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Lee Y. Pediatric Percutaneous Endoscopic Gastrostomy in Korea - When? By Whom? How? J Korean Med Sci 2022; 37:e313. [PMID: 36254533 PMCID: PMC9577354 DOI: 10.3346/jkms.2022.37.e313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Yoon Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
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2
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Ponsky JL. Percutaneous endoscopic gastrostomy: after 40 years. Gastrointest Endosc 2021; 93:1086-1087. [PMID: 33685624 DOI: 10.1016/j.gie.2020.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/19/2020] [Indexed: 02/08/2023]
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3
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Farag S, Georgy SS, Fathy M, elSadek A, Abdulghani KO. Attitude and experience of neurologists towards percutaneous endoscopic gastrostomy: an Egyptian study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Dysphagia is a common symptom among various neurological diseases. Guidelines recommend gastrostomy insertion for prolonged dysphagia with lower rate of intervention failure encountered with percutaneous endoscopic gastrostomy (PEG) as compared to nasogastric tube insertion.
Methods
Neurology consultants only were included and completed a self-administered questionnaire concerning their practice backgrounds and previous experience with PEG feeding during their practice.
Results
Ninety-eight percent stated that they would recommend PEG for patients with prolonged need of nasogastric feeding. However, only 88% actually referred patients to perform PEG, with the cerebrovascular disorders being the most common cases to be referred. The main barriers the surveyed neurologists faced were family resistance and financial reasons (53.5%). Interestingly, younger neurologists practicing for less than 15 years referred patient to perform PEG significantly more frequent than older ones (p = 0.01). About 18% of our sample confirmed the lack of sufficient knowledge about the benefits of PEG feeding, and only 22% previously attended scientific sessions about the benefits and indications of PEG.
Conclusion
Based on our study, we recommend that PEG should be more encouraged in indicated neurological cases. Scientific sessions targeting neurologists and public awareness about the benefits of PEG and its relatively infrequent complications are highly demanded.
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Partovi S, Li X, Moon E, Thompson D. Image guided percutaneous gastrostomy catheter placement: How we do it safely and efficiently. World J Gastroenterol 2020; 26:383-392. [PMID: 32063687 PMCID: PMC7002903 DOI: 10.3748/wjg.v26.i4.383] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 02/06/2023] Open
Abstract
Gastrostomy tube is an effective and safe long-term feeding access that is well-tolerated by patients. The typical placement routes include surgical, endoscopic and interventional radiologic placement. In particular, percutaneous interventional radiologic gastrostomy (PIRG) has increasingly become the preferred method of choice in many practices. Although many PIRG techniques have been developed since the 1980s, there is still a paucity of evidence supporting the choice of a most-optimal PIRG technique. Hence, there is a large variation in institutional approach to PIRG. We are a large, quaternary academic institution with an extensive experience in PIRG. Therefore, we aim to present the “push” PIRG technique utilized in our institution, to review the current literature, to discuss the optimal choice of PIRG technique and to generate further interests in comparison studies.
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Affiliation(s)
- Sasan Partovi
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Xin Li
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Eunice Moon
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Dustin Thompson
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
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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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Oliveira GPD, Santos CA, Fonseca J. The role of surgical gastrostomy in the age of endoscopic gastrostomy: a 13 years and 543 patients retrospective study. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2016; 108:776-779. [PMID: 27822950 DOI: 10.17235/reed.2016.4060/2015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) became the gold standard for enteral feeding. Currently, surgical gastrostomy is seldom used. OBJECTIVE Evaluating the role of surgical gastrostomy in a center with a large experience in PEG. METHODS A retrospective study ranged 13 years, collecting from clinical records: age, gender, underlying disease, date of procedure, technique, primary surgery, complications, 30-day mortality. Patients were divided according to indication for gastrostomy: a) neurological; b) head and neck cancer; c) other diseases; and d) drainage. PEG, open surgical and laparoscopic gastrostomies were compared concerning evolution of the number of procedures, characteristics of patients, complications and mortality. RESULTS We identified 509 PEG, 26 open and 8 laparoscopic surgical gastrostomies. An increasing number of the percutaneous approach over the years was observed, while the number of surgical gastrostomies remains steady (mean: 2.6/year). All percutaneous endoscopic gastrostomies but three were feeding procedures, mostly in neurological patients. All laparoscopic gastrostomies were feeding procedures in head and neck cancer. Most open surgical gastrostomies were secondary procedures, part of more complex surgeries, and frequently for drainage purposes. The open surgical approach displayed more morbidity and mortality, reflecting the severity of underlying diseases. CONCLUSIONS In our institution, open surgical gastrostomy is seldom used, and mostly as part of complex procedures, frequently for drainage purposes. PEG is the choice to most dysphagic patients needing an enteral feeding access. When not feasible, laparoscopic gastrostomy is a suitable alternative.
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Affiliation(s)
| | | | - Jorge Fonseca
- Gastroenterology Department, Hospital Garcia de Orta
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7
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Sarkar P, Cole A, Scolding NJ, Rice CM. Percutaneous Endoscopic Gastrostomy Tube Insertion in Neurodegenerative Disease: A Retrospective Study and Literature Review. Clin Endosc 2016; 50:270-278. [PMID: 27737522 PMCID: PMC5475517 DOI: 10.5946/ce.2016.106] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/16/2016] [Accepted: 09/09/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS With the notable exceptions of dementia, stroke, and motor neuron disease, relatively little is known about the safety and utility of percutaneous endoscopic gastrostomy (PEG) tube insertion in patients with neurodegenerative disease. We aimed to determine the safety and utility of PEG feeding in the context of neurodegenerative disease and to complete a literature review in order to identify whether particular factors need to be considered to improve safety and outcome. METHODS A retrospective case note review of patients referred for PEG insertion by neurologists in a single neuroscience center was conducted according to a pre-determined set of standards. For the literature review, we identified references from searches of PubMed, mainly with the search items "percutaneous endoscopic gastrostomy" and "neurology" or "neurodegenerative disease." RESULTS Short-term mortality and morbidity associated with PEG in patients with neurological disease were significant. Age greater than 75 years was associated with poor outcome, and a trend toward adverse outcome was observed in patients with low serum albumin. CONCLUSIONS This study highlights the relatively high risk of PEG in patients with neurodegenerative disease. We present points for consideration to improve outcome in this particularly vulnerable group of patients.
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Affiliation(s)
- Pamela Sarkar
- Department of Neurology, Southmead Hospital, Bristol, UK.,Clinical Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Alice Cole
- Clinical Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Neil J Scolding
- Department of Neurology, Southmead Hospital, Bristol, UK.,Clinical Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Claire M Rice
- Department of Neurology, Southmead Hospital, Bristol, UK.,Clinical Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, UK
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8
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Garland M, Miller P, Hildreth A, Hale AL, Kaiser ML. The Utility of Abdominal CT for Preoperative Planning of Percutaneous Endoscopic Gastrostomy Tube Placement. Am Surg 2016. [DOI: 10.1177/000313481608200902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mary Garland
- Wake Forest Baptist Health Center Winston-Salem, North Carolina
| | - Preston Miller
- Wake Forest Baptist Health Center Winston-Salem, North Carolina
| | - Amy Hildreth
- Wake Forest Baptist Health Center Winston-Salem, North Carolina
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Abstract
Percutaneous translumbar duodenostomy for enteral feeding was performed in one patient with nutritional difficulties. No complication was encountered. The procedure can be an alternative to percutaneous gastrostomy and jejunostomy for enteral feeding in special situations.
