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Costici PF, Russo R, Brigato P, De Salvatore S, Vescio A, Oggiano L, Donati F. Safety and efficacy of the novel subfascial with umbilicus detachment technique for intrathecal baclofen therapy in pediatric patients with cerebral palsy and low body mass index. Childs Nerv Syst 2025; 41:118. [PMID: 39985717 DOI: 10.1007/s00381-025-06772-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Accepted: 02/13/2025] [Indexed: 02/24/2025]
Abstract
PURPOSE Intrathecal baclofen (ITB) therapy is a key intervention for managing severe spasticity in pediatric cerebral palsy (CP) patients. However, standard surgical techniques for ITB pump placement pose challenges in low body mass index (BMI) patients, who have limited soft tissue coverage, increasing the risk of complications such as infections and skin erosions. This study compares three techniques-subcutaneous (SC), subfascial (SF), and a novel subfascial with umbilicus detachment (SFUD) approach-specifically aimed at reducing these risks and improving surgical outcomes in this vulnerable population. METHODS Retrospective cohort study on 54 pediatric CP patients (BMI ≤ 18.5 kg/m2) who underwent initial ITB implantation from January 2004 to July 2018. Patients were divided into SC, SF, and SFUD groups, and outcomes such as surgical time, blood loss, length of hospital stay (LOS), complications, and pump explants were analyzed. RESULTS The SFUD group had the highest successful implant rate (93.7%), compared to 79.2% for SF and 57.1% for SC (p < 0.05). SFUD also showed the lowest complication rates, with minimal infections and no skin erosions or pump removals. The SC group experienced the highest complications, including infections and skin erosions. Mean LOS was significantly shorter in the SFUD group. CONCLUSION The SFUD technique provides a safe and effective alternative for ITB pump implantation in CP patients with low BMI, reducing complications and improving implant stability. Further studies are warranted to confirm these findings and support broader clinical adoption.
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Affiliation(s)
- Pier Francesco Costici
- Department of General Surgery and Medical Surgical Specialties, Orthopedics Unit, Bambino Gesù Pediatric Hospital, Palidoro, Rome, Italy
| | - Rosa Russo
- Department of General Surgery and Medical Surgical Specialties, Orthopedics Unit, Bambino Gesù Pediatric Hospital, Palidoro, Rome, Italy
| | - Paolo Brigato
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy
| | - Sergio De Salvatore
- Department of General Surgery and Medical Surgical Specialties, Orthopedics Unit, Bambino Gesù Pediatric Hospital, Palidoro, Rome, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy.
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, Policlinico-Vittorio Emanuele, University of Catania, A.O.U, Catania, Italy
| | - Leonardo Oggiano
- Department of General Surgery and Medical Surgical Specialties, Orthopedics Unit, Bambino Gesù Pediatric Hospital, Palidoro, Rome, Italy
| | - Fabrizio Donati
- Department of General Surgery and Medical Surgical Specialties, Orthopedics Unit, Bambino Gesù Pediatric Hospital, Palidoro, Rome, Italy
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Shimamoto K, Matsui R, Nishiyama Y, Nishino K, Ban H. Impact of severe dysphagia on overall survival after percutaneous endoscopic gastrostomy. Sci Rep 2025; 15:3617. [PMID: 39875545 PMCID: PMC11775191 DOI: 10.1038/s41598-025-88097-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 01/24/2025] [Indexed: 01/30/2025] Open
Abstract
In this study, we investigated the effect of severe dysphagia on the overall survival of patients who underwent PEG. A cohort of patients who underwent PEG between April 2016 and April 2021 was retrospectively analyzed. The Hyodo-Komagane score was used to evaluate swallowing via endoscopy. Patients with a Hyodo-Komagane score ≤ 8 were defined as having moderate dysphagia, whereas those with a score ≥ 9 were defined as having severe dysphagia. The primary outcome was overall survival. The prognostic factors were identified using multivariate analysis with the Cox proportional hazards model. Values of p < 0.05 were considered statistically significant. Among the 107 patients, 60 (56.1%) were classified into the moderate dysphagia group and 47 (43.9%) into the severe dysphagia group. The median follow-up period was 16.7 months. The overall survival was significantly worse in the severe group than in the moderate group (p < 0.0001). A multivariate analysis revealed that severe dysphagia was an independent poor prognostic factor (hazard ratio, 2.956; 95% confidence interval, 1.592-5.489; p < 0.001). Aspiration-related pneumonia was most common causes of death after PEG. Severe dysphagia was identified as an independent poor prognostic factor for survival in patients who underwent PEG.
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Affiliation(s)
- Kazumi Shimamoto
- Department of Gastroenterology, Omi Medical Center, 1660 Yabase-cho, Kusatsu, 525- 8585, Shiga, Japan.
| | - Ryota Matsui
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
- Department of Upper Gastrointestinal Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo- ku, Tokyo, 113-8431, Japan
| | - Yorihiro Nishiyama
- Department of Gastroenterology, Omi Medical Center, 1660 Yabase-cho, Kusatsu, 525- 8585, Shiga, Japan
| | - Kyohei Nishino
- Department of Gastroenterology, Omi Medical Center, 1660 Yabase-cho, Kusatsu, 525- 8585, Shiga, Japan
| | - Hiromitsu Ban
- Department of Gastroenterology, Omi Medical Center, 1660 Yabase-cho, Kusatsu, 525- 8585, Shiga, Japan
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Girardi N, Wharton B, Cicuto K, Wiley A, LaGrone L. Hybrid Endoscopic/Fluoroscopic Gastrostomy Tube Placement: Case Report of a Novel Technique. Case Rep Gastroenterol 2025; 19:72-78. [PMID: 39967998 PMCID: PMC11835415 DOI: 10.1159/000542809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 11/18/2024] [Indexed: 02/20/2025] Open
Abstract
Introduction We report the case of a 60-year-old female with a history of perforated gastric ulcer, abdominal abscesses, enterocutaneous fistula, and small bowel obstruction requiring durable gastric decompression prior to delayed fistula takedown. The patient had contraindications to or failed attempts at traditional gastrostomy approaches (surgical, endoscopic, interventional radiology). Case Report Gastrostomy was successfully performed via a novel technique combining interventional radiology and endoscopic placement. Discussion In certain patients with complex presentations, a hybrid approach to gastrostomy tube placement using fluoroscopy and endoscopy may prove a viable alternative when traditional methods are contraindicated or unsuccessful.
