|
1
|
Frank C, Williams RF, Boulden T, Kink R, Paton EA. Ultrasound is safe and highly specific for confirmation of proper gastrostomy tube replacement in pediatric patients. J Pediatr Surg 2022; 57:390-395. [PMID: 35216797 DOI: 10.1016/j.jpedsurg.2022.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gastrostomy tube (GT) dislodgement is a common cause of Pediatric Emergency Department (PED) visits. Postoperative patients and those who require stoma dilation are more likely to have complications during emergent replacement. Although incorrect replacement can cause significant morbidity overall, the occurrence is infrequent. Contrast injection of the GT is considered the standard for confirming proper placement. Case reports in both pediatric and adult patients suggest that ultrasound can be used to confirm proper replacement. The objective of the present study was to assess the utility of ultrasound to confirm GT placement in pediatric patients most at risk for complications from incorrect replacement. METHODS This is a non-randomized cohort pilot trial to determine the sensitivity and specificity of ultrasound to confirm proper replacement of a GT in a Pediatric Emergency Department. RESULTS We enrolled 55 pediatric subjects, of which 50 had ultrasound imaging after GT replacement in the PED prior to contrast injection. Ultrasound was found to have 96% sensitivity and 100% specificity for confirming GT placement. CONCLUSIONS Ultrasound is a safe and reliable confirmatory study to confirm GT placement in pediatric patients, especially those at highest risk of complications from incorrect placement. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Cailin Frank
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN 38103, United States; University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN 38103, United States.
| | - Regan F Williams
- University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN 38103, United States; Division of Pediatric Surgery, Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN 38103, United States
| | - Thomas Boulden
- University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN 38103, United States; Department of Radiology, Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN 38103, United States
| | - Rudy Kink
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN 38103, United States; University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN 38103, United States
| | - Elizabeth A Paton
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN 38103, United States; College of Nursing, University of Tennessee Health Science Center, 874 Union Ave, Memphis, TN 38103, United States
| |
Collapse
|
|
2
|
Alerhand S, Tay ET. Point-of-care ultrasound for confirmation of gastrostomy tube replacement in the pediatric emergency department. Intern Emerg Med 2020; 15:1075-1079. [PMID: 32133576 DOI: 10.1007/s11739-020-02294-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/13/2020] [Indexed: 01/01/2023]
Abstract
Gastrostomy tubes (G-tubes) are frequently used in children for feeding and nutrition. Complications related to G-tubes (and G-buttons) in children represent a common presentation to the emergency department (ED). G-tube replacement is usually performed by pediatric emergency medicine physicians. Misplacement may lead to tract disruption, perforation, fistula tract formation, or feeding into the peritoneum. Contrast-enhanced radiographs are traditionally used for confirmation. In addition to a longer length-of-stay, repeat ED visits result in repeated radiation exposure. The use of point-of-care ultrasound (POCUS) instead of radiography avoids this exposure to ionizing radiation. Here, we describe three patients who presented with G-tube complications in whom POCUS alone performed by pediatricians was used for confirmation of the tubes' replacement. Two children presented to the ED with G-tube dislodgement, and one child presented with a ruptured balloon. In all three cases, a new G-tube was replaced at the bedside using POCUS guidance without the need for further radiographic studies. There were no known ED or clinic returns for G-tube complaints over the next 30 days. This is the first report of pediatricians using POCUS to guide and confirm G-tube replacement in children. The success of these cases suggests the technique's feasibility. Future prospective studies are needed to evaluate the learning curves, diagnostic accuracy, ED length-of-stay, and use of confirmatory imaging.
Collapse
Affiliation(s)
- Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, 07103, USA.
| | - Ee Tein Tay
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, NY, 10016, USA
| |
Collapse
|
|
3
|
Tabashy R, Darwish A, Ibrahim A, Gad El-Mola M. Modified percutaneous radiologic gastrostomy technique without endoscopic or nasogastric access. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0086-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of this study is to evaluate the efficacy and safety of a modified percutaneous radiologic gastrostomy (MPRG) technique under ultrasound and fluoroscopic guidance without endoscopic or nasogastric access.