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10
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Lindberg CG, Ivancev K, Kan Z, Lindberg R. Percutaneousc Gastrostomy. Acta Radiol 2016. [DOI: 10.1177/028418519103200407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fluoroscopic percutaneous gastrostomy for the purpose of nutrition was performed in 28 patients with the aid of a specially designed gastrostomy set. No major complications were reported. Exchange to Foley catheter was performed after 7 days and could be used without complications for the patients' remaining life span. In order to evaluate the formation of a gastrocutaneous tract, an experimental study with the same instruments as in clinical practice was performed in 13 rabbits. Within one week a gastrocutaneous tract was formed, which was possible to dilate for insertion of a balloon catheter of larger size. The described procedure is a simple and time-saving method for a percutaneous gastrostomy in debilitated patients with dysphagia.
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Mittal R, Young M, Tan CS, Chen C, Tham WY, Seong LPS, Tan TL, Koh GCH. Trends of Patients’ Characteristics Admitted Into a Multi-Professional Home Medical Care Service From 2000 to 2009 in Singapore. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2016. [DOI: 10.1177/1084822316662196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The main aim of this study is to present the socio-demographic, clinical, and functional characteristics of home medical care patients admitted into one of the oldest home care service over a 10-year period. Data were manually retrospectively extracted from the non-computerized medical records of all patients admitted into Code 4 Home Medical Service from January 1, 2000, to December 31, 2009. Records of 1,069 patients were examined. Over the 10-year period, there was an increasing proportion of patients older than 70 years ( B [95% CI], 1.08 [0.43, 1.73]) and dependency on foreign domestic workers as primary caregivers ( B [95% CI], 4.65 [3.71, 5.58]). Cognitive impairment and functional dependency of the patients increased over the years, as assessed using Abbreviated Mental Test score < 7 ( B [95% CI], 1.73 [0.71-2.76]) and Barthel Index = 0 ( B [95% CI], 4.32 [2.74-5.91]). Knowledge about these trends may be helpful to project future demands for home medical care in Singapore.
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Affiliation(s)
- Rakhi Mittal
- National University of Singapore, Singapore
- National University Health System, Singapore
| | | | - C. S. Tan
- National University of Singapore, Singapore
- National University Health System, Singapore
| | - C. Chen
- National University of Singapore, Singapore
- National University Health System, Singapore
| | | | - Lydia P. S. Seong
- Adjunct Associate Professor, Saw Swee Hock School of Public Health, Singapore
| | | | - G. Choon-Huat Koh
- National University of Singapore, Singapore
- National University Health System, Singapore
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Kawashima K, Adachi K, Onishi K, Fukuda K, Kazumori H, Ohno Y, Katoh T, Sonoyama H, Tada Y, Kusunoki R, Oka A, Fukuba N, Oshima N, Yuki T, Ishihara S, Kinoshita Y. Usefulness of computed tomography with air insufflation of the stomach prior to percutaneous endoscopic gastrostomy procedure. J Clin Biochem Nutr 2016; 58:246-250. [PMID: 27257351 PMCID: PMC4865598 DOI: 10.3164/jcbn.15-145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/05/2016] [Indexed: 12/11/2022] Open
Abstract
We examined the results of computed tomography (CT) with and without air insufflation of the stomach prior to performing percutaneous endoscopic gastrostomy (PEG). We retrospectively analyzed 366 patients who underwent PEG. CT images obtained with and without air insufflation were examined for the presence or absence of contact between the gastric anterior wall and abdominal wall. PEG outcome based on CT findings was also examined. CT with and without air insufflation was performed in 272 and 94 patients, respectively. Contact between the gastric anterior wall and abdominal wall was shown in 254 (93.4%) with and 45 (47.9%) without air insufflation, all of whom underwent a successful PEG procedure. In patients without contact between the gastric anterior wall and abdominal wall, PEG was not successful in 3 of 49 (6.1%) examined by CT without and 6 of 18 (33.3%) examined with air insufflation (p = 0.004). Values for diagnostic accuracy for contact between the gastric anterior wall and abdominal wall shown by CT with and without air insufflation in successful PEG cases were 0.96 and 0.51, respectively. In conclusion, CT with air insufflation more often revealed contact between the gastric anterior wall and abdominal wall as compared to CT without air insufflation, which may help to predict PEG procedure success.
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Affiliation(s)
- Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
- Department of Internal Medicine, Matsue Seikyo General Hospital, Matsue, Shimane 690-8522, Japan
| | - Kyoichi Adachi
- Health Center, Shimane Environment and Health Public Corporation, Matsue, Shimane 690-0012, Japan
| | - Koji Onishi
- Department of Internal Medicine, Matsue Seikyo General Hospital, Matsue, Shimane 690-8522, Japan
| | - Kosuke Fukuda
- Department of Internal Medicine, Matsue Seikyo General Hospital, Matsue, Shimane 690-8522, Japan
| | - Hideaki Kazumori
- Department of Internal Medicine, Matsue Seikyo General Hospital, Matsue, Shimane 690-8522, Japan
| | - Yasuhiko Ohno
- Department of Internal Medicine, Matsue Seikyo General Hospital, Matsue, Shimane 690-8522, Japan
| | - Takao Katoh
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Yasumasa Tada
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Ryusaku Kusunoki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Nobuhiko Fukuba
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Takafumi Yuki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
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Lin LF. Transnasal versus conventional peroral insertion of percutaneous endoscopic gastrostomy using pull method. ADVANCES IN DIGESTIVE MEDICINE 2015. [DOI: 10.1016/j.aidm.2014.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Oppong P, Pitts N, Chudleigh V, Latchford A, Roy A, Rocket M, Lewis S. Pain and Anxiety Experienced by Patients Following Placement of a Percutaneous Endoscopic Gastrostomy. JPEN J Parenter Enteral Nutr 2014; 39:823-7. [DOI: 10.1177/0148607114551798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 08/12/2014] [Indexed: 01/12/2023]
Affiliation(s)
- Philip Oppong
- Department of Gastroenterology, Derriford Hospital, Plymouth, UK
| | - Narrie Pitts
- Department of Gastroenterology, Derriford Hospital, Plymouth, UK
| | | | | | - Amy Roy
- Department of Oncology, Derriford Hospital, Plymouth, UK
| | - Mark Rocket
- Department of Anaesthesia, Derriford Hospital, Plymouth, UK
| | - Stephen Lewis
- Department of Gastroenterology, Derriford Hospital, Plymouth, UK
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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: 259] [Impact Index Per Article: 23.5] [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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Tang SJ, Wu R. Percutaneous Endoscopic Gastrostomy (pull method) and Jejunal Extension Tube Placement. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.vjgien.2013.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Abstract
AIM The present prospective observational study investigates the safety of transnasal percutaneous endoscopic gastrostomy (T-PEG) carried out by a single physician using an ultrathin endoscope. METHODS A single endoscopist attempted the unsedated transnasal insertion of a 20-Fr PEG tube using a pull-method in 31 dysphagic patients: 11 females and 20 males aged 76.5±10.6(46-96)years, using a 5-mm-diameter endoscope. The indications for PEG, cardiopulmonary function before and after T-PEG, operation time, success or failure, and any immediate adverse events that occurred during each procedure were recorded. Complications, including peristomal infection, systemic infection, tube lifespan, and patient mortality were monitored throughout the post-T-PEG follow-up period. RESULTS Thirty (96.8%) of the transnasal PEG insertions were successful. The mean operation time was 14.7±2.9 (10-20) min, and cardiopulmonary function did not change before and after T-PEG. Complications included three (10%) cases of epistaxis, eight (26.6%) cases of minor Pseudomonas wound infection and two cases of Foley-related urinary tract infection (UTI). No self-extubation was observed, and the mean lifespan of the PEG tubes was 10.7±2.2months. Four patients died from pneumonia 10months after T-PEG insertion. CONCLUSION Unsedated T-PEG insertion carried out by a single physician is a feasible and safe procedure. No major complications or mortality were observed following the procedures; only minor Pseudomonas aeruginosa wound infections were noted. It is an alternative method for dysphagic patients when transoral insertion of endoscopy is impossible.