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Affiliation(s)
| | | | | | - Alysia Wiley
- UCHealth, Medical Center of the Rockies, Loveland, CO, USA
| | - Lacey LaGrone
- UCHealth, Medical Center of the Rockies, Loveland, CO, USA
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Ahmad MB, Ansar F, Shakoor K, Adnan M, Naqi SA, Tahir Z, Rauf MS, Bin Shafaat Chaudhary U, Alamgir A, Aslam N. Compliance With Percutaneous Endoscopic Gastrostomy Tube Insertion Guidelines and Associated Complications in a Tertiary Care Setting: A Clinical Audit. Cureus 2023; 15:e43566. [PMID: 37719490 PMCID: PMC10503224 DOI: 10.7759/cureus.43566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION Percutaneous endoscopic gastrostomy (PEG) tube insertion is a widely utilized enteral access technique offering long-term nutritional support for patients unable to tolerate oral intake. While the PEG tube provides numerous advantages, adherence to evidence-based guidelines is crucial to minimize complications. This study aims to evaluate adherence to PEG tube insertion guidelines and analyze associated complication rates in a tertiary care setting. METHODS A retrospective clinical audit was conducted at Quaid-e-Azam International Hospital, Islamabad. Data were collected over three years from patients undergoing PEG tube insertion by a single consultant gastrointestinal surgeon. Adherence to guidelines was evaluated using a 10-item checklist developed based on European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Complication rates and patient characteristics were analyzed. RESULTS The study included 70 participants (mean age = 72.21 ± 13.17). The PEG tube insertion rate was 100%. The mean checklist score was 8.34 ± 1.2. Laboratory investigations were performed for 98.6% of patients. 91.4% of patients had a life expectancy exceeding 30 days. 60% of patients received an anticoagulation hold. Prophylactic antibiotics were administered to 90% of patients. Psychological counseling and dietician consultation were offered to 38.6% and 64.2% of patients, respectively. Caregivers received specialized training in 98.5% of cases. 12.8% of patients experienced early complications post-procedure, and 14.2% experienced late complications. PEG tube removal occurred in 27% of patients, with only one patient experiencing complications after removal. CONCLUSION Adherence to PEG tube insertion guidelines was observed in various aspects of patient care, resulting in a low incidence of complications. Comprehensive auditing and guideline adherence are essential to ensure optimal patient safety and procedural outcomes.
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Affiliation(s)
| | - Farrukh Ansar
- Medicine, Quaid-e-Azam International Hospital, Islamabad, PAK
| | - Kainaat Shakoor
- Medicine, Quaid-e-Azam International Hospital, Islamabad, PAK
| | - Muhammad Adnan
- Medicine, Quaid-e-Azam International Hospital, Islamabad, PAK
| | - Syed Ali Naqi
- Surgery, Quaid-e-Azam International Hospital, Islamabad, PAK
| | - Zainab Tahir
- Surgery, Quaid-e-Azam International Hospital, Islamabad, PAK
| | - Mohammad S Rauf
- Medicine and Surgery, Northwest General Hospital, Peshawar, PAK
| | | | - Asad Alamgir
- Internal Medicine, Fauji Foundation Hospital Rawalpindi, Islamabad, PAK
| | - Nabiha Aslam
- Surgery, Quaid-e-Azam International Hospital, Islamabad, PAK
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Muacevic A, Adler JR, Asiri D, Yaqoub N, Alfraih S, Chachar YS, Jamil SF. A Comparison Between the Complications of Laparoscopic and Open Gastrostomy Tube Insertions: A Single-Center Study From Riyadh, Saudi Arabia. Cureus 2022; 14:e31992. [PMID: 36589165 PMCID: PMC9797873 DOI: 10.7759/cureus.31992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background and objective Gastrostomy is a procedure that involves placing a feeding tube through the abdominal wall into the stomach to provide nutritional support. There are several modes of gastrostomy tube insertion including laparoscopic-assisted gastrostomy (LAG), percutaneous endoscopic gastrostomy (PEG), and open gastrostomy (OG) procedure, among others. Although it is a widely performed procedure, limited data is available regarding gastrostomy in Saudi Arabia, specifically among the pediatric population. This study aimed to shed more light on different aspects of surgical gastrostomy procedures among pediatric patients at the King Abdullah Specialist Children's Hospital (KASCH) in Riyadh, Saudi Arabia. The main objective of our study was to report the indications and complications of both LAG and OG insertions in the pediatric population. Methods A retrospective cross-sectional study was conducted at KASCH to analyze the different parameters related to LAG and OG insertions, and to evaluate for any association between these modes of insertion and their complications. Pertinent data on children from birth to 14 years of age were collected through consecutive sampling using a chart review. A total of 107 pediatric patients who underwent the procedure from 2016 to 2020 were evaluated. Results Demographically, the majority (58%) of gastrostomies were performed in infants (less than a year old). Additionally, our study showed a significantly increased association between LAG and complications such as discharge, (27.12%), skin manifestations (27.12%), and bleeding (10.17%) when compared to OG. Conclusion Based on our findings, LAG showed less favorable outcomes in contrast to OG. Further studies should be conducted to validate our findings and ensure consistent results and outcomes among different methods of gastrostomy tube insertion.