Results
The study included 24 patients: 10 males and 14 females whose ages ranged from 44 to 80 years old. Ten patients had esophageal cancer and 14 patients had neck cancer. Technical success was achieved in 23 out of the 25 procedures (92%). Two procedures failed (8%) and were converted to the conventional technique by using the nasogastric tube. No major complications were reported. Minor complications were observed in 5 patients (20%): intraperitoneal air and contrast leakage in 4 patients and focal mucosal dissection by the contrast in 1 patient.
Conclusion
The MPRG has high technical success rate, is safe with no major complications, and is most feasible when endoscopic or nasogastric access cannot be performed.
Collapse
|
|
4
|
Shukla PA, Kolber MK, Tapnio R, Zybulewski A, Kumar A, Patel RI. Safety and Feasibility of Ultrasound-Guided Gastric Access for Percutaneous Transabdominal Gastrostomy Tube Placement. Gastroenterology Res 2019; 12:115-119. [PMID: 31236151 PMCID: PMC6575128 DOI: 10.14740/gr1136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/30/2019] [Indexed: 11/30/2022] Open
Abstract
Background The aim of the study was to evaluate the safety and feasibility of ultrasound guidance gastric access for percutaneous retrograde transabdominal gastrostomy (G)-tube placement. Methods Twenty-eight patients undergoing 31 percutaneous retrograde transabdominal G-tube placements utilizing ultrasound-guided gastric accesses were retrospectively identified. Results All patients had successful placement of G tubes with ultrasound-guided gastric access. There were no cases of aspiration or peritonitis. Average fluoroscopy time was 2.7 ± 1.4 min and average radiation dose was 220 ± 202 µGym2. Conclusions Ultrasound-guided access for gastrostomy placement is safe and feasible and can be performed with minimal fluoroscopy times resulting in low patient and operator radiation dose.
Collapse
Affiliation(s)
- Pratik A Shukla
- Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, Mount Sinai Hospital System, Icahn School of Medicine, First Avenue at Sixteenth Street, New York, NY 10010, USA
| | - Marcin K Kolber
- Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, Mount Sinai Hospital System, Icahn School of Medicine, First Avenue at Sixteenth Street, New York, NY 10010, USA
| | - Richard Tapnio
- Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, Mount Sinai Hospital System, Icahn School of Medicine, First Avenue at Sixteenth Street, New York, NY 10010, USA
| | - Adam Zybulewski
- Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, Mount Sinai Hospital System, Icahn School of Medicine, First Avenue at Sixteenth Street, New York, NY 10010, USA
| | - Abhishek Kumar
- Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, Mount Sinai Hospital System, Icahn School of Medicine, First Avenue at Sixteenth Street, New York, NY 10010, USA
| | - Rajesh I Patel
- Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, Mount Sinai Hospital System, Icahn School of Medicine, First Avenue at Sixteenth Street, New York, NY 10010, USA
| |
Collapse
|
|
5
|
Moriwaki Y, Otani J, Okuda J, Zotani H, Kasuga S. Percutaneous sonographically assisted endoscopic gastrostomy for difficult cases with interposed organs. Nutrition 2018; 54:100-104. [PMID: 29778906 DOI: 10.1016/j.nut.2018.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/17/2018] [Accepted: 02/13/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this retrospective observational study was to clarify the usefulness and safety of percutaneous sonographically assisted endoscopic gastrostomy or duodenostomy (PSEGD) using the introduction method. METHODS The information for the sequential 22 patients who could not undergo standard percutaneous endoscopic gastrostomy (PEG) and underwent PSEGD for 3 y was extracted and was reviewed. In standard PEG, we performed pushing out of the stomach from the mediastinum and full distention to adhere the gastric wall to the peritoneal wall without interposing of the intraperitoneal tissues by air inflation and a turning-over procedure of the endoscope, four-point square fixation of the stomach to the peritoneal wall by using a Funada-style gastric wall fixation kit under diaphanoscopy, extracorporeal thumb pushing, and in difficult cases extracorporeal ultrasound guidance, and if necessary confirmation of fixation of the gastric wall to the peritoneal wall and placement of the PEG tube without any interposed tissues by using ultrasound. RESULTS Twenty-one patients (95.5%) successfully underwent PSEGD. Early complications (more than grade 2 in Clavien-Dindo classification) just after the procedure occurred in one case (active oozing). We did not encounter a case with mispuncture of the intraperitoneal organs and tissues. Delayed complications occurring within 1 mo were pneumonia in five patients, including death in three cases; bleeding from puncture site in two patients; and atrial fibrilation in one patient. CONCLUSION PSEGD using the introduction method is a useful procedure for difficult patients in whom intraperitoneal organ or tissue is suspected to be interposed between the abdominal wall and stomach.
Collapse
Affiliation(s)
| | - Jun Otani
- Department of Surgery, Unnan City Hospital, Shimane, Japan
| | - Junzo Okuda
- Department of Surgery, Unnan City Hospital, Shimane, Japan
| | - Hitomi Zotani
- Department of Surgery, Unnan City Hospital, Shimane, Japan
| | - So Kasuga
- Department of Surgery, Unnan City Hospital, Shimane, Japan
| |
Collapse
|
|
6
|
Use of Point-of-Care Ultrasound to Guide Pediatric Gastrostomy Tube Replacement in the Emergency Department. Pediatr Emerg Care 2018; 34:145-148. [PMID: 29346232 DOI: 10.1097/pec.0000000000001400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The presentation of a pediatric patient to the emergency department for a malfunctioning or dislodged gastrostomy tube (G-tube) is not uncommon. As such, these tubes are often replaced at the bedside. Improper placement can result in a number of complications, including perforation, fistula tract formation, peritonitis, and sepsis. The current criterion standard method to confirm proper G-tube placement is contrast-enhanced radiography. However, point-of-care ultrasound may be an alternative method to guide and confirm pediatric G-tube replacement in the emergency department. We report a series of cases on this novel point-of-care ultrasound application.
Collapse
|
|
7
|
Ultrasound-guided gastrostomy tube placement: A case series. J Pediatr Surg 2017; 52:1210-1214. [PMID: 28408076 DOI: 10.1016/j.jpedsurg.2017.03.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/10/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Gastrostomy tubes (G-tubes) can be placed utilizing a variety of techniques. Here we present a case series to demonstrate feasibility of a novel method, ultrasound-guided G-tube placement (USGTP). METHODS All cases of USGTP at our institution from September 2015-August 2016 were reviewed. Data included demographics, operative time, complications, time to first feeding, and 30-day readmissions. All steps of the procedure were carried out using ultrasound guidance, resulting in placement of a low-profile G-tube. RESULTS Twelve patients underwent USGTP. Median age at operation was 2.6years (IQR 0.9-5.3) and median weight 9.9kg (IQR 7.2-18.4). Median operative time was 27min. (IQR 20-44). First feeding occurred 8.8±2.9h after the procedure. The second patient in the series experienced the only operative complication. In this case, a linear probe was used with insufficient gastric distension, resulting in placement of the tube through a fold in the stomach wall. This was recognized and remedied intraoperatively. This prompted successful technique modification for future USGTPs. Only one patient was readmitted within 30days, and this was related to urinary retention, an underlying problem. CONCLUSION US-guided G-tube placement appears initially to be safe, efficient and effective. Advantages include good anatomical delineation, a single incision, initial placement of a low-profile G-tube, and avoidance of endoscopy, laparoscopy, and radiation. This report illustrates feasibility of USGTP paving the way for further investigation and comparison to other existing gastrostomy insertion methods. LEVEL OF EVIDENCE IV.
Collapse
|
|
8
|
Kato K, Iwasaki Y, Onodera K, Matsuda M, Higuchi M, Kato K, Kato Y, Taniguchi M, Furukawa H. Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy Combined with CT-GC. J INVEST SURG 2017; 30:193-200. [PMID: 27700181 DOI: 10.1080/08941939.2016.1232451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/31/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. MATERIALS AND METHODS In total, seven high-risk individuals diagnosed using computed tomography (CT)-gastrocolonography (GC) underwent laparoscopic-assisted PEG (LAPEG) placement. Study endpoints included the success of LAPEG under local anesthetic and intravenous sedation, inability to thread the PEG tube, the eventual tube location, the number of tube adjustments needed, adverse events, the operating time, and PEG tube-related infection. RESULTS In total, 135 PEG procedures were performed during this study. Successful CT-GC was achieved in all 135 patients, and we successfully used a standard PEG technique to place the gastrostomy tube in 128 patients (95%). In seven patients (5%), the LAPEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. LAPEG procedure-related minor complications were observed in two patients. CONCLUSIONS LAPEG combined with CT-GC can be used for patients with difficult anatomical orientations and may minimize the risk of complications in PEG placement.
Collapse
Affiliation(s)
- Kazuya Kato
- a Department of Surgery , Pippu Clinic , Hokkaido , Japan
| | - Yoshiaki Iwasaki
- b Department of Gastroenterology and Hepatology , Okayama University , Okayama , Japan
| | | | - Minoru Matsuda
- d Department of Surgery , Nihon University , Tokyo , Japan
| | - Mineko Higuchi
- a Department of Surgery , Pippu Clinic , Hokkaido , Japan
| | - Kimitaka Kato
- a Department of Surgery , Pippu Clinic , Hokkaido , Japan
| | - Yurina Kato
- e Department of Oral Surgery , Jikei University , Tokyo , Japan
| | - Masahiko Taniguchi
- f Department of Surgery , Asahikawa Medical University , Asahikawa , Japan
| | - Hiroyuki Furukawa
- f Department of Surgery , Asahikawa Medical University , Asahikawa , Japan
| |
Collapse
|
|
9
|
Ray DM, Srinivasan I, Tang SJ, Vilmann AS, Vilmann P, McCowan TC, Patel AM. Complementary roles of interventional radiology and therapeutic endoscopy in gastroenterology. World J Radiol 2017; 9:97-111. [PMID: 28396724 PMCID: PMC5368632 DOI: 10.4329/wjr.v9.i3.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/12/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Acute upper and lower gastrointestinal bleeding, enteral feeding, cecostomy tubes and luminal strictures are some of the common reasons for gastroenterology service. While surgery was initially considered the main treatment modality, the advent of both therapeutic endoscopy and interventional radiology have resulted in the paradigm shift in the management of these conditions. In this paper, we discuss the patient’s work up, indications, and complementary roles of endoscopic and angiographic management in the settings of gastrointestinal bleeding, enteral feeding, cecostomy tube placement and luminal strictures. These conditions often require multidisciplinary approaches involving a team of interventional radiologists, gastroenterologists and surgeons. Further, the authors also aim to describe how the fields of interventional radiology and gastrointestinal endoscopy are overlapping and complementary in the management of these complex conditions.
Collapse
|
|
10
|
Abstract
The early institution of enteral nutrition is now accepted as the preferred route of feeding in critically ill patients with a functioning gastrointestinal tract. It is particularly important to establish early enteral nutrition in mechanically ventilated patients because of the metabolic demands associated with mechanical ventilation. The options for enteral access in mechanically ventilated patients are reviewed, with an emphasis on those techniques that may be performed at the bedside. The advantages, disadvantages, and complications of the different techniques will be considered.
Collapse
Affiliation(s)
- Andrew D Guidroz
- Section of Gastroenterology/Hepatology, Medical College of Georgia, Augusta, Georgia 30912, USA
| | | |
Collapse
|
|
11
|
Moriwaki Y, Otani J, Sawada Y, Okuda J, Niwano T, Ntta T, Ohshima C. Percutaneous transhepatic duodenostomy for a gastrectomy case with CT guidance and real-time visualization by an ultrasound and endoscopy. Nutrition 2015; 31:1168-72. [PMID: 26233876 DOI: 10.1016/j.nut.2015.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 03/19/2015] [Accepted: 04/07/2015] [Indexed: 01/25/2023]
Abstract
After gastrectomy, the remnant stomach, a small stomach behind the lateral segment of the liver, is thought to be a relative contraindication to receiving a percutaneous endoscopy-guided gastrostomy (PEG). We successfully performed a percutaneous duodenostomy in a case with remnant stomach. We used a transhepatic pull method with computed tomography (CT) guidance and real-time visualization by using ultrasound (US) and an endoscopy. The procedure was as follows: 1. Full stretching of the remnant stomach; 2. Insertion of a fine injection needle into the duodenal lumen through the lateral segment of the liver without an intrahepatic vascular and biliary injury using real-time visualization through US; 3. Confirmation of the location of the fine needle using abdominal CT, which showed the fine needle penetrating through the lateral segment and the duodenal lumen; 4. Insertion of the thick needle of the PEG kit just laterally of the fine needle; 5. Confirmation of the location of the thick needle using a repeated CT; 6. Endoscopic confirmation of the location of the two needles; 7. Changing the direction of the thick needle using guidance with endoscopy, inserting the thick needle into the duodenal lumen, and removing the fine needle; 8. Insertion of the guide wire through the thick needle; and 9. Placement of the PEG tube using the pull method. Using a real-time US scan, we detected the puncture of the anterior wall of the duodenum or stomach and avoided intrahepatic major vascular and biliary injuries.
Collapse
Affiliation(s)
| | - Jun Otani
- Department of Surgery, Unnan City Hospital, Unnan, Shimane, Japan; Department of Nutritional Support, Unnan City Hospital, Unnan, Shimane, Japan
| | - Yoshiyuki Sawada
- Department of Surgery, Unnan City Hospital, Unnan, Shimane, Japan; Department of Nutritional Support, Unnan City Hospital, Unnan, Shimane, Japan
| | - Junzo Okuda
- Department of Surgery, Unnan City Hospital, Unnan, Shimane, Japan
| | - Toshiyuki Niwano
- Department of Surgery, Unnan City Hospital, Unnan, Shimane, Japan
| | - Tachiko Ntta
- Department of Nutritional Support, Unnan City Hospital, Unnan, Shimane, Japan
| | - Chiaki Ohshima
- Department of Nutritional Support, Unnan City Hospital, Unnan, Shimane, Japan
| |
Collapse
|
|
12
|
Kato K, Taniguchi M, Iwasaki Y, Sasahara K, Nagase A, Onodera K, Matsuda M, Inaba Y, Kawakami T, Higuchi M, Kobashi Y, Furukawa H. Computed tomography-gastro-colonography for percutaneous endoscopic gastrostomy using a helical computed tomography. Am J Surg 2015; 210:374-381. [PMID: 25912624 DOI: 10.1016/j.amjsurg.2014.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/04/2014] [Accepted: 10/11/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. METHODS In total, 48 individuals underwent computed tomography-gastro-colonography (CT-GC)-guided PEG placement. Study end points included success of CT-GC, inability to thread the PEG tube, the eventual tube location, tube adjustments needed, adverse events, operating time, and PEG tube-related infection. RESULTS A successful CT-GC was achieved in all 48 patients (100%), and we successfully used a standard PEG technique to place the gastrostomy tube in 44 patients (92%). In 4 patients (8%), the laparoscopic-assisted PEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. The overall procedure-related minor complication rate was 8%. CONCLUSION CT-GC is an optional method for the estimation of intra-abdominal, anatomical orientations that may minimize the risk of complications before PEG placement.
Collapse
Affiliation(s)
- Kazuya Kato
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan.
| | - Masahiko Taniguchi
- Department of Surgery, Asahikawa Medical University, 1-1, 2-1, Midorigaoka, Asahikawa City 078-8510, Japan
| | - Yoshiaki Iwasaki
- Department of Gastroenterology and Hepatology, Okayama University, 2-5-1, Shikata Town, Okayama City, Okayama 700-8558, Japan
| | - Keita Sasahara
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan
| | - Atsushi Nagase
- Department of Surgery, Asahikawa Medical Center, 4048, 7 cyome, Hanasaki-cyo, Asahikawa City 070-8644, Japan
| | - Kazuhiko Onodera
- Department of Surgery, Hokuyu Hospital, 5-1, 6-6 Higashi-Sappro, Shiroishi-ku, Sapporo City 003-0006, Japan
| | - Minoru Matsuda
- Department of Surgery, Nihon University, 1-8-13 Surugadai Kanda, Chiyoda-ku, Tokyo 010-8309, Japan
| | - Yuhei Inaba
- Department of Internal Medicine, Asahikawa Medical University, 1-1, 2-1, Midorigaoka, Asahikawa City 078-8510, Japan
| | - Takako Kawakami
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan
| | - Mineko Higuchi
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan
| | - Yuko Kobashi
- Department of Radiology, Jikei University, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroyuki Furukawa
- Department of Surgery, Asahikawa Medical University, 1-1, 2-1, Midorigaoka, Asahikawa City 078-8510, Japan
| |
Collapse
|
|
13
|
Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol 2014; 20:8505-8524. [PMID: 25024606 PMCID: PMC4093701 DOI: 10.3748/wjg.v20.i26.8505] [Citation(s) in RCA: 266] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 02/23/2014] [Accepted: 04/15/2014] [Indexed: 02/06/2023] Open
Abstract
Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction, and patients who are critically ill. However, despite the benefits and widespread use of enteral tube feeding, some patients experience complications. This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding, together with associated complications and special aspects. We conducted an extensive literature search on PubMed, Embase and Medline using index terms relating to enteral access, enteral feeding/nutrition, tube feeding, percutaneous endoscopic gastrostomy/jejunostomy, endoscopic nasoenteric tube, nasogastric tube, and refeeding syndrome. The literature showed common routes of enteral access to include nasoenteral tube, gastrostomy and jejunostomy, while complications fall into four major categories: mechanical, e.g., tube blockage or removal; gastrointestinal, e.g., diarrhea; infectious e.g., aspiration pneumonia, tube site infection; and metabolic, e.g., refeeding syndrome, hyperglycemia. Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route, gastrointestinal complications are without doubt the most common. Complications associated with enteral tube feeding can be reduced by careful observance of guidelines, including those related to food composition, administration rate, portion size, food temperature and patient supervision.
Collapse
|
|
14
|
Chang WK, Hsieh TY. Safety of percutaneous endoscopic gastrostomy in high-risk patients. J Gastroenterol Hepatol 2013; 28 Suppl 4:118-22. [PMID: 24251717 DOI: 10.1111/jgh.12300] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 12/21/2022]
Abstract
Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure. However, failure to transilluminate the anterior wall of the stomach or visualize the indentation of the physician's finger represents the most frequent obstacles encountered by the endoscopist in safely completing PEG tube placement. We described several methods to safely assess PEG placement in high-risk patients. An abdominal plain film after gastric insufflated with 500 mL of air is obtained before PEG in patients. The body of the stomach near the angularis, equidistant from the greater and lesser curves, was defined as the optimal gastric puncture point. The location of the puncture points varied greatly, being situated over the right upper quadrant in 31% of patients, left upper in 59%, left lower in 5%, and right lower quadrant in 5% of patients. If there is any question of safe puncture site selection, safe track technique can be used to provide the information of depth and angle of the puncture tract. Computed tomography can provide detailed anatomy and orientation along the PEG tube and show detailed anatomical images along the PEG tract. Computed tomography-guided PEG tube placement is used when there is difficulty either insufflating the stomach, or the patients had previous surgery, or anatomical problems. Full assessment of the position of the stomach and adjacent organs prior to gastric puncture may help minimize the risk for potential complications and provide safety for the high-risk patients.
Collapse
Affiliation(s)
- Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | |
Collapse
|
|
15
|
Inaba Y, Yamaura H, Sato Y, Kashima M, Kato M, Inoue D, Kurinobu T, Sato T. Percutaneous Radiologic Gastrostomy in Patients with Malignant Pharyngoesophageal Obstruction. Jpn J Clin Oncol 2013; 43:713-718. [DOI: 10.1093/jjco/hyt069] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
|
16
|
Heberlein WE, Goodwin WJ, Wood CE, Yousaf M, Culp WC. Gastrostomy Tube Placement Without Nasogastric Tube: A Retrospective Evaluation in 85 Patients. Cardiovasc Intervent Radiol 2011; 35:1433-8. [DOI: 10.1007/s00270-011-0321-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 11/12/2011] [Indexed: 10/14/2022]
|
|
17
|
Marcy PY, Lacout A, Figl A, Thariat J. Re: Tips and tricks of percutaneous gastrostomy under image guidance in patients with limited access. Korean J Radiol 2011; 12:648-9; author reply 650. [PMID: 21927571 PMCID: PMC3168811 DOI: 10.3348/kjr.2011.12.5.648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 06/03/2011] [Indexed: 11/15/2022] Open
Affiliation(s)
- Pierre-Yves Marcy
- Interventional Radiology Department, Antoine Lacassagne Cancer Research Institute, Sophia Antipolis University, 06189 Nice cedex 1, France
| | - Alexis Lacout
- Radiodiagnostic Department, Centre Médico-Chirurgical, 15000-Aurillac, France
| | - Andrea Figl
- Oncology Surgeon, Oncology Surgery Department, Antoine Lacassagne Cancer Research Institute, Sophia Antipolis University, 06189 Nice cedex 1, France
| | - Juliette Thariat
- Radiotherapy Department, Antoine Lacassagne Cancer Research Institute, Sophia Antipolis University, 06189 Nice cedex 1, France
| |
Collapse
|
|
18
|
Abstract
Many patients with advanced head and neck cancer are already in a poor nutritional status and need supportive nutritional therapy at the time of initial diagnosis. Malnutrition is associated with delayed recovery, prolonged hospital stay and unfavorable prognosis. By using percutaneous endoscopic gastrostomy (PEG), the social stigmatization for the patient resulting from the conspicuous nasal feeding tube is avoided. The PEG can be easily implemented at the time of diagnosis by head and neck surgeons in patients suffering from massive tumor-associated weight loss, when definitive or adjuvant radiochemotherapy is anticipated, or prior to tumor surgery likely to be followed by prolonged significant dysphagia and protracted swallowing rehabilitation. Analgesics can be administered via the PEG tube, thus simplifying adequate pain management, which plays a central role in the care of head and neck cancer patients.
Collapse
|
|
19
|
Oleszczuk A, Spannbauer MM, Bluher M, Ott R, Pietsch UC, Schneider K, Madaj-Sterba P, Furll M, Hauss JP, Schön MR. Percutaneous intragastric catheter (PIC) for administration of an unpalatable substance to large animals. J INVEST SURG 2009; 22:122-8. [PMID: 19283615 DOI: 10.1080/08941930802713050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We studied an easy and reliable technique for administration of an unpalatable substance to large animals. There were three groups of pigs: group I (n = 6) received 1 g ethanol/kg body weight per day orally with water for 24 days, group II (n = 6) received 2 g ethanol/kg orally with water for 24 days and 4 g ethanol/kg via percutaneous intragastric catheter (PIC) for the next 24 days, group III (n = 6) received 6 g ethanol/kg via PIC for 72 days. The catheter was placed after insufflation of the stomach using an orogastric tube. PIC was successfully placed in each pig. No complications occurred during placement. The total amount of the administrated dose was assimilated each time. PIC is a safe, effective, well tolerated, and precise method of administering ethanol that is inexpensive and easy to perform. Ethanol administration via PIC is a convenient and effective mean of exposing animals to high levels of alcohol on a long-term basis.
Collapse
|
|
20
|
Meyer L, Pothuri B. Decompressive percutaneous gastrostomy tube use in gynecologic malignancies. Curr Treat Options Oncol 2006; 7:111-20. [PMID: 16455022 DOI: 10.1007/s11864-006-0046-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Percutaneous gastrostomy tube placement is a technically feasible and safe procedure for palliation in patients with small bowel obstruction (SBO) caused by advanced gynecologic malignancies. It is used commonly in patients who are poor surgical candidates, those who elect to not undergo surgery, and in patients with a limited lifespan because of end-stage cancer. Percutaneous gastrostomy tube placement is even technically possible in patients with tumor encasing the stomach, diffuse carcinomatosis, and ascites. Percutaneous endoscopic gastrostomy (PEG) tubes provide symptomatic relief of nausea and vomiting in most patients with advanced gynecologic cancer and SBO. PEG tube placement allows most patients to have end- of-life care at home or in an inpatient hospice. It is a cost effective procedure and is associated with low morbidity and mortality. Placement of PEG tubes should be highly considered in patients who present with recurrent bowel obstruction and who have undergone a prior operation for SBO in the setting of advanced gynecologic malignancy.
Collapse
Affiliation(s)
- Larissa Meyer
- Columbia University, College of Physicians and Surgeons, 161 Fort Washington Avenue, Herbert Irving Pavilion, 8-837, New York, NY 10032, USA
| | | |
Collapse
|
|
21
|
Quadri A, Umapathy N, Orme R. Percutaneous gastrostomy in patients with complete obstruction of the upper digestive tract. Eur J Radiol 2005; 56:74-7. [PMID: 15894446 DOI: 10.1016/j.ejrad.2005.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Revised: 03/16/2005] [Accepted: 03/24/2005] [Indexed: 11/23/2022]
Abstract
Gastrostomy for nutritional support can be performed radiologically when endoscopic technique is not possible. In patients with complete obstruction of the upper digestive tract, the radiological technique in its conventional method may not be possible, as insertion of naso-gastric tube for gastric insufflation is not always successful. We reviewed our experience of gastrostomy insertion in nine such patients after failure of the conventional method. In seven of the nine patients, initial gastric puncture was achieved with a 22G needle under direct ultrasound visualisation. In the remaining two patients, initial puncture was made into locules of gas in the stomach with fluoroscopy. The stomach was then distended with air and a gastrostomy tube inserted by conventional technique. We conclude that percutaneous gastrostomy can be undertaken safely even in the presence of complete obstruction of the upper digestive tract and recommend this technique in this selective group of patients.
Collapse
Affiliation(s)
- A Quadri
- Department of Head and Neck Surgery, Royal Shrewsbury Hospital, Shrewsbury SY3 8XQ, UK
| | | | | |
Collapse
|
|
22
|
Sinaasappel M, Stern M, Littlewood J, Wolfe S, Steinkamp G, Heijerman HGM, Robberecht E, Döring G. Nutrition in patients with cystic fibrosis: a European Consensus. J Cyst Fibros 2004; 1:51-75. [PMID: 15463811 DOI: 10.1016/s1569-1993(02)00032-2] [Citation(s) in RCA: 258] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This document is the result of an European Consensus conference which took place in Artimino, Tuscany, Italy, in March 2001 involving 33 experts on nutrition in patients with cystic fibrosis, organised by the European Cystic Fibrosis Society, and sponsored by Axcan-Scandipharm, Baxter, Dr Falk Pharma, Fresenius, Nutricia, SHS International, Solvay Pharmaceuticals (major sponsor). The purpose of the conference was to develop a consensus document on nutrition in patients with cystic fibrosis based on current evidence.
Collapse
Affiliation(s)
- M Sinaasappel
- Department of Paediatric Gastroenterology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
|
23
|
Varella LD, Young RJ. New options for pumps and tubes: progress in enteral feeding techniques and devices. Curr Opin Clin Nutr Metab Care 1999; 2:271-5. [PMID: 10453305 DOI: 10.1097/00075197-199907000-00004] [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: 11/25/2022]
Abstract
In the past, blenderized tube feeds prepared in the hospital kitchen were delivered by bolus or gravity at intervals of 4-6 h. These methods lack consistent steady flow and many times are not a safe mode of delivery for those at risk of vomiting and aspiration, and cause more patient discomfort than nutritional benefit. More recently, enteral feeding administration techniques and devices have been developed for the delivery of commercially prepared enteral formulas designed for specific disease states. These technological advances have improved enteral feeding practices.
Collapse
Affiliation(s)
- L D Varella
- Department of Surgery/Surgical Nutrition Service, Syracuse, New York 13210, USA
| | | |
Collapse
|
|
24
|
Abstract
Enteral nutrition is the preferred route for nutritional support compared with parenteral nutrition if the gastrointestinal tract is functionally preserved. Long-standing nasogastric or nasoenteric feeding tubes are not well tolerated. Alternative routes are gastrostomy and jejunostomy. Percutaneous endoscopic gastrostomy/jejunostomy or those guided by fluoroscopy, sonography or tomography should be the first choices. Laparoscopy or laparotomy gastrostomy/jejunostomy routes should be reserved for specific situations. Insufflation of the stomach with air or saline solution facilitates the placement of nasoenteric feeding tubes or percutaneous sonographic-guided gastrostomy. The gastrostomy button is a safe and aesthetic alternative, at least in children. Comparison between percutaneous endoscopic gastrostomy and surgical gastrostomy performed either via laparotomy or laparoscopy favours the first in terms of costs and risks. Whenever associated intra-abdominal procedures or anatomic difficulties arise, a laparoscopic or an open access becomes necessary. Complications with feeding tubes are not uncommon and should be promptly recognized and treated.
Collapse
Affiliation(s)
- A C Campos
- Department of Surgery, Federal University of Parana, Curitiba, Brazil.
| | | |
Collapse
|