation. PEG is the procedure of choice should gastrostomy be needed.
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50
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Gauderer MW, Stellato TA. Gastrostomies: evolution, techniques, indications, and complications. Curr Probl Surg 1986; 23:657-719. [PMID: 3095034 DOI: 10.1016/0011-3840(86)90020-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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