• accelerated treatment
• antibacterial
• gastrostomy
• multifunctional hydrogels
• nano-manganese dioxide

• Animals
• Hydrogels/chemistry
• Hydrogels/pharmacology
• Rabbits
• Anti-Bacterial Agents/pharmacology
• Anti-Bacterial Agents/chemistry
• Mice
• Gastrostomy
• Wound Healing/drug effects
• Hyaluronic Acid/chemistry
• Hyaluronic Acid/pharmacology
• Humans
• Polylysine/chemistry
• Polylysine/pharmacology
• Cell Movement/drug effects
• Cell Proliferation/drug effects
• Male
• Alginates/chemistry
• Alginates/pharmacology
• Escherichia coli/drug effects

• Enteral Access
• Enteral Nutrition
• Gastrostomy Tube
• Jejunostomy Tube

• Humans
• Gastroenterology/standards
• Enteral Nutrition/standards
• Enteral Nutrition/methods
• Enteral Nutrition/instrumentation
• Societies, Medical/standards
• Endoscopy, Gastrointestinal/standards
• Endoscopy, Gastrointestinal/methods
• Intubation, Gastrointestinal/standards
• Intubation, Gastrointestinal/methods
• United States

• Early feed
• Infection
• Late feed
• Mortality
• PEG tube

• Humans
• Enteral Nutrition/methods
• Enteral Nutrition/adverse effects
• Enteral Nutrition/instrumentation
• Gastrostomy/methods
• Gastrostomy/adverse effects
• Time Factors
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Gastroscopy/methods
• Gastroscopy/adverse effects
• Intubation, Gastrointestinal/methods
• Intubation, Gastrointestinal/adverse effects
• Treatment Outcome

• enteral feeding
• percutaneous endoscopic gastrostomy
• percutaneous radiological gastrostomy

• Humans
• Enteral Nutrition/methods
• Gastrostomy/methods
• Gastrostomy/adverse effects
• Randomized Controlled Trials as Topic
• Treatment Outcome

• Endoscopy
• Gastrostomy
• Guideline

• Humans
• Aged
• Gastrostomy
• Quality of Life
• Enteral Nutrition
• Intubation, Gastrointestinal
• Endoscopy, Gastrointestinal

• Enteral nutrition
• Percutaneous endoscopic gastrostomy
• Surveys and questionnaires

• Humans
• Aged
• Enteral Nutrition/methods
• Gastrostomy/methods
• Gastroscopy/methods
• Surveys and Questionnaires
• Republic of Korea
• Retrospective Studies

• early feeding
• enteral nutrition
• feeding strategy
• gastrointestinal anastomosis
• hospital stay
• late feeding
• surgery

• Child
• Infant
• Infant, Newborn
• Humans
• Digestive System Surgical Procedures
• Enteral Nutrition/methods
• Surgical Wound Infection
• Anastomotic Leak
• Anastomosis, Surgical

Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are minimally invasive techniques commonly used for prolonged enteral nutrition. Despite safe, both techniques may lead to complications, such as bleeding, infection, pain, peritonitis, and tube-related complications. The literature is unclear on which technique is the safest.

To establish which approach has the lowest complication rate.

A database search was performed from inception through November 2022, and comparative studies of PEG and PRG were selected following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All included studies compared the two techniques directly and provided absolute values of the number of complications. Studies with pediatric populations were excluded. The primary outcome of this study was infection and bleeding. Pneumonia, peritonitis, pain, and mechanical complications were secondary outcomes. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB2) and we used The Risk of Bias in Nonrandomized Studies (ROBINS-I) to analyze the retrospective studies. We also performed GRADE analysis to assess the quality of evidence. Data on risk differences and 95% confidence intervals were obtained using the Mantel-Haenszel test.

Seventeen studies were included, including two randomized controlled trials and fifteen retrospective cohort studies. The total population was 465218 individuals, with 273493 having undergone PEG and 191725 PRG. The only outcome that showed a significant difference was tube related complications in retrospective studies favoring PEG (95%CI: 0.03 to 0.08; P < 0.00001), although this outcome did not show significant difference in randomized studies (95%CI: -0.07 to 0.04; P = 0.13). There was no difference in the analyses of the following outcomes: infection in retrospective (95%CI: -0.01 to 0.00; P < 0.00001) or randomized (95%CI: -0.06 to 0.04; P = 0.44) studies; bleeding in retrospective (95%CI: -0.00 to 0.00; P < 0.00001) or randomized (95%CI: -0.06 to 0.02; P = 0.43) studies; pneumonia in retrospective (95%CI: -0.04 to 0.00; P = 0.28) or randomized (95%CI: -0.09 to 0.11; P = 0.39) studies; pain in retrospective (95%CI: -0.05 to 0.02; P < 0.00001) studies; peritonitis in retrospective (95%CI: -0.02 to 0.01; P < 0.0001) studies.

PEG has lower levels of tube-related complications (such as dislocation, leak, obstruction, or breakdown) when compared to PRG.

• Gastrostomy
• Adverse events
• Meta-analysis
• Percutaneous endoscopic
• Radiological gastrostomy

• Adverse events
• Mortality
• Percutaneous endoscopic gastrostomy

• Humans
• Gastrostomy/adverse effects
• Gastrostomy/methods
• Pilot Projects
• Surgical Stomas
• Endoscopy, Gastrointestinal/adverse effects
• Radiography
• Retrospective Studies

Gastro-jejunostomy tubes, or percutaneous endoscopic gastrostomy tubes with jejunal extension (PEG-J), hold a significant role in the long-term nutritional management of patients with poor oral intake. This can be for a variety of reasons; ranging from metabolic conditions, including diabetes mellitus, inherited or congenital conditions like Ehler Danlos syndrome, or patients with neurological disorders, such as stroke, advanced Parkinson's disease or multiple sclerosis. Although they are very helpful for the overall nutritional needs of such patients, they are associated with complications, including the dislodging of jejunal tubes. The need to promptly recognise, investigate and manage this, in a timely manner, is vital, particularly during the COVID-19 pandemic times, as such patients may be associated with multiple comorbidities.

Nutritional support is essential in patients who have a limited capability to maintain their body weight. Therefore, oral feeding is the main approach for such patients. When physiological nutrition is not possible, positioning of a nasogastric, nasojejunal tube, or other percutaneous devices may be feasible alternatives. Creating a percutaneous endoscopic gastrostomy (PEG) is a suitable option to be evaluated for patients that need nutritional support for more than 4 wk. Many diseases require nutritional support by PEG, with neurological, oncological, and catabolic diseases being the most common. PEG can be performed endoscopically by various techniques, radiologically or surgically, with different outcomes and related adverse events (AEs). Moreover, some patients that need a PEG placement are fragile and are unable to express their will or sign a written informed consent. These conditions highlight many ethical problems that become difficult to manage as treatment progresses. The aim of this manuscript is to review all current endoscopic techniques for percutaneous access, their indications, postprocedural follow-up, and AEs.

• Percutaneous endoscopic gastrostomy
• Enteral nutrition
• Gastrostomy
• Percutaneous endoscopic jejunostomy
• Indications and techniques

Gastrostomy tube placement is a procedure that achieves enteral access for nutrition, decompression, and medication administration. Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events (AEs). Appropriate indications, contraindications, ethical considerations, and comorbidities of patients referred for gastrostomy placement should be weighed and balanced. Additionally, endoscopist should consider either a transoral or transabdominal approach is appropriate, and radiologic or surgical gastrostomy tube placement is needed. However, medical history, physical examination, and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.

• Gastrostomy
• Gastropexy
• Enterostomy
• Decompression
• Enteral nutrition
• Endoscopy

• ENDOSCOPIC GASTROSTOMY
• ENTERAL NUTRITION
• GASTROSTOMY

Background: Nasogastric tube (NGT) placement is a daily routine in the Intensive Care Unit (ICU), and misplacement of the NGT can cause serious complications. In COVID-19 ARDS patients, proning has emerged the need for frequent NGT re-evaluations. The gold standard technique, chest X-ray, is not always feasible. In the present study we report our experience with the use of ultrasonographic confirmation of NGT position. Methods: A prospective study in 276 COVID-19 ARDS patients admitted after intubation in the ICU. Ultrasonographic evaluation was performed using longitudinal or sagittal epigastric views. Examinations were performed during the initial NGT placement and every time the patients returned to the supine position after they had been proned or whenever critical care physicians or nurses considered that reconfirmation was necessary. Results: Ultrasonographic confirmation of correct NGT placement was feasible in 246/276 (89.13%) patients upon ICU admission. In 189/246 (76.8%) the tube could be visualized in the stomach (two parallel lines), in 172/246 (69.9%) the ultrasonographic whoosh test (“flash” due to air instillation through the tube, seen with ultrasonography) was evident, while in 164/246 (66.7%) both tests confirmed correct NGT placement. During ICU stay 590 ultrasonographic NGT evaluations were performed, and in 462 (78.14%) cases correct NGT placement were confirmed. In 392 cases, a chest X-ray was also ordered. The sensitivity of ultrasonographic NGT confirmation in these cases was 98.9%, specificity 57.9%, PPV 96.2%, and NPV 3.8%. The time for the full evaluation was 3.8 ± 3.4 min. Conclusion: Ultrasonographic confirmation of correct NGT placement is feasible in the initial placement, but also whenever needed thereafter, especially in the COVID-19 era, when changes in posture have become a daily practice in ARDS patients.

The preferential use of the oral/enteral route in critically ill patients over gut rest is uniformly recommended and applied. This article provides practical guidance on enteral nutrition in compliance with recent American and European guidelines. Low-dose enteral nutrition can be safely started within 48 h after admission, even during treatment with small or moderate doses of vasopressor agents. A percutaneous access should be used when enteral nutrition is anticipated for ≥ 4 weeks. Energy delivery should not be calculated to match energy expenditure before day 4–7, and the use of energy-dense formulas can be restricted to cases of inability to tolerate full-volume isocaloric enteral nutrition or to patients who require fluid restriction. Low-dose protein (max 0.8 g/kg/day) can be provided during the early phase of critical illness, while a protein target of > 1.2 g/kg/day could be considered during the rehabilitation phase. The occurrence of refeeding syndrome should be assessed by daily measurement of plasma phosphate, and a phosphate drop of 30% should be managed by reduction of enteral feeding rate and high-dose thiamine. Vomiting and increased gastric residual volume may indicate gastric intolerance, while sudden abdominal pain, distension, gastrointestinal paralysis, or rising abdominal pressure may indicate lower gastrointestinal intolerance.

• Critically ill
• Energy metabolism
• Gastrointestinal dysfunction
• Muscle wasting
• Refeeding syndrome
• Sarcopenia
• Stress response

• Enteral formula
• Home enteral nutrition
• Monitoring
• Nutrition support team
• Tube feeding

• enteral nutrition
• gastric tube verification
• gastrostomy tube
• patient safety

• PEG
• complications
• longevity
• replacement

• Adult
• Aged
• Aged, 80 and over
• Anesthesia/adverse effects
• Catheters
• Female
• Fluoroscopy
• Gastrostomy/instrumentation
• Gastrostomy/methods
• Humans
• Laryngeal Neoplasms/complications
• Male
• Middle Aged
• Oropharyngeal Neoplasms/complications
• Radiography, Interventional/methods
• Retrospective Studies
• Risk
• Stomach/diagnostic imaging
• Stomach/surgery
• Young Adult

• Japan
• gastrostomy
• infections
• survival rate
• ventriculoperitoneal shunt

• Intensive Care Unit (ICU)
• Percutaneous endoscopic gastrostomy (PEG) placement
• interventional pulmonology

Percutaneous dilatational tracheostomy (PDT) and percutaneous endoscopic gastrostomy (PEG) tube placements are routine procedures performed in the intensive care units (ICUs). They are performed to facilitate care and promote healing. They also help prevent complications from prolonged endotracheal intubation and malnutrition. In most cases, both are performed simultaneously. Physicians performing them require knowledge of local anatomy, tissue and vascular relationships, along with advance bronchoscopy and endoscopy skills. Although PDTs and PEGs are considered relatively low-risk procedures, operators need to have the knowledge and skill to recognize and prevent adverse outcomes. Current published literature on post-procedural care and stoma wound management was reviewed. Available recommendations for the routine care of tracheostomy and PEG tubes are included in this review. Signs and symptoms of early PDT- and PEG-related complications and their management are discussed in detail. These include hemorrhage, infection, accidental decannulation, tube obstruction, clogging, and dislodgement. Rare, life-threatening complications are also discussed. Multidisciplinary teams are needed for improved patient care, and members should be aware of all pertinent care aspects and potential complications related to PDT and PEG placement. Each institute is strongly encouraged to have detailed protocols to standardize care. This review provides a state-of-the-art guidance on the care of patients with tracheostomies and gastrostomies specifically in the ICU setting.

• Critical care
• gastrostomy
• nursing care
• tracheostomy
• wounds

Patient: Male, 34-year-old

Final Diagnosis: Jejunal volvulus

Symptoms: Vomiting

Medication:—

Clinical Procedure: Laparotomy

Specialty: Gastroenterology and Hepatology • Radiology • Surgery

Levodopa–carbidopa intestinal gel (LCIG) treatment, a unique drug delivery system for patients with advanced Parkinson’s disease (PD), is covered by health insurance in Japan since September 2016. Various LCIG procedure/device-associated adverse events (AEs) have been reported; however, reports on their treatment have been limited. This is the first multicenter study to clarify the frequency and timing of device-related AEs.

Between September 2016 and December 2018, 104 patients introduced to the LCIG treatment for advanced PD in 11 hospitals were included. The patients’ characteristics, AEs incidence, AEs time, and tube exchange time were investigated.

The median follow-up period was 21.5 months. Minor AE cases were 29.4%, whereas major AE cases were 43.1%. Majority of major AEs (n = 55, 94.8%) were managed with endoscopic treatment, such as tube exchange. Few severe AEs required surgical treatment (n =3, 5.2%). The mean (range) exposure to percutaneous endoscopic gastrojejunostomy (PEG-J) was 14.7 (0–33) months. One year after the LCIG treatment introduction, 55 patients (54.0%) retained the original PEG-J tube. The mean PEG-J tube exchange time was 10.8 ± 7.0 months in all patients, 11.6 ± 4.7 and 10.5 ± 7.7 months in patients with scheduled exchange and who underwent exchange due to AEs, respectively.

Some device-related AEs occurred during the LCIG treatment; however, only few were serious, most of which could be treated with simple procedures or tube replacement with endoscopy. Therefore, the LCIG treatment is feasible and safe and is a unique treatment option for PD, requiring endoscopists’ understanding and cooperation.

The online version contains supplementary material available at 10.1186/s12883-021-02269-7.

• Levodopa–carbidopa intestinal gel
• Parkinson’s disease
• Percutaneous endoscopic gastrojejunostomy

• Aspirin
• clopidogrel
• gastrostomy
• hemorrhage
• platelet aggregation inhibitors

• CPT
• Enteric tubes
• Fluoroscopy
• Interventional radiology
• Medicare

• Ventriculoperitoneal shunt
• cerebrospinal fluid
• gastrostomy
• shunt infection
• shunt revision

Percutaneous endoscopic gastrostomy (PEG) has been used in patients with dysphagia and inadequate food intake via an oral route. Despite being a procedure with a high success rate, complications and death have been reported. The aim was to identify the factors related to major complications and mortality, as well as PEG removal prognostic factors due to improvement of their general condition.

Patient characteristics, comorbidities, laboratory data, concomitant medication, sedation, and indication for PEG placement were collected. Major complications, mortality, and PEG removal factors were assessed.

A total of 388 patients were enrolled. There were 15 (3.9%) cases of major complications, with major bleeding being the most frequent in 6 (1.5%) patients. Corticosteroids were the independent variable associated with major complications (odds ratio [OR] 5.85; 95% confidence interval [CI] 1.71–20; P = <0.01). Advanced cancer (hazard ratio [HR] 0.5; 95% CI 0.3–1; P = 0.05), albumin (HR 0.6; 95% CI 0.4–0.9; P = <0.01), and C‐reactive protein (CRP) (HR 1.1; CI 1–1.2; P = 0.01) were considered risk factors for mortality. Previous pneumonia (HR 0.4; CI 0.2–0.9; P = 0.02) was a factor for permanent use of a PEG; however, oncological indication (HR 8.2; CI 3.2–21; P = <0.01) was factors for PEG withdrawal.

Chronic corticosteroid users potentially present with major complications. Low albumin levels and elevated CRP were associated with death. Previous aspiration pneumonia was a factor associated with permanent use of PEG; however, patients with oncological indication were the most benefited.

• corticosteroids
• major complications
• oncological indication
• percutaneous endoscopic gastrostomy

• accuracy
• chest radiography
• management
• nasogastric tube
• positioning
• ultrasound

• general practice / family medicine
• healthcare improvement and patient safety
• home care nursing
• long term care

• GI bleeding
• endoscopy
• oesophagus

• buried bumper syndrome
• dysphagia
• egd
• peg tube placement