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Affiliation(s)
- Lian-Feng Lin
- Division of Gastroenterology, Department of Internal Medicine, Pingtung Christian Hospital, Taiwan.
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18
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Lohsiriwat V. Percutaneous endoscopic gastrostomy tube replacement: A simple procedure? World J Gastrointest Endosc 2013; 5:14-8. [PMID: 23330049 PMCID: PMC3547115 DOI: 10.4253/wjge.v5.i1.14] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 09/04/2012] [Accepted: 12/01/2012] [Indexed: 02/05/2023] Open
Abstract
Replacement of gastrostomy tube in patients undergoing percutaneous endoscopic gastrostomy (PEG) is generally considered as a safe and simple procedure. However, it could be associated with serious complications, such as gastrocutaneous tract disruption and intraperitoneal tube placement, which may lead to chemical peritonitis and even death. When PEG tube needs a replacement (e.g., occlusion or breakage of the tube), clinicians must realize that the gastrocutaneous tract of PEG is more friable than that of surgical gastrostomy because there is no suture fixation between gastric wall and abdominal wall in PEG. In general, the tract of PEG begins to mature in 1-2 wk after placement and it is well formed in 4-6 wk. However, this process could take a longer period of time in some patients. Accordingly, this article describes three major principles of a safe PEG tube replacement: (1) good control of the replacement tube along the well-formed gastrocutaneous tract; (2) minimal insertion force during the replacement, and, most importantly; and (3) reliable methods for the confirmation of intragastric tube insertion. In addition, the management of patients with suspected intraperitoneal tube placement (e.g., patients having abdominal pain or signs of peritonitis immediately after PEG tube replacement or shortly after tube feeding was resumed) is discussed. If prompt investigation confirms the intraperitoneal tube placement, surgical intervention is usually required. This article also highlights the fact that each institute should have an optimal protocol for PEG tube replacement to prevent, or to minimize, such serious complications. Meanwhile, clinicians should be aware of these potential complications, particularly if there are any difficulties during the gastrostomy tube replacement.
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Affiliation(s)
- Varut Lohsiriwat
- Varut Lohsiriwat, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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19
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Teriaky A, Gregor J, Chande N. Percutaneous endoscopic gastrostomy tube placement for end-stage palliation of malignant gastrointestinal obstructions. Saudi J Gastroenterol 2012; 18:95-8. [PMID: 22421713 PMCID: PMC3326983 DOI: 10.4103/1319-3767.93808] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND/AIM Decompression of malignant gastrointestinal obstructions is an uncommon indication for percutaneous endoscopic gastrostomy (PEG) tubes. The purpose of this study is to determine the efficacy of venting PEG tubes in relieving nausea and vomiting and assessing complications associated with tube placement. PATIENTS AND METHODS This study is a retrospective chart review of patients with PEG tubes placed to decompress malignant gastrointestinal obstructions between January 2005 and September 2010 by the gastroenterology service at our institute. Patient demographics, symptom relief, procedural complications, diet tolerability and home palliation were reviewed. RESULTS Seven PEG tubes were inserted to decompress malignant gastrointestinal obstructions. The mean patient age was 62 years (range 37-82 years). The underlying primary malignancies were small intestine (1), appendiceal (1), pancreatic (2), and colon (3) cancer. Gastric outlet obstruction was present in 3 (43%) patients while small bowel obstruction occurred in 4 (57%) patients. There was relief of nausea and vomiting in 6 (86%) patients. Procedural complications were present in 1 (14%) patient and involved superficial cellulitis followed by peristomal leakage. Patients with gastric outlet obstruction continued to have limited oral intake while patients with small bowel obstruction tolerated varying degrees of oral nutrition. Six (86%) patients were discharged home after PEG tube placement, but only 2 (33%) were able to undergo end-stage palliation at home without re-admission for hospital palliation. CONCLUSIONS Venting PEG tubes significantly reduce the symptoms of nausea and vomiting in patients with metastatic gastrointestinal obstruction due to primary gastrointestinal malignancies. Complications associated with tube placement were minimal.
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Affiliation(s)
- Anouar Teriaky
- Division of Gastroenterology, Department of Medicine, The University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada.
| | - Jamie Gregor
- Division of Gastroenterology, Department of Medicine, The University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada
| | - Nilesh Chande
- Division of Gastroenterology, Department of Medicine, The University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada
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Kulvatunyou N, Joseph B, Tang A, O'Keeffe T, Wynne JL, Friese RS, Latifi R, Rhee P. Gut access in critically ill and injured patients: Where have we gone thus far? Eur Surg 2011. [DOI: 10.1007/s10353-011-0590-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Al-Zubeidi D, Rahhal RM. Safety techniques for percutaneous endoscopic gastrostomy tube placement in Pierre Robin Sequence. JPEN J Parenter Enteral Nutr 2011; 35:343-5. [PMID: 21282476 DOI: 10.1177/0148607110381268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Pierre Robin Sequence (PRS) is a craniofacial anomaly characterized by a triad of micrognathia, glossoptosis, and cleft palate. Infants with PRS frequently have feeding problems that may require supplemental nutrition through a nasogastric or gastrostomy tube. Very few published studies have illustrated the most appropriate method for securing an enteral feeding route in this patient population. One case report described a major complication leading to death from airway compromise following percutaneous endoscopic gastrostomy (PEG) tube placement. The authors describe a case of an infant with PRS who underwent successful PEG tube placement without complications, and they highlight certain techniques to improve procedure success and patient safety.
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Affiliation(s)
- Dina Al-Zubeidi
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of Iowa, Iowa City 52241, USA
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22
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Yokohama S, Aoshima M, Koyama S, Hayashi K, Shindo J, Maruyama J. Possibility of oral feeding after induction of percutaneous endoscopic gastrostomy. J Gastroenterol Hepatol 2010; 25:1227-31. [PMID: 20594248 DOI: 10.1111/j.1440-1746.2009.06190.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIM Although percutaneous endoscopic gastrostomy (PEG) has become established as a useful enteral nutrition technique, the associated risks must always be kept in mind. Recently, we experienced several patients who could orally ingest after PEG. To avoid unnecessary PEG, we investigated patients who could orally ingest after PEG, and analyzed predictive factors of postoperative oral feeding. METHODS We retrospectively analyzed data of 302 patients who underwent PEG at our hospital. After all patients were divided according to postoperative oral feeding status, we assessed factors of patients' backgrounds. In patients who could orally ingest after PEG, we investigated the course of oral feeding status. We attempted to identify predictive factors for postoperative oral feeding using logistic regression analysis. RESULTS Mean age was high in both groups, and overall condition was markedly poor. Forty-four patients (15%) were able to ingest orally after PEG. Enteral nutrition could be avoided during our observation period in 15 cases, because sufficient oral intake was achieved. Conversely, oral feeding was reduced or discontinued in 14 cases. Multivariate analysis identified the following independent predictive factors for postoperative oral feeding: (i) absence of dysphagia or aphagia; (ii) younger age; (iii) favorable performance status; (iv) presence of post-traumatic encephalopathy; and (v) preoperative swallowing training. CONCLUSIONS A total of 15% of PEG cases were able to ingest orally after PEG. In patients showing positive predictive factors, indications for PEG should be carefully considered.
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Affiliation(s)
- Shiro Yokohama
- Department of Gastroenterology, Asahikawa Rehabilitation Hospital, Asahikawa, Japan.