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Saneian H, Mehrannia A, Sabzghabaee AM, Feizi A, Famouri F, Abtahi‐Naeini B. Topical Sucralfate for Prevention of Peristomal Wound Reaction related to Percutaneous Endoscopic Gastrostomy in Children: A Randomized Controlled Trial. Dermatol Ther 2022; 35:e15729. [DOI: 10.1111/dth.15729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/22/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Hossein Saneian
- Department of Pediatric Gastroenterology, Child Growth and Development Research Center, Research Institute of Primordial Prevention of Non‐Communicable Disease Isfahan University of Medical Sciences Isfahan Iran
| | - Atoosa Mehrannia
- Department of Pediatrics Isfahan University of Medical Sciences Isfahan Iran
| | | | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Health Isfahan University of Medical Sciences Isfahan Iran
| | - Fatemeh Famouri
- Department of Pediatric Gastroenterology, Child Growth and Development Research Center, Research Institute of Primordial Prevention of Non‐Communicable Disease Isfahan University of Medical Sciences Isfahan Iran
| | - Bahareh Abtahi‐Naeini
- Pediatric Dermatology Division of Department of Pediatrics, Imam Hossein Children's Hospital Isfahan University of Medical Sciences Isfahan Iran
- Skin Diseases and Leishmaniasis Research Center Isfahan University of Medical Sciences Isfahan Iran
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Essat M, Coates E, Clowes M, Beever D, Hackney G, White S, Stavroulakis T, Halliday V, McDermott C. Understanding the current nutritional management for people with amyotrophic lateral sclerosis - A mapping review. Clin Nutr ESPEN 2022; 49:328-340. [DOI: 10.1016/j.clnesp.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/17/2022] [Accepted: 03/13/2022] [Indexed: 11/16/2022]
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Bianchini S, Rigotti E, Monaco S, Nicoletti L, Auriti C, Castagnola E, Conti G, Galli L, Giuffrè M, La Grutta S, Lancella L, Lo Vecchio A, Maglietta G, Petrosillo N, Pietrasanta C, Principi N, Tesoro S, Venturini E, Piacentini G, Lima M, Staiano A, Esposito S, the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Group. Surgical Antimicrobial Prophylaxis in Abdominal Surgery for Neonates and Paediatrics: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:279. [PMID: 35203881 PMCID: PMC8868062 DOI: 10.3390/antibiotics11020279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 01/26/2023] Open
Abstract
Surgical site infections (SSIs), i.e., surgery-related infections that occur within 30 days after surgery without an implant and within one year if an implant is placed, complicate surgical procedures in up to 10% of cases, but an underestimation of the data is possible since about 50% of SSIs occur after the hospital discharge. Gastrointestinal surgical procedures are among the surgical procedures with the highest risk of SSIs, especially when colon surgery is considered. Data that were collected from children seem to indicate that the risk of SSIs can be higher than in adults. This consensus document describes the use of preoperative antibiotic prophylaxis in neonates and children that are undergoing abdominal surgery and has the purpose of providing guidance to healthcare professionals who take care of children to avoid unnecessary and dangerous use of antibiotics in these patients. The following surgical procedures were analyzed: (1) gastrointestinal endoscopy; (2) abdominal surgery with a laparoscopic or laparotomy approach; (3) small bowel surgery; (4) appendectomy; (5) abdominal wall defect correction interventions; (6) ileo-colic perforation; (7) colorectal procedures; (8) biliary tract procedures; and (9) surgery on the liver or pancreas. Thanks to the multidisciplinary contribution of experts belonging to the most important Italian scientific societies that take care of neonates and children, this document presents an invaluable reference tool for perioperative antibiotic prophylaxis in the paediatric and neonatal populations.
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Affiliation(s)
- Sonia Bianchini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Erika Rigotti
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (G.P.)
| | - Sara Monaco
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Laura Nicoletti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Cinzia Auriti
- Neonatology and Neonatal Intensive Care Unit, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Giannina Gaslini, 16147 Genoa, Italy;
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy;
| | - Luisa Galli
- Pediatric Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Mario Giuffrè
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90141 Palermo, Italy;
| | - Stefania La Grutta
- Institute for Biomedical Research and Innovation, National Research Council, 90146 Palermo, Italy;
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, Via D. Montesano 49, 80131 Naples, Italy; (A.L.V.); (A.S.)
| | - Giuseppe Maglietta
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy;
| | | | - Carlo Pietrasanta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Mother, Child and Infant, NICU, 20122 Milan, Italy;
| | | | - Simonetta Tesoro
- Division of Anesthesia, Analgesia and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, 06129 Perugia, Italy;
| | - Elisabetta Venturini
- Pediatric Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (G.P.)
| | - Mario Lima
- Paediatric Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, Via D. Montesano 49, 80131 Naples, Italy; (A.L.V.); (A.S.)
| | - Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
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Bowman CA, Hutchins E, Burgermaster M, Sant V, Seres DS. Nasal Feeding Tubes Are Associated with Fewer Adverse Events than Feeding via Ostomy in Hospitalized Patients Receiving Enteral Nutrition. Am J Med 2022; 135:97-102.e1. [PMID: 34543647 PMCID: PMC8688227 DOI: 10.1016/j.amjmed.2021.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 07/29/2021] [Accepted: 08/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical feeding ostomies (eg, gastrostomy) have become required by many nursing facilities for all patients receiving enteral nutrition, whether for short- or long-term use. These policies lack supportive evidence. Comparisons of adverse event rates between surgical and natural orifice tubes are few and lacking in the inpatient setting. Additionally, we hypothesize that adverse events related to feeding tubes are underreported. We sought to quantify adverse events to test the relative safety of surgical feeding ostomies and natural orifice (eg. nasogastric or orogastric) feeding tubes in hospitalized patients. METHODS This was a prospective observational cohort study of enterally fed inpatients using semiweekly focused physical examination, scripted survey, and chart review. RESULTS All tube-fed patients admitted to a large, urban, academic hospital received semiweekly bedside evaluation and chart review over a 9-week period (n = 226 unique patients, mean 6.25 visits each, total 1118 observations). Demographics were comparable between 148 subjects with natural orifice and 113 subjects with surgical feeding tubes. A higher incidence of adverse events was observed with surgical tubes (3.34 vs 1.25 events per 100 subject days, P < .001). Only 50% of all adverse events were documented in the medical record. More patients with surgical tubes were discharged to skilled nursing facilities (58% vs 24%). CONCLUSIONS Surgical feeding tubes are associated with significantly higher in-hospital adverse event rates when compared with natural orifice (nasal or oral) feeding tubes. Policies requiring surgical feeding ostomies should be reevaluated.
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Affiliation(s)
| | | | - Marissa Burgermaster
- Department of Nutritional Sciences, Dell Medical School, University of Texas at Austin, Austin
| | - Vivek Sant
- Department of Surgery, NYU School of Medicine, New York, NY
| | - David S Seres
- Institute of Human Nutrition and Department of Medicine, Columbia Univeristy Irving Medical Center, New York, NY.
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Zhu C, Platoff R, Ghobrial G, Saddemi J, Evangelisti T, Bucher E, Saracco B, Adams A, Kripalani S, Atabek U, Spitz FR, Hong YK. What to do When Decompressive Gastrostomies and Jejunostomies are not Options? A Scoping Review of Transesophageal Gastrostomy Tubes for Advanced Malignancies. Ann Surg Oncol 2022; 29:262-271. [PMID: 34546480 DOI: 10.1245/s10434-021-10667-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/05/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND In advanced malignant bowel obstruction, decompressive gastrostomy tubes (GTs) may not be feasible due to ascites, peritoneal carcinomatosis, and altered gastric anatomy. Whereas nasogastric tubes (NGTs) allow temporary decompression, percutaneous transesophageal gastrostomy tubes (PTEGs) are an alternative method for long-term palliative decompression. This study performed a scoping review to determine outcomes with PTEG in advanced malignancies. METHODS A systematic literature search was performed to include all studies that reported the clinical results of PTEGs for malignancy. No language, national, or publication status restrictions were used. RESULTS The analysis included 14 relevant studies with a total of 340 patients. In 11 studies, standard PTEGs were inserted with a rupture-free balloon's placement into the mouth or nose and esophageal puncture under fluoroscopy or ultrasound, followed by a guidewire into the stomach with placement of a single-lumen tube. Of 340 patients, 65 (19.1%) had minor complications, and 5 (2.1%) had significant complications, including bleeding and severe aspiration pneumonia. Of 171 patients, 169 with PTEGs (98.8%) reported relief of nasal discomfort from NGT and alleviation of obstructive symptoms. The one randomized controlled trial reported a significantly higher quality of life with PTEGs than with NGTs. CONCLUSIONS When decompression for advanced malignancy is technically not feasible with a gastrostomy tube, the PTEG is a viable, safe option for palliation. The PTEG is associated with lower significant complication rates than the gastrostomy tube and significantly higher patient-derived outcomes than the NGT.
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Affiliation(s)
- Clara Zhu
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | - Rebecca Platoff
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | - Gaby Ghobrial
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | - Jackson Saddemi
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | - Taylor Evangelisti
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | - Emily Bucher
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | | | - Amanda Adams
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Umur Atabek
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | - Francis R Spitz
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | - Young K Hong
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA.
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Kim IG, Cho H, Choi JJ, Shin JW, Chung EJ. Alternative non-oral nutrition in a rat model: a novel modified gastrostomy technique. Exp Anim 2021; 71:36-45. [PMID: 34470977 PMCID: PMC8828398 DOI: 10.1538/expanim.20-0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The gastrostomy technique is essential for esophageal reconstruction using a scaffold. To date, there are no established methods to supply nutrients through a gastrostomy tube in rats. The
purpose of this study was to analyze the feasibility of a newly modified gastrostomy technique for non-oral nutrition in an adult rat model. We modified the gastrostomy technique for adult
rats in a few different ways. (1) The external opening for food injection was made at the midpoint between the ears to prevent damage due to self-harm behaviour. (2) An imbedded subcutaneous
tunnel was created between the internal and external openings of the gastrostomy. We compared the efficacy and safety between groups with a T-tube for biliary drainage (TT group, n=14) and a
conventional silicone Foley catheter (FC group, n=7) as optimal gastrostomy tubes for in a rat model. We also evaluated the feasibility of the heparin cap connector at the end of gastrostomy
tube to control food supply in the TT group (with a cap, n=7; without a cap, n=7). No mortality was observed in the TT group with a cap, whereas most rats in the FC group died within 2 weeks
after the procedure. Weight loss decreased significantly in the TT group with a cap compared with all the other groups. The appearance and attitude scores were significantly better in the TT
group with a cap. In addition, histologic analysis showed that the TT group a cap showed a marked decrease over time in tissue fibrosis and macrophages compared with the other experimental
groups. Therefore, gastrostomy using a silicone T-tube plugged with a cap proved to be a stable and effective option for non-oral feeding in an adult rat model.
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Affiliation(s)
- In Gul Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital
| | - Hana Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital
| | - Jun Jae Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital
| | | | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital
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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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Abstract
Various approaches for enteral access exist, but because there is no single best approach it should be tailored to the needs of the patient. This article discusses the various enteral access techniques for nasoenteric tubes, gastrostomy, gastrojejunostomy, and direct jejunostomy as well as their indications, contraindications, and pitfalls. Also discussed is enteral access in altered anatomy. In addition, complications associated with these endoscopic techniques and how to either prevent or properly manage them are reviewed.
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Elsaid Hussein ES, Mohamed Abu Negm LM. Nursing-Based Guidelines for Caregivers regarding Adult Patients with Percutaneous Endoscopic Gastrostomy. Open Nurs J 2020. [DOI: 10.2174/1874434602014010148] [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
Background:
Percutaneous Endoscopic Gastrostomy (PEG) may cause complications when the management is inadequate and inappropriate. To avoid these complications, caregivers’ experiences and practices must be considered.
Study Aim:
This study aimed to evaluate the effect of nursing- based guidelines on caregivers’ knowledge and practices regarding adult patients with percutaneous endoscopic gastrostomy.
Methods:
A quasi-experimental design was used. The study was conducted in the medical and surgical departments in the National Cancer Institute, Cairo University, Egypt. Sample: The sample consisted of 30 patients with PEG and their caregivers. A Structured interviewing questionnaire, Self-Administered Structured Questionnaire for caregiver, Caregiver Performance observation checklist, and PEG-specific questionnaire were obtained for data collection
Results:
The majority of studied patients (86.7%) were suffering from oncologic problems, in post-test and following up, the majority (83.3%) of caregivers had satisfactory level (76.7) (90%) (70%) in knowledge, complication and management of PEG, respectively. During follow up, the majority (73.3%) (90%) of caregivers were well level as regarding nutritional management and care of PEG. There were statistically significant differences between pre/post and follow-up nursing-based guidelines for caregivers’ knowledge and practice regarding patients with percutaneous endoscopic gastrostomy. The results show an improvement in the patients outcomes and the level of caregiver coping with the care of PEG and overall Patient satisfaction at (χ2 = 3.844, 4.097) p<0.001
Conclusion:
Nursing-based guidelines were helpful in the improvement of the caregiver's knowledge and practice regarding percutaneous endoscopic gastrostomy.
Recommendations
Periodic educational training programs regarding PEG were based on the best practice guidelines for caregivers of those patients.