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Rio A, Ellis C, Shaw C, Willey E, Ampong MA, Wijesekera L, Rittman T, Nigel Leigh P, Sidhu PS, Al-Chalabi A. Nutritional factors associated with survival following enteral tube feeding in patients with motor neurone disease. J Hum Nutr Diet 2010; 23:408-15. [PMID: 20487174 DOI: 10.1111/j.1365-277x.2010.01057.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Motor neurone disease (MND) is a progressive neurodegenerative disease leading to limb weakness, wasting and respiratory failure. Prolonged poor nutritional intake causes fatigue, weight loss and malnutrition. Consequently, disease progression requires decisions to be made regarding enteral tube feeding. The present study aimed to investigate the survival, nutritional status and complications in patients with MND treated with enteral tube feeding. METHODS A retrospective case note review was performed to identify patients diagnosed with MND who were treated with enteral tube feeding. A total of 159 consecutive cases were identified suitable for analysis. Patients were treated with percutaneous endoscopic gastrostomy (PEG), radiologically inserted gastrostomy (RIG) or nasogastric feeding tube (NGT). Nutritional status was assessed by body mass index (BMI) and % weight loss (% WL). Serious complications arising from tube insertion and prescribed daily energy intake were both recorded. RESULTS Median survival from disease onset was 842 days [interquartile range (IQR) 573-1263]. Median time from disease onset to feeding tube was PEG 521 days (IQR 443-1032), RIG 633 days (IQR 496-1039) and NGT 427 days (IQR 77-781) (P = 0.28). Median survival from tube placement was PEG 200 (IQR 106-546) days, RIG 216 (IQR 83-383) days and NGT 28 (IQR 14-107) days. Survival between gastrostomy and NGT treated patients was significant (P < or = 0.001). Analysis of serious complications by nutritional status was BMI (P = 0.347) and % WL (P = 0.489). CONCLUSIONS Nutritional factors associated with reduced survival were weight loss, malnutrition and severe dysphagia. Serious complications were not related to nutritional status but to method of tube insertion. There was no difference in survival between PEG and RIG treated patients.
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Affiliation(s)
- A Rio
- Department of Nutrition & Dietetics, King's College Hospital, London SE5 9RS, UK.
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Zorron R, Cazarim D, Flores D, Fontes Meyer CA, de Castro LM, Kanaan E. Single-Access Gastrostomy (SAG) Dispenses Endoscopy or Laparoscopy: A Simple Method Under Local Anesthesia. Surg Innov 2009; 16:337-342. [DOI: 10.1177/1553350609351694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Objective. Gastrostomy for feeding or desobstructive purposes is often performed transendoscopically. However, as endoscopy specialists and instruments are not widely available in community hospitals in Brazil, an alternative method was developed at the authors’ institution. Surgical single-access gastrostomy (SAG), performed under local anesthesia and requiring no endoscopic guidance is described. Methods. The authors used the SAG technique on 19 patients eligible for gastrostomy, and the data were prospectively documented. After local anesthesia and a 1-cm incision, the gastric wall was localized under direct vision. Purse string sutures were placed to work as a fixed valve to rectus sheath. Results. SAG was feasible in all patients. Minor complications occurred in 3 patients. The mean operative time was 44.2 minutes, and the mean institution of gastrostomy feeding was 27.8 hours. Conclusion. SAG may dispense with the use of endoscopy and laparoscopy, providing a feasible, reproducible, and effective feeding gastrostomy in developing countries where alternative methods are not available.
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Affiliation(s)
- Ricardo Zorron
- University Hospital Teresopolis HCTCO- FESO, Rio de Janeiro, Brazil, , Hospital Municipal Lourenço Jorge, Rio de Janeiro, Brazil
| | - Davi Cazarim
- Hospital Municipal Lourenço Jorge, Rio de Janeiro, Brazil
| | - Daniel Flores
- Hospital Municipal Lourenço Jorge, Rio de Janeiro, Brazil
| | | | | | - Eduardo Kanaan
- Hospital Municipal Lourenço Jorge, Rio de Janeiro, Brazil
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Vervloessem D, van Leersum F, Boer D, Hop WCJ, Escher JC, Madern GC, de Ridder L, Bax KNMA. Percutaneous endoscopic gastrostomy (PEG) in children is not a minor procedure: risk factors for major complications. Semin Pediatr Surg 2009; 18:93-7. [PMID: 19348998 DOI: 10.1053/j.sempedsurg.2009.02.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Percutaneous endoscopic gastrostomy (PEG) provides for enteral nutrition in children with feeding problems. PEG, however, is not without complications. The present study has a twofold aim: (1) comparing our incidence of major complications after PEG with the incidence in other centers, and (2) identifying risk factors for major complications. All patients receiving a PEG or laparoscopic-assisted PEG (lap PEG) in the period 1992-2008 were reviewed. Primary outcome was the occurrence of major complications, defined as the need for surgery, non-prophylactic antibiotics, or blood transfusion, and procedure-related death. Potential risk factors, eg, age under 1 year, mental retardation, scoliosis, constipation, hepatomegaly, upper abdominal surgery, ventriculoperitoneal shunt, peritoneal dialysis, esophageal stenosis, and coagulopathy, were analyzed. Of the 467 patients (448 PEG, 19 lap PEG), 12.6% developed major complications. The complication rate significantly decreased (P = 0.003) over the years. A significantly higher complication rate of 32% (P = 0.02) occurred in children with a ventriculoperitoneal shunt. None of the lap PEG procedures was associated with a major complication, but the difference was not significant, perhaps because of the small numbers in the latter group. The major complication rate after PEG in children is high. Preexisting ventriculoperitoneal shunt is a significant risk factor. Laparoscopically assisted PEG procedures seem to be associated with a lesser major complication rate.
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Affiliation(s)
- Dirk Vervloessem
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
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Clostridium difficile-associated enteric disease after percutaneous endoscopic gastrostomy. J Gastroenterol 2009; 44:121-5. [PMID: 19214673 DOI: 10.1007/s00535-008-2283-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 08/15/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) has become established as a useful enteral nutrition technique. Although various adverse events related to PEG are known, few reports have described Clostridium difficile-associated enteric disease (CDED) after PEG. We encountered several cases of CDED with onset soon after PEG. The present study examined these cases in detail and analyzed potential risk factors. METHODS A total of 239 patients underwent PEG at our hospital from 1999, and the subjects comprised 233 patients for whom data could be statistically analyzed. CDED with onset soon after PEG was defined for cases with symptoms within 1 month after PEG. We investigated features and prognosis of these cases. A total of 19 predictors were chosen, and logistic regression analysis was performed using CDED with onset soon after PEG as a dependent variable. RESULTS Mean patient age was high, and about 65% were men. Their body weights were low and their general condition was markedly poor. CDED with onset soon after PEG was shown in 15 patients (6.4%). Although oral administration of vancomycin resulted in prompt recovery in most cases, enteral nutrition was interrupted for a long period, and the general condition deteriorated markedly in two patients. Logistic regression analysis identified "past history of CDED" and "antibiotic dosing period at PEG" as risk factors for CDED onset soon after PEG. CONCLUSIONS CDED occurred with onset soon after PEG at a comparatively high rate. Our analysis suggested "past history of CDED" and "antibiotic dosing period at PEG" as risk factors for CDED after PEG.
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Yokohama S, Aoshima M, Nakade Y, Shindo J, Maruyama J, Yoneda M. Investigation and prediction of enteral nutrition problems after percutaneous endoscopic gastrostomy. World J Gastroenterol 2009; 15:1367-72. [PMID: 19294767 PMCID: PMC2658839 DOI: 10.3748/wjg.15.1367] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate and predict enteral nutrition problems after percutaneous endoscopic gastrostomy (PEG).
METHODS: We retrospectively analyzed data for 252 out of 285 patients who underwent PEG at our hospital from 1999 to 2008. Enteral nutrition problems after PEG were defined as: (1) patients who required ≥ 1 mo after surgery to switch to complete enteral nutrition, or who required additional parenteral alimentation continuously; or (2) patients who abandoned switching to enteral nutrition using the gastrostoma and employed other nutritional methods. We attempted to identify the predictors of problem cases by using a logistic regression analysis that examined the patients’ backgrounds and the specific causes that led to their problems.
RESULTS: Mean age of the patients was 75 years, and in general, their body weight was low and their overall condition was markedly poor. Blood testing revealed that patients tended to be anemic and malnourished. A total of 44 patients (17.5%) were diagnosed as having enteral nutrition problems after PEG. Major causes of the problems included pneumonia, acute enterocolitis (often Clostridium difficile-related), paralytic ileus and biliary tract infection. A multivariate analysis identified the following independent predictors for problem cases: (1) enteral nutrition before gastrectomy (a risk reduction factor); (2) presence of esophageal hiatal hernia; (3) past history of paralytic ileus; and (4) presence of chronic renal dysfunction.
CONCLUSION: Enteral nutrition problems after PEG occurred at a comparatively high rate. Patient background analysis elucidated four predictive factors for the problem cases.
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Johnston SD, Tham TCK, Mason M. Death after PEG: results of the National Confidential Enquiry into Patient Outcome and Death. Gastrointest Endosc 2008; 68:223-7. [PMID: 18329030 DOI: 10.1016/j.gie.2007.10.019] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 10/02/2007] [Indexed: 01/27/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is an accepted method of placing a feeding tube to enable enteral feeding in patients with swallowing difficulties. However, the factors associated with complications and death after PEG have not been studied in detail. We describe the largest audit of deaths after PEG tube insertion. OBJECTIVE Our purpose was to determine the factors associated with death after PEG tube insertion. DESIGN Deaths occurring within 30 days after PEG tube insertion in the United Kingdom between April 2002 and March 2003 were identified and a questionnaire was sent to the consultant endoscopist for completion. PATIENTS A total of 719 patients (391 male, median age 80 years, range 26-98 years) who died within 30 days after PEG insertion were identified for this study. SETTING United Kingdom hospitals. MAIN OUTCOME MEASUREMENT Cause of death. RESULTS A total of 97% of the identified patients had coexistent neurologic disease. PEG tubes were inserted by specialized GI physicians in 522 cases (73%). Seventy-two patients (10%) required reversal agents after sedation. After PEG tube insertion, 309 patients (43%) died within 1 week. Death was due to cardiovascular disease (n = 175), respiratory disease (n = 508), central nervous system disease (n = 358), renal disease (n = 38), and hepatic failure (n = 11). In 136 cases (19%) the National Confidential Enquiry into Patient Outcome and Death expert panel regarded the procedure as futile. LIMITATIONS Retrospective review of case records. CONCLUSIONS Mortality and morbidity rates after PEG tube insertion are not insignificant. Selection of patients is paramount to good patient outcomes. Multidisciplinary team assessment should be performed on all patients being referred for PEG tube insertion.
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Affiliation(s)
- Simon D Johnston
- Department of Gastroenterology, Belfast City Hospital, Northern Ireland
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29
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NISHIGUCHI Y, YOSHIKAWA K, MICHIGAMI S, TANAKA H, OSAKA H, SOWA M. Buried Bumper Syndrome as a Rare Complication of Percutaneous Endoscopic Gastrostomy. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.1998.tb00553.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Yukio NISHIGUCHI
- First Department of Surgery, Osaka City University Medical School, Osaka, Japan
| | - Kazuhiko YOSHIKAWA
- First Department of Surgery, Osaka City University Medical School, Osaka, Japan
| | - Shinya MICHIGAMI
- First Department of Surgery, Osaka City University Medical School, Osaka, Japan
| | - Hiroaki TANAKA
- First Department of Surgery, Osaka City University Medical School, Osaka, Japan
| | - Hirohisa OSAKA
- First Department of Surgery, Osaka City University Medical School, Osaka, Japan
| | - Michio SOWA
- First Department of Surgery, Osaka City University Medical School, Osaka, Japan
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30
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Kaplan R, Delegge M. An unusual case of a ventral Richter's hernia at the site of a previous PEG tube. Dig Dis Sci 2006; 51:2389-92. [PMID: 17123153 DOI: 10.1007/s10620-006-9357-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 03/25/2006] [Indexed: 12/20/2022]
Affiliation(s)
- Rya Kaplan
- Medical University of South Carolina, 96 Jonathan Lucas St., Suite 210, Charleston, SC 29425, USA
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31
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Horiuchi A, Nakayama Y, Fujii H, Kajiyama M. Endoscopic holder-assisted percutaneous endoscopic gastrostomy placement: results of a prospective, randomized comparison study. Gastrointest Endosc 2006; 64:627-31. [PMID: 16996359 DOI: 10.1016/j.gie.2006.02.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Accepted: 02/03/2006] [Indexed: 12/10/2022]
Abstract
BACKGROUND We developed a new method of endoscope holder-assisted percutaneous endoscopic gastrostomy (PEG) placement requiring only a single physician. OBJECTIVE This study compared the feasibility and safety of the new method with the conventional pull method of PEG performed by 2 physicians. DESIGN Prospective, randomized comparison study. SETTING Rural municipal hospital. PATIENTS Eighty consecutive patients with dysphagia. INTERVENTIONS Patients were randomized to receive PEG placement by a single physician using the endoscope holder (40 patients) or by 2 physicians using the conventional pull method (40 patients). MAIN OUTCOME MEASUREMENTS The success rate, duration, and complications of both methods were scored. RESULTS The success rate of PEG by either method was similar (98%) using the endoscope holder compared with 100% with the conventional method. The duration of both endoscopic procedures was also similar (12.9 +/- 2 and 11.5 +/- 2 minutes) (P = .43). No major complication occurred with either procedure. There was 1 death within 30 days (of aspiration pneumonia) 3 days after conventional PEG placement. LIMITATIONS The number of patients evaluated is small. CONCLUSIONS Endoscope holder-assisted PEG placement allows a single physician to perform all the important aspects of pull PEG placement under direct vision without assistance from another specially trained individual. The method appears to be as feasible and safe as the conventional pull method.
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Affiliation(s)
- Akira Horiuchi
- Department of Gastroenterology, Showa Inan General Hospital, Komagane, Japan
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Zorrón R, Flores D, Meyer CAF, Castro LMD, Madureira FAV, Madureira Filho D. Gastrostomia de incisão única como alternativa para o procedimento endoscópico. Rev Col Bras Cir 2005. [DOI: 10.1590/s0100-69912005000300011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: A gastrostomia, realizada para possibilitar acesso nutricional ou descompressão, é comumente realizada por via endoscópica, por radiologia intervencionista, e, mais raramente, por via cirúrgica através de videolaparoscopia ou incisão mediana supra-umbilical. Os métodos endoscópico e radiológico, apesar de estabelecidos em muitos centros, não constituem rotina em hospitais comunitários pela necessidade de pessoal qualificado e material descartável, sendo usualmente realizada a gastrostomia cirúrgica com incisão mediana e anestesia geral. A Gastrostomia de Incisão Única descrita neste trabalho é um novo método cirúrgico menos invasivo, que foi desenvolvido para ser realizado sob anestesia local, com uma única incisão e sem necessidade de equipamento especial. MÉTODO: Quinze pacientes elegíveis para gastrostomia por diferentes indicações foram operados sob anestesia local. Após incisão subcostal de 1cm sobre o músculo reto abdominal esquerdo, uma área de parede gástrica era localizada, com ajuda de azul de metileno injetado no estômago, e exteriorizada através da incisão. Duas suturas em bolsa eram realizadas e a sonda gástrica introduzida. O estômago era fixado à aponeurose, resultando em uma gastrostomia de incisão única, segura e bem fixada. Alimentação pôde ser iniciada através da gastrostomia em 24 a 48hs. RESULTADOS: Todos os pacientes foram submetidos à técnica com sucesso. Complicações menores ocorreram em três pacientes: um apresentou alargamento do estoma, necessitando de sutura local adicional, e em outro, ocorreu deiscência parcial de mucosa que foi tratada conservadoramente. Em um terceiro paciente, houve lesão iatrogênica de cólon transverso, que foi suturada sem intercorrências. O tempo operatório médio foi de 49,4 min, e a introdução de alimentação foi de 34,3 hs em média. Não houve falha na instituição de dieta com esta técnica, nem complicações maiores como fístula ou peritonite. CONCLUSÕES: Os resultados desta casuística inicial sugerem que a abordagem é efetiva em propiciar um acesso rápido e seguro para gastrostomia, com ferida única, dispensando o uso de suporte endoscópico e anestesia geral. Pode ser utilizado como opção ao método endoscópico em pacientes com obstrução neoplásica faríngea ou esofageana. Uma casuística mais expressiva, acompanhamento mais longo dos casos, e estudos prospectivos randomizados são necessários para estabelecer o papel desta nova técnica na rotina cirúrgica.
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Affiliation(s)
- Ricardo Zorrón
- Universidade Federal do Rio de Janeiro; Hospital Municipal Lourenço Jorge; Fundação Educacional Serra dos Órgãos; Sociedade de Cirurgia Vídeo-endoscópica do Rio de Janeiro
| | | | | | | | | | - Delta Madureira Filho
- Sociedade de Cirurgia Vídeo-endoscópica do Rio de Janeiro; Universidade Federal do Rio de Janeiro; Universidade Federal do Rio de Janeiro
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Ehrsson YT, Langius-Eklöf A, Bark T, Laurell G. Percutaneous endoscopic gastrostomy (PEG) - a long-term follow-up study in head and neck cancer patients. ACTA ACUST UNITED AC 2005; 29:740-6. [PMID: 15533171 DOI: 10.1111/j.1365-2273.2004.00897.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Many patients with head and neck cancer experience problems related to swallowing. A retrospective study of 156 consecutive patients who received a percutaneous endoscopic gastrostomy (PEG) at a teaching hospital is presented. The results showed that 42% had complications. Fatal complications were seen in connection with PEG tube placement, but severe and minor complications could occur much later. The method of PEG tube insertion did not affect the complication rates. The spectrum of observed complications is different to that reported earlier, suggesting that the learning curve of surgeons under training could have influenced the outcome. It may be concluded that for a very sick patient a theoretically easy surgical procedure could turn into a potentially dangerous operation. It is important to select suitable candidates for a PEG. Head and neck cancer patients with a PEG need special attention in connection with the PEG tube placement and also in a long perspective, e.g. by follow-up at a nurse-led outpatient clinic.
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Affiliation(s)
- Y T Ehrsson
- Department of Otolaryngology and Head & Neck Surgery, Karolinska Hospital, Stockholm, Sweden.
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Abstract
BACKGROUND By using a small-diameter endoscope, EGD can be performed transnasally in adults. A prospective study was conducted to evaluate the feasibility of transnasal PEG placement without conscious sedation. METHODS Unsedated transnasal PEG was attempted in 23 patients by using a 5.9-mm-diameter videoendoscope. The indication for PEG insertion, success or failure, reason(s) for failure, and adverse effects of the procedure were recorded. During the first month, all patients were monitored by telephone contact for complications and to verify functionality of the PEG. RESULTS Transnasal PEG insertion was successful in 21 (91%) patients. The cause for failure was the inability to transilluminate the abdominal wall. Complications included epistaxis (n=1), minor wound infection (n=1), and soiling around the stoma (n=1). Of the 21 patients in whom transnasal PEG placement was successful, all were alive, with a functional gastrostomy at the 1-month follow-up. CONCLUSIONS Unsedated transnasal PEG tube insertion is minimally invasive, is feasible in daily practice in selected patients, and rarely is associated with complications.
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Affiliation(s)
- Jérôme Dumortier
- Department of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France
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35
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Lujber L, Pytel J. Second look endoscopy by a laryngo-fiberscope passed via the feeding tube of the percutaneous endoscopic gastrostomy. Surg Laparosc Endosc Percutan Tech 2003; 13:212-4. [PMID: 12819508 DOI: 10.1097/00129689-200306000-00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The most commonly used techniques for percutaneous endoscopic gastrostomy (PEG) require two passes of the gastroscope. The aim of this study was to clarify whether the second per oral gastroscopy can be replaced by passing a laryngo-fiberscope through the previously inserted PEG feeding tube. Twelve patients with head and neck cancer undergoing "pull through" PEG procedures were included in this prospective study. Instead of the second per oral pass of the gastro-intestinal fiberscope, a laryngo-fiberscope was passed through the inserted feeding tube to assess the correct position of the PEG internal disc. To gain more deflection to the tip of the instrument a string was led through the instrument channel and was brought back to the hand of the examiner outside the instrument. Pulling the string provided a bigger angulation to the end of the scope and thus a good view. In all twelve patients the "trans tubal" endoscopy was successful and provided a good second look to judge the position PEG internal disc. The procedure caused no inconvenience for the patient. "Trans tubal" endoscopy is a simple, safe and painless procedure to assess the position of the PEG feeding tube without having to pass the gastro-intestinal fiberscope a second time.
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Affiliation(s)
- László Lujber
- Department of Otorhinolaryngology, Faculty of Medicine, Pécs University, Hungary.
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36
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Abstract
Esophageal and gastric malignancies are common worldwide. Less than half are amenable to curative treatment at the time of diagnosis because of advanced or metastatic disease. Palliation is often required for symptoms, such as dysphagia, gastrointestinal bleeding, aspiration caused by tracheoesophageal fistula, nausea and emesis secondary to gastric outlet obstruction, and malnutrition. This article reviews the gastric outlet obstruction, and malnutrition. This article reviews the medical, endoscopic, and surgical options for palliative treatment.
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Affiliation(s)
- Carla L Nash
- Gastroenterology-Nutrition Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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37
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Lockett MA, Templeton ML, Byrne TK, Norcross ED. Percutaneous Endoscopic Gastrostomy Complications in a Tertiary-Care Center. Am Surg 2002. [DOI: 10.1177/000313480206800202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Since its introduction in 1980 the percutaneous endoscopic gastrostomy (PEG) has become the procedure of choice for establishing enteral access. However, there is still a relatively high complication rate associated with PEG placement. We reviewed the complications associated with PEG placement at our tertiary-care referral center. A retrospective chart review was conducted on patients over 17 years of age undergoing PEG placement between January 1, 1994 and March 1, 1996. Indications for surgery, antibiotic use, and postoperative complications were determined. There were 166 PEGs placed during this time and 27 (16.3%) complications. There was one death (0.6%) directly related to PEG placement. Thirteen patients (7.8%) died within 30 days of PEG placement and an additional 12 patients (7.2%) died before leaving the hospital. Wound infections occurred in nine (5.4%) patients including one case of necrotizing fasciitis. Only four of 153 (2.6%) patients who received preoperative antibiotics developed wound infections, whereas five of 13 (38.5%) patients without antibiotic prophylaxis developed infections. We conclude that percutaneous endoscopic gastrostomy is a safe and effective way of establishing enteral access in most patients. A relatively high mortality rate can be expected as a result of underlying medical problems. Antibiotics should be given to help prevent local wound infections.
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Affiliation(s)
- Mark A. Lockett
- From the Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Mia L. Templeton
- From the Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - T. Karl Byrne
- From the Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - E. Douglas Norcross
- From the Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
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Dwolatzky T, Berezovski S, Friedmann R, Paz J, Clarfield AM, Stessman J, Hamburger R, Jaul E, Friedlander Y, Rosin A, Sonnenblick M. A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people. Clin Nutr 2001; 20:535-40. [PMID: 11884002 DOI: 10.1054/clnu.2001.0489] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To compare the indications for and the outcome of long-term enteral feeding by nasogastric tube (NGT) with that of percutaneous endoscopic gastrostomy (PEG) tube. DESIGN A prospective, multicenter cohort study. SETTING Acute geriatric units and long-term care (LTC) hospitals in Jerusalem, Israel. PARTICIPANTS 122 chronic patients aged 65 years and older for whom long-term enteral feeding was indicated as determined by the treating physician. Patients with acute medical conditions at the time of tube placement were excluded. MEASUREMENTS We examined the indications for enteral feeding, nutritional status, outcome and complications in all subjects. Subjects were followed for a minimum period of six months. RESULTS Although the PEG patients were older and had a higher incidence of dementia, there was an improved survival in those patients with PEG as compared to NGT (hazard ratio (HR)=0.41; 95% confidence interval (CI) 0.22-0.76; P=0.01). Also, the patients with PEG had a lower rate of aspiration (HR=0.48; 95% CI 0.26-0.89) and self-extubation (HR=0.17; 95% CI 0.05-0.58) than those with NGT. Apart from a significant improvement in the serum albumin level at the 4-week follow-up assessment in the patients with PEG compared to those with NGT (adjusted mean 3.35 compared to 3.08; F=4.982), nutritional status was otherwise similar in both groups. CONCLUSION In long-term enteral feeding, in a selected group of non-acute patients, the use of PEG was associated with improved survival, was better tolerated by the patient and was associated with a lower incidence of aspiration. A randomized controlled study is needed to determine whether PEG is truly superior to NGT.
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Affiliation(s)
- T Dwolatzky
- Department of Geriatric Medicine, Shaare Zedek Medical Center, Jesuralem, Israel
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Gluck M. A survey on percutaneous endoscopically placed gastrostomy in the Northwest: influence of work setting. Am J Gastroenterol 2001; 96:2349-53. [PMID: 11513173 DOI: 10.1111/j.1572-0241.2001.04044.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE A survey was undertaken to determine the influence of practice setting on the way Pacific Northwest gastroenterologists perform and manage percutaneous endoscopically placed gastrostomy (PEG). METHODS A 12-question survey was distributed to 196 members of the Pacific Northwest Gastroenterology Society (PNWGS) regarding their specifics of placing and managing PEG. The responses were compared according to work setting, i.e., private practice, armed services, staff model HMO's, and university affiliated hospitals. The data were analyzed using the chi2 test. RESULTS Sixty-nine of 126 practicing gastroenterologists responded; 75% were in private practice (PP) and 25% in the combined other work settings (non-PP). The mean number of PEG placed by all groups was 23. Seventy-three percent of PP performed PEG without a second physician. Antibiotics were used prophylactically in both PP and non-PP by 96%. There was no difference between groups in use of standardized forms or in time before instituting feedings. The non-PP groups used preprocedure labs (p = 0.037) and loosening skin surface bumpers (p = 0.035) more frequently. The uniform impression was that PEG was associated with the same or fewer complications currently than in the past. CONCLUSIONS In the PP setting, gastroenterologists tend to place PEGs without a second physician and use standardized forms and bumper loosening less frequently than non-PP gastroenterologists. These variations reflect that teaching institutions as well as staff model HMOs make access to an assistant easier. Respondents expressed confusions on billing for PEG. They perceived the procedure to be as safe or safer than in the past. The PEG has evolved into a frequently performed procedure whose practice variations are outgrowths of one's work environment as well as one's training.
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Affiliation(s)
- M Gluck
- Department of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington 98111, USA
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Baron TH, Morgan DE. Endoscopic transgastric irrigation tube placement via PEG for debridement of organized pancreatic necrosis. Gastrointest Endosc 1999; 50:574-7. [PMID: 10502187 DOI: 10.1016/s0016-5107(99)70089-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- T H Baron
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Brant CQ, Stanich P, Ferrari AP. Improvement of children's nutritional status after enteral feeding by PEG: an interim report. Gastrointest Endosc 1999; 50:183-8. [PMID: 10425410 DOI: 10.1016/s0016-5107(99)70222-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Enteral feeding by percutaneous endoscopic gastrostomy is indicated as long-term nutritional support for children with neurologic impairment and dysphagia. We report our experience with percutaneous endoscopic gastrostomy and evaluate the age range of children with cerebral palsy who benefit most with weight and height gain. METHODS In a prospective study, from August 1996 to August 1997, 20 endoscopic gastrostomies were performed in 20 children diagnosed with cerebral palsy (16), myopathy (2), and brain trauma (2). The mean age was 6.5 years and the mean follow-up 5.9 months. All patients had severe mental impairment and oropharyngeal dysphagia. They were followed up monthly on an outpatient basis by both the gastroenterologist and the dietitian, who assessed gastrostomy complications and performed anthropometric measurements. RESULTS All 20 patients benefited from enteral nutrition with a statistically significant gain in weight (p < 0.01), and there was a trend toward improved weight/height ratio in children under 4 years of age according to Z-score and mid-arm muscle area (p < 0.01). Triceps skinfold thickness failed to reach statistical significance. There were no immediate complications related to the procedure. Perforations occurred with three (15%) tubes, and the plugs for introduction of food had to be replaced after 4 months of use. All complications, namely formation of granulation tissue at the stoma (7), stoma infection (4), gastroesophageal reflux pneumonia (3), and pneumoperitoneum (1) were managed clinically. CONCLUSIONS Endoscopic gastrostomy is a safe procedure for children. Enteral feeding resulted in a trend toward a normalized weight/height ratio for children with cerebral palsy younger than 4 years and significant weight gain in those older than 12 years.
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Affiliation(s)
- C Q Brant
- Universidade Federal de São Paulo (UNIFESP), Division of Gastroenterology and Associação de Assistência Criança Defeituosa, São Paulo, Brazil
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Abstract
This study evaluates our complications arising directly or indirectly from placement or management of percutaneous endoscopic gastrostomy (PEG) tubes and provides recommendations for avoidance of complications. Seventy-one patients received PEG tube placement by otolaryngologists between January 1991 and May 1997. Records were reviewed for diagnoses, combined procedures, and complications. Addressing potential causes of complications prompted modification of our technique of PEG tube placement and management. Twenty-three patients received PEG for dysphagia/aspiration unrelated to neoplasia, 11 received PEG with staging endoscopy, 11 received PEG after treatment for head and neck neoplasm, and 26 received PEG at the time of primary resection. Major complications included retained PEG hub and delayed colon abscess ultimately resulting in death. Minor complications included skin abscesses, cellulitis, and early and late vasovagal response with PEG tube removal. An airway emergency, on attempted oral airway intubation, resulted in an aborted PEG attempt and constituted another complication outside the 4 groups stated above. The major complication was not found within a literature review. We have modified our management for avoidance of this complication. We believe the causes of the minor complications have been identified, and with additional modifications in our technique, we have not had any similar complications recently. The recommended techniques are discussed in detail.
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Affiliation(s)
- P M Santos
- Division of Otolaryngology, Southern Illinois University School of Medicine, USA
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Serrano P, Velloso A, García-Luna PP, Pereira JL, Fernádez Z, Ductor MJ, Castro D, Tejero J, Fraile J, Romero H. Enteral nutrition by percutaneous endoscopic gastrojejunostomy in severe hyperemesis gravidarum: a report of two cases. Clin Nutr 1998; 17:135-9. [PMID: 10205331 DOI: 10.1016/s0261-5614(98)80008-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We describe the first two cases in which percutaneous endoscopic gastrojejunostomy was used as a means to provide enteral nutrition in severe hypermesis gravidarum. The use of this method of enteral access provided an alternative to parenteral nutrition, was well tolerated, cost-effective and had no major complications. In both cases the nutritional goal for mothers as well as appropriate fetal growth and development were achieved.
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Affiliation(s)
- P Serrano
- Department of Clinical Nutrition, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Gadducci, Iacconi, Fanucchi, Cosio, Miccoli, Genazzani. Survival after intestinal obstruction in patients with fatal ovarian cancer: Analysis of prognostic variables. Int J Gynecol Cancer 1998. [DOI: 10.1046/j.1525-1438.1998.97118.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Van Natta TL, Morris JA, Eddy VA, Nunn CR, Rutherford EJ, Neuzil D, Jenkins JM, Bass JG. Elective bedside surgery in critically injured patients is safe and cost-effective. Ann Surg 1998; 227:618-24; discussion 624-6. [PMID: 9605653 PMCID: PMC1191333 DOI: 10.1097/00000658-199805000-00002] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The success of elective minimally invasive surgery suggested that this concept could be adapted to the intensive care unit. We hypothesized that minimally invasive surgery could be done safely and cost-effectively at the bedside in critically injured patients. SUMMARY BACKGROUND DATA This case series, conducted between October 1991 and June 1997 at a Level I trauma center, examined bedside dilatational tracheostomy (BDT), percutaneous endoscopic gastrostomy (PEG), and inferior vena cava (IVC) filter placement. All procedures had been performed in the operating room (OR) before initiation of this study. METHODS All BDTs and PEGs were performed with intravenous general anesthesia (fentanyl, diazepam, and pancuronium) administered by the surgical team. IVC filters were placed using local anesthesia and conscious sedation. BDTs were done using a Ciaglia set, PEGs were done using a 20 Fr Flexiflow Inverta-PEG kit, and IVC filters were placed percutaneously under ultrasound guidance. Cost difference (delta cost) was defined as the difference in hospital cost and physician charges incurred in the OR as compared to the bedside. RESULTS Of 16,417 trauma admissions, 379 patients (2%) underwent 472 minimally invasive procedures (272 BDTs, 129 PEGs, 71 IVC filters). There were four major complications (0.8%). Two patients had loss of airway requiring reintubation. Two patients had an intraperitoneal leak from the gastrostomy requiring operative repair. No patient had a major complication after IVC filter placement. Total delta cost was $611,994. When examined independently, the cost was $324,224 for BDT, $164,088 for PEG, and $123,682 for IVC filter. OR use was reduced by 506 hours. CONCLUSIONS These bedside procedures have minimal complications, eliminate the risk associated with patient transport, reduce cost, improve OR utilization, and should be considered for routine use in the general surgery population.
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Affiliation(s)
- T L Van Natta
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA
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Luck A, Hewett P. Laparoscopic gastrostomy: towards the ideal technique. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1998; 68:281-3. [PMID: 9572339 DOI: 10.1111/j.1445-2197.1998.tb02083.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Laparoscopic gastrostomy is the best option for long-term gastric intubation when percutaneous endoscopic gastrostomy is not possible. The ideal technique is yet to be defined. METHODS A technique of suturing the gastric wall to the posterior rectus sheath under direct vision has been developed. The method is simple and avoids the difficulties and potential complications described with other techniques. RESULTS The technique has been used in three cases with excellent results and no complications. CONCLUSION The described technique is a further advance in defining the 'ideal' technique of laparoscopic gastrostomy.
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Affiliation(s)
- A Luck
- Department of Surgery, Queen Elizabeth Hospital, Woodville South, South Australia, Australia
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McCarter TL, Condon SC, Aguilar RC, Gibson DJ, Chen YK. Randomized prospective trial of early versus delayed feeding after percutaneous endoscopic gastrostomy placement. Am J Gastroenterol 1998; 93:419-21. [PMID: 9517650 DOI: 10.1111/j.1572-0241.1998.00419.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE By convention, most clinicians delay feeding through the gastrostomy tube until 24 h after placement. However, evidence is lacking to support the rationale for such a delay in PEG use. This randomized, prospective study was designed to assess the safety of early feeding after PEG placement. METHODS One hundred-twelve patients referred for PEG were randomized to begin tube feedings at 4 h (group A) or at 24 h (group B) after placement. All patients received prophylactic antibiotics. Full-strength Isocal was administered with the following schedule: day 1, 100 ml every 4 h for six feedings; day 2, 200 ml every 4 h for six feedings. Immediately before each scheduled feeding, gastric residual volume was recorded and the next feeding was withheld if the residual volume was > 50 percent (gastric retention). Patients were evaluated on day 1, day 2, day 7, and day 30 for major and minor complications. RESULTS The two groups were similar with regard to age, gender, baseline nutritional status, and indications for PEG placement. On the first day of feeding, 14 of 57 patients (25%) in group A, but only five of 55 patients (9%) in group B, had evidence of gastric retention, p = 0.029. The proportion of patients with high gastric residual volumes was not significantly different on day two. In group B, one death occurred because of aspiration of gastric contents on day 2. All other complications were minor and did not differ significantly between the two groups. CONCLUSIONS Early initiation of PEG feedings is safe, well tolerated, and reduces cost by decreasing hospital stay.
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Affiliation(s)
- T L McCarter
- Department of Medicine, Loma Linda University Medical Center, CA 92354, USA
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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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Munk PL, Lee MJ, Poon PY, Rankin RN, Sheehan B, Tsang V, Bromley P, Tyldesley S. Percutaneous gastrostomy in radiologic practice. ACTA ACUST UNITED AC 1997. [DOI: 10.1111/j.1440-1673.1997.tb00645.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Lees J. Nasogastric and percutaneous endoscopic gastrostomy feeding in head and neck cancer patients receiving radiotherapy treatment at a regional oncology unit: a two year study. Eur J Cancer Care (Engl) 1997; 6:45-9. [PMID: 9238929 DOI: 10.1111/j.1365-2354.1997.tb00268.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of this prospective two year study was to compare the outcome of two methods of nutritional support, namely nasogastric [NG] and percutaneous endoscopic gastrostomy [PEG] feeding implemented for head and neck cancer patients unable to maintain their nutritional status whilst receiving radiotherapy treatment at a regional oncology unit. The nutritional requirements of the 100 patients included in the study were calculated and an enteral feeding regime implemented to ensure the nutritional requirements of each individual patient were met. Any changes in the weight and body mass index [BMI] of each patient during the study period were documented. The method of delivery, composition of feed and duration of nutritional support of each feeding method were determined. The feeding methods were found to be equally effective at maintaining body weight. Patients with NG tubes in situ were more frequently prescribed a standard 1 kcal/ml feed administered via an enteral feeding pump, whereas patients with PEG tubes in situ were more frequently prescribed a high energy 1.5 Kcal/ ml feed administered by the bolus method. A number of advantages are associated with PEG feeding including greater mobility, cosmesis and quality of life. Evidence indicates the outcome of radiotherapy treatment is not as favourable if interrupted, therefore, it is essential PEG tubes are sited prior to commencing treatment, illustrating the necessity for dietetic intervention for every patient to be addressed and incorporated into the treatment plan on diagnosis of head and neck cancer before definitive management commences.
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Affiliation(s)
- J Lees
- Clatterbridge centre for oncology, Bebington, Wirral, Merseyside, UK
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