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Siu J, Fuller K, Nadler A, Pugash R, Cohen L, Deutsch K, Enepekides D, Karam I, Husain Z, Chan K, Singh S, Poon I, Higgins K, Xu B, Eskander A. Metastasis to gastrostomy sites from upper aerodigestive tract malignancies: a systematic review and meta-analysis. Gastrointest Endosc 2020; 91:1005-1014.e17. [PMID: 31926149 DOI: 10.1016/j.gie.2019.12.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/26/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Metastasis to the gastrostomy site in patients with upper aerodigestive tract (UADT) malignancies is a rare but devastating adverse event that has been poorly described. Our aim was to determine the overall incidence and clinicopathologic characteristics observed with development of gastrostomy site metastasis in patients with UADT cancers. METHODS This was a systematic review and meta-analysis of 6138 studies retrieved from Medline, EMBASE, CINAHL, and the Cochrane Register after being queried for studies including gastrostomy site metastasis in patients with UADT malignancies. RESULTS The final analysis included 121 studies. Pooled analysis showed an overall event rate gastrostomy site metastasis of .5% (95% confidence interval [CI], .4%-.7%). Subgroup analysis showed an event rate of .56% (95% CI, .40%-.79%) with the pull technique and .29% (95% CI, .15%-.55%) with the push technique. Clinicopathologic characteristics observed with gastrostomy site metastasis were late-stage disease (T3/T4) (57.8%), positive lymph node status (51.2%), and no evidence of systemic disease (M0) (62.8%) at initial presentation. The average time from gastrostomy placement to diagnosis of metastasis was 7.78 ± 4.9 months, average tumor size on detection was 4.65 cm (standard deviation, 2.02), and average length of survival was 7.26 months (standard deviation, 6.23). CONCLUSIONS Gastrostomy site metastasis is a rare but serious adverse event that occurs at an overall rate of .5%, particularly in patients with advanced-stage disease, and is observed with a very poor prognosis. These findings emphasize a need for clinical practice guidelines to include a regular assessment of the PEG site and highlight the importance of detection and management of gastrostomy site metastasis by the multidisciplinary care oncology team.
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Affiliation(s)
- Jennifer Siu
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kaitlin Fuller
- Gerstein Science Information Centre, University of Toronto Libraries, Toronto, Ontario, Canada
| | - Ashlie Nadler
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robyn Pugash
- Vascular/Interventional Radiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lawrence Cohen
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Konrado Deutsch
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada; Head & Neck Surgical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kelvin Chan
- Division of Medical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Canada
| | - Simron Singh
- Division of Medical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada; Head & Neck Surgical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada; Head & Neck Surgical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Otolaryngology-Head & Neck Surgery, Surgical Oncology, Michael Garron Hospital, Toronto, Ontario, Canada; Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Science, Toronto, Ontario, Canada
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A Case of Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy (LAPEG) for Gastric Volvulus. Case Rep Med 2019; 2019:3468084. [PMID: 31871462 PMCID: PMC6913307 DOI: 10.1155/2019/3468084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/24/2019] [Accepted: 11/20/2019] [Indexed: 11/18/2022] Open
Abstract
Background Percutaneous endoscopic gastrostomy (PEG) is the standard modality for long-term enteral nutrition for patients with dysphagia. Compared with open gastrostomy, though PEG is an extremely safe procedure with fewer complications, there are severe cases due to anatomical features. For these cases, laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) is the optimal method. Case Presentation A 52-year-old man had a disturbance in swallowing because of cerebral infarction. We attempted PEG under gastrointestinal fiberscope (GIF) and colon fiberscope inspection; however, the procedure was unsuccessful because it was impossible to move the transverse colon downward. We therefore attempted LAPEG to observe the stomach and other organs. Under laparoscopic observation, we diagnosed gastric volvulus, classified as the organo-axial type. For this reason, inserting the tube through the skin was very difficult. We easily corrected the gastric volvulus by using laparoscopic forceps and were finally able to place the PEG tube safely. Discussion Gastric volvulus is rare in clinical practice. The treatment of gastric volvulus depends on whether mucosal ischemia is present. Endoscopic reduction of gastric volvulus is effective for many patients. Surgical treatment should be considered for patients with gastric volvulus that frequently recurs. In our patient, completely inserting the GIF was impossible; therefore, we could not correctly diagnose gastric volvulus. Laparoscopy-assisted PEG is a useful and safe technique for placing a gastrostomy tube in patients presenting with anatomical difficulties. Moreover, in our patient, gastropexy was performed with PEG. Therefore, LAPEG may be used to prevent the recurrence of gastric volvulus. Gastropexy is a useful option in LAPEG. Conclusions Laparoscopy has the advantage of allowing a direct inspection of the stomach while gastrostomy is performed and may reveal complications to PEG insertion. Furthermore, in our patient, gastropexy was performed with PEG.
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Hausmann J, Kubesch A, Müller von der Grün J, Goettlich CM, Filmann N, Oliver Tal A, Vermehren J, Friedrich-Rust M, Wächtershäuser A, Bojunga J, Blumenstein I. Prophylactic percutaneous endoscopic gastrostomy in patients with head and neck cancer: Influence on nutritional status, utilisation rate and complications. Int J Clin Pract 2019; 73:e13405. [PMID: 31408231 DOI: 10.1111/ijcp.13405] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/30/2019] [Accepted: 08/08/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with head and neck cancer (HNC) are at high risk for malnutrition because of tumour localisation and therapy. Prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement is common practice to prevent malnutrition. OBJECTIVE To investigate the benefits of prophylactic PEG tube placement for HNC patients in terms of the influence on patients' nutritional status, utilisation rate, complications and to identify the predictors of PEG tube utilisation. METHODS All consecutive HNC patients who underwent prophylactic PEG tube insertion between 1 January 2011 and 31 December 2012 prior to therapy were enrolled. The PEG tube utilisation rate, complications, the patients' nutritional status and tumour therapy were evaluated with the help of electronic patient charts and telephone interviews. RESULTS A total of 181 patients (48 female, median 67.5 years) were included. The PEG utilisation rate in the entire cohort was 91.7%. One hundred and forty-nine patients (82.3%) used the PEG tube for total enteral nutrition, 17 patients (9.4%) for supplemental nutrition and 15 patients (8.3%) made no use of the PEG tube. Peristomal wound infections were the most common complications (40.3%) in this study. A high Nutritional Risk Screening (NRS) score prior to tube insertion was found to be independently associated with PEG utilisation. No significant weight changes were observed across the three patient subgroups. CONCLUSIONS The overall PEG tube utilisation rate was high in this study. However, given the high rate of infections, diligent patient selection is crucial in order to determine which patients benefit most from prophylactic PEG tube insertion.
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Affiliation(s)
- Johannes Hausmann
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alica Kubesch
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jens Müller von der Grün
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Carmen M Goettlich
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andrea Oliver Tal
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Johannes Vermehren
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Astrid Wächtershäuser
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jörg Bojunga
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Irina Blumenstein
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
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Tsaousi G, Stavrou G, Kapanidis K, Michalopoulos A, Kotzampassi K. Unsedated Outpatient Percutaneous Endoscopic Gastrostomy in Stroke Patients: Is It Feasible and Safe? Surg Laparosc Endosc Percutan Tech 2019; 29:383-388. [PMID: 31033632 DOI: 10.1097/sle.0000000000000661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Percutaneous endoscopic gastrostomy (PEG) is an established practice for long-term nutrition in dysphagia-suffering stroke patients. This study sought to determine the feasibility and safety of outpatient, unsedated PEG implementation in stroke patients. This retrospective cohort study involved stroke victims who underwent unsedated outpatient PEG insertion from 2014 to 2017 at our Surgical Endoscopy Unit. Patients were given pharyngeal anesthesia with lidocaine 10% spray, while the PEG tube was placed under local anesthesia. The incidence of intraprocedural and postprocedural complications and 30-day mortality rate were recorded. Data from 127 cases were analyzed. The procedures were performed with minor, transient complications, which resolved after rescue maneuvers. No intraprocedural and postprocedural major complications or death were observed. During the 30-day follow-up, the most important complication involved a single case of accidental PEG removal that was successfully resolved surgically. Unsedated PEG insertion appears to be a feasible, well-tolerated, and safe option for stroke-related dysphagia.
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Affiliation(s)
- Georgia Tsaousi
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
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19
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Cmorej P, Mayuiers M, Sugawa C. Management of early PEG tube dislodgement: simultaneous endoscopic closure of gastric wall defect and PEG replacement. BMJ Case Rep 2019; 12:12/9/e230728. [PMID: 31488448 DOI: 10.1136/bcr-2019-230728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
A 53-year-old man with dysphagia underwent uneventful placement of a percutaneous endoscopic gastrostomy (PEG) tube for long-term enteral feeding access. 11 hours after the procedure, it was discovered that he had accidentally dislodged the feeding tube. On physical examination, he was found to have a benign abdomen without evidence of peritonitis or sepsis. He was observed overnight with serial abdominal examinations and nasogastric decompression. In the morning, he was taken back to the endoscopy suite where endoscopic clips were employed to close the gastric wall defect and a PEG tube was replaced at an adjacent site. The patient was fed 24 hours thereafter and discharged from the hospital 48 hours after the procedure. Early accidental removal of a PEG tube in patients without sepsis or peritonitis can be safely treated with simultaneous endoscopic closure of the gastrotomy and PEG tube replacement, resulting in earlier enteral feeding and shorter hospital stay.
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Affiliation(s)
- Peter Cmorej
- Department of Surgery, Wayne State University, Detroit, Michigan, USA
| | - Matthew Mayuiers
- Department of Surgery, Wayne State University, Detroit, Michigan, USA
| | - Choichi Sugawa
- Department of Surgery, Wayne State University, Detroit, Michigan, USA
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20
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Evaluation of burden and depression among caregivers of stroke patients: The role of percutaneous endoscopic gastrostomy feeding tube. Clin Nutr ESPEN 2019; 33:154-157. [PMID: 31451253 DOI: 10.1016/j.clnesp.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 05/27/2019] [Accepted: 06/03/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND & AIMS Malnutrition problems are very common after a stroke. Several clinical studies have shown the contribution of percutaneous endoscopic gastrostomy (PEG) feeding after stroke in terms of improving nutritional status and reducing mortality. The aim of this study is to compare the burden and depression among caregivers of ischemic stroke patients fed with PEG and orally. METHODS A total of 63 caregivers of patients with acute ischemic stroke who were followed up in the neurointensive care unit with modified Rankin Scale 4 or 5 were recruited in this cross-sectional survey. Clinical data of patients and demographical profile as age, gender, kinship to patient, income, and level of education of caregivers were recorded. On their 3rd-month follow-up visit, Beck Depression Inventory and The Zarit Burden Interview (ZBI) were administered to caregivers to evaluate depressive symptoms and caregiver burden. A semi-structured questionnairre was developed and conducted by the researchers with the caregivers to assess their thoughts of nutrition. RESULTS Thirty-two caregivers of stroke patients on PEG and 31 caregivers of stroke patients who were fed orally were evaluated. The groups did not differ statistically in terms of demographic variables and depression scores (p > 0.05). However, the mean score of ZBI was significantly higher in the group of caregivers of stroke patients who were fed orally (p = 0.00). Caregivers of stroke patients on PEG had higher scores of caregivers' thoughts of nutrition support therapy questionnairre (p = 0.00). CONCLUSIONS Our findings demonstrate that caregivers of stroke patients report lower burden and higher level of positive thinking with PEG feeding than oral feeding. This suggests that nutritional care could include convenient and practicable methods for caregivers of patients with stroke in order to meet patients' nutritional requirements.
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Sezer RE, Ozdemir Koken Z, Senol Celik S. Home Percutaneous Endoscopic Gastrostomy Feeding: Difficulties and Needs of Caregivers, Qualitative Study. JPEN J Parenter Enteral Nutr 2019; 44:525-533. [PMID: 31148223 DOI: 10.1002/jpen.1612] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/14/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) may cause complications when adequate and appropriate care is not provided. To avoid these complications, caregivers' experiences and practices must be considered. METHODS This study used the phenomenological qualitative research method. Twenty-one caregivers underwent in-depth interviews and were observed for PEG practices. Interview and observational data were analyzed using content analysis. RESULTS This study revealed 8 themes and 24 subthemes under 3 categories of PEG management, social-emotional change of the caregivers, and expectations, and it was observed that caregivers made errors in stoma care, tube feeding, and medication administration through the PEG tube. CONCLUSION Results indicated that comprehensive and practical discharge training, and home care and counseling services should be provided to effectively address the challenges faced by caregivers of patients with PEG.
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Affiliation(s)
- Rana Elcin Sezer
- Faculty of Nursing, Surgical Nursing Department, Hacettepe University, Ankara, Turkey
| | - Zeliha Ozdemir Koken
- Faculty of Nursing, Surgical Nursing Department, Hacettepe University, Ankara, Turkey
| | - Sevilay Senol Celik
- Faculty of Health Sciences, Nursing Department, University of Kyrenia, Kyrenia, Cyprus
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22
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Dvorak J, Ridder D, Martin B, Ton-That H, Baldea A, Gonzalez RP. Is Tracheostomy Insertion an Indication for Gastrostomy Insertion? Am Surg 2019. [DOI: 10.1177/000313481908500530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the study was to determine the frequency of surgical patients who undergo tracheostomy and gastrostomy insertion during the same hospitalization. Secondary outcomes included ICU and hospital length of stay (LOS) for patients who underwent concomitant tracheostomy and gastrostomy versus those who did not. This study is a retrospective review of trauma and acute care surgery (ACS) patients between 2006 and 2015 who underwent tracheostomy. Patients who also underwent open gastrostomy or percutaneous endoscopic gastrostomy during the same hospitalization were identified. Data collected included patient demographics, hospital LOS, ICU LOS, and timing of tracheostomy and gastrostomy. Three hundred one trauma and ACS patients who underwent tracheostomy were identified. Seventy- three per cent of tracheostomy patients underwent gastrostomy during the same admission. Of patients who had both tubes inserted, 79 per cent (175) underwent gastrostomy with tracheostomy as the concomitant procedure, whereas 21 per cent received gastrostomy as a delayed procedure. Median hospital LOS for patients who underwent concomitant procedures was 25 days versus 22 days for those who had delayed or no gastrostomy ( P = 0.24). Eighty-four per cent of patients who had tracheostomy for prolonged or anticipated prolonged mechanical ventilation were receiving tube feeds at discharge, and 78 per cent had not been advanced to an oral diet at discharge. Most trauma/ACS patients who undergo tracheostomy also undergo gastrostomy during their hospitalization. Concomitant gastrostomy is not associated with a decrease in hospital LOS; however, most patients who undergo tracheostomy for prolonged mechanical ventilation are discharged receiving enteral nutrition. These patients may benefit from concomitant ICU gastrostomy as a way to improve efficiency and cost-saving.
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Affiliation(s)
- Justin Dvorak
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - David Ridder
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Brendan Martin
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Hieu Ton-That
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Anthony Baldea
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Richard P. Gonzalez
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
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Rowell NP. Tumor implantation following percutaneous endoscopic gastrostomy insertion for head and neck and oesophageal cancer: Review of the literature. Head Neck 2019; 41:2007-2015. [PMID: 30684284 DOI: 10.1002/hed.25652] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 12/18/2018] [Accepted: 12/28/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Because of publication bias, there is uncertainty about the true incidence of tumor seeding or implantation in patients with head and neck or oesophageal cancer undergoing percutaneous endoscopic gastrostomy (PEG) insertion. METHODS In order to obtain a more reliable estimate of risk, a systematic review was undertaken. Randomized or non-randomized studies and case reports were identified by electronic searching. A risk of bias assessment was carried out for each study. RESULTS Ninety-eight cases from 74 published case reports and 1 unpublished case were identified. Synchronous distant metastases were present in 37%. Analysis of case series (6192 patients) considered to carry a moderate risk of bias suggests an incidence of seeding after PEG insertion of 0.32%. Studies carrying a lower risk of bias indicate a risk of seeding closer to 1 in 2000. CONCLUSION The true risk of seeding after PEG insertion is probably less than 1 in 1000.
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Affiliation(s)
- Nicholas P Rowell
- Clinical Oncology, Kent Oncology Centre, Maidstone Hospital, Maidstone, Kent, United Kingdom
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24
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Molina Villalba C, Vázquez Rodríguez JA, Gallardo Sánchez F. Percutaneous endoscopic gastrostomy. Indications, care and complications. Med Clin (Barc) 2018; 152:229-236. [PMID: 30424936 DOI: 10.1016/j.medcli.2018.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 02/08/2023]
Abstract
Percutaneous endoscopic gastrostomy (PEG) is an effective and safe method for nutritional support in patients with malnutrition and impossibility of oral intake with an estimated survival higher than the months that require enteral nutrition beyond four weeks. The main indications include neoplasms of the upper air-digestive tract and neurological diseases, with dementia currently considered a controversial indication. Anatomical alterations and infectious diseases are the most frequent contraindications. There are different endoscopic techniques; the most widely used being the "pull" method, with a low mortality. Complications are more frequent in patients with multiple pathologies and the elderly. Wound infection, extraction of the tube, tube blockage and bronchoaspiratory pneumonia are the most prevalent complications. Adequate prior preparation of the patient and exhaustive maintenance of the tube can reduce the appearance of these.
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25
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Espeli V, Vergotte S, Dietrich PY, Pichard C, Siano M. Prolonged Versus Short-Duration Use of Nasogastric Tubes in Patients with Head and Neck Cancer During Radiotherapy Alone or Combined Chemoradiotherapy. Nutr Cancer 2018; 70:1069-1074. [PMID: 30273007 DOI: 10.1080/01635581.2018.1497670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To compare safety and effectiveness of prolonged (>28 days) versus short duration (≤28 days) use of nasogastric tube for enteral nutrition and weight loss prevention during curative radiotherapy with or without concurrent chemotherapy or cetuximab for head and neck cancer patients. We performed a retrospective study and database review of all patients at our center, treated with radiotherapy for head and neck cancer receiving enteral nutrition by nasogastric tube. Type of treatment, weight and body mass index changes, and related complications (gastroesophageal reflux, pneumonia, ulcer, feeding tube obstruction, or dislocation) were documented. Comparison between patients with prolonged (>28 days, group A) and short duration (≤28 days, group B) of EN through nasogastric tube was performed. Data expressed as mean ± SD or median (min; max) values as appropriate, and analyzed by ANOVA repeated measures and Kaplan-Meier estimates. We identified 114 patients who fulfilled the inclusion criteria. Among them, 10% were treated with radiotherapy alone, while 90% received concurrent chemotherapy or cetuximab. Ninety-four patients (82%, group A) had a nasogastric tube in place for a period >28 days and 20 (18%, group B) for ≤28 days during treatment. Patients were mainly men (86 patients, 75%), with a median age of 61 years (range 49-73) and advanced stage IV disease in most cases (87 patients, 76%) without differences between both groups (p = 0.53, 0.47, and 0.30, respectively). Treatment discontinuation did not occur within both groups. Fifty-six patients (49%) developed complications, without a significant difference between both groups (P = 0.23). Body weight and BMI changes did not differ during EN (-0.8 ± 4.5 and -0.3 ± 1.6), the oncological treatment (-5.3 ± 4.0 and -1.8 ± 1.4), or 6 months after the end of treatment (-0.6 ± 4.4 and -0.2 ± 1.5). Our findings suggest that prolonged enteral nutrition by nasogastric tube is safe and effective in preventing weight loss during curative radiotherapy or radio-chemotherapy for head and neck cancer.
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Affiliation(s)
- Vittoria Espeli
- a Department of Oncology , Oncology Institute of Southern Switzerland , Bellinzona , Switzerland
| | - Stephanie Vergotte
- b Department of Nutrition , Geneva University Hospital , Geneva , Switzerland
| | | | - Claude Pichard
- b Department of Nutrition , Geneva University Hospital , Geneva , Switzerland
| | - Marco Siano
- d Department of Oncology and Haematology , Cantonal Hospital , St. Gallen , Switzerland
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Kulvatunyou N, Zimmerman SA, Sadoun M, Joseph BA, Friese RS, Gries LM, O'Keeffe T, Tang AL. Comparing Outcomes Between "Pull" Versus "Push" Percutaneous Endoscopic Gastrostomy in Acute Care Surgery: Under-Reported Pull Percutaneous Endoscopic Gastrostomy Incidence of Tube Dislodgement. J Surg Res 2018; 232:56-62. [PMID: 30463774 DOI: 10.1016/j.jss.2018.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 03/24/2018] [Accepted: 06/01/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) complications are often under-reported in the literature, especially regarding the incidence of tube dislodgement (TD). TD can cause significant morbidity depending on its timing. We compared outcomes between "push" and "pull" PEGs. We hypothesized that push PEGs, because of its T-fasteners and balloon tip, would have a lower incidence of TD and complications compared with pull PEGs. METHODS We performed a chart review of our prospectively maintained acute care surgery database for patients who underwent PEG tube placement from July 1, 2009 through June 30, 2013. Data regarding age, gender, body mass index, indications (trauma versus nontrauma), and complications (including TD) were extracted. Procedure-related complications were classified as either major if patients required an operative intervention or minor if they did not. We compared outcomes between pull PEG and push PEG. Multiple regression analysis was performed to identify risk factors associated with major complications. RESULTS During the 4-y study period, 264 patients underwent pull PEGs and 59 underwent push PEGs. Age, gender, body mass index, and indications were similar between the two groups. The overall complications (major and minor) were similar (20% pull versus 22% push, P = 0.61). The incidence of TD was also similar (12% pull versus 9% push, P = 0.49). However, TD associated with major complications was higher in pull PEGs but was not statistically significant (6% pull versus 2% push, P = 0.21). Multiple regression analysis showed that dislodged pull PEG was associated with major complications (odds ratio 29.5; 95% confidence interval, 11.3-76.9; P < 0.001). CONCLUSIONS The incidence of pull PEG TD associated with major complications is under-recognized. Specific measures should be undertaken to help prevent pull PEG TD. LEVEL OF EVIDENCE IV, therapeutic.
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Affiliation(s)
- Narong Kulvatunyou
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Steven A Zimmerman
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona.
| | - Moutamn Sadoun
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Bellal A Joseph
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Randall S Friese
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Lynn M Gries
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Terence O'Keeffe
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Andrew L Tang
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
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Lee J, Shim KN, Lee KH, Lee KE, Chang JY, Tae CH, Moon CM, Kim SE, Jung HK, Jung SA. [Clinical Course of Percutaneous Endoscopic Gastrostomy: A Single-center Observational Study]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 71:24-30. [PMID: 29361810 DOI: 10.4166/kjg.2018.71.1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background/Aims Percutaneous endoscopic gastrostomy (PEG) is a widely used method for long-term tube feeding. This study aimed to investigate the clinical characteristics and outcomes of patients who utilized long-term feeding tube via PEG. Methods The medical records of 137 patients who underwent PEG tube insertion at Ewha Womans University Mokdong Hospital between January 2002 and December 2013 were reviewed. Results PEG was indicated most frequently for cerebrovascular accidents (66 patients, 48.2%), followed by head and neck cancer (20 patients, 14.6%), and Parkinson's disease (10 patients, 7.3%). The tubes were endoscopically inserted in 133 patients (97.1%); 4 patients (2.9%) underwent radiologic intervention. The tubes of 90 patients (65.7%) were exchanged at least once during the follow- up period. At the first exchange, 71 patients (78.9%) had their tubes exchanged by endoscopy, 24 patients (16.7%) by manually, and 4 patients (4.4%) by radiologic intervention. Of the 61 patients (44.5%) who had their tubes exchanged twice, 44 patients (72.1%) changed their tubes by endoscopic exchange, 13 patients (21.3%) by manually, and 4 patients (4.4%) via radiologic intervention. The mean time interval between the initial insertion and the first exchange was 9.83±6.19 months, and that between the initial insertion and the second exchange was 10.7±6.25 months. Of all the 137 patients, acute complications at initial insertion occurred in only 18 patients (13.1%), with insertion site infection (9 patients, 6.6%) being the most common acute complication. Conclusions PEG appears to be a safe procedure for providing long-term tube feeding. Our results may help to develop strategies for further management of subjects receiving feeding tubes via PEG.
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Affiliation(s)
- Jihyun Lee
- Department of Internal Medicine and Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ki Nam Shim
- Department of Internal Medicine and Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kang Hoon Lee
- Department of Internal Medicine and Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ko Eun Lee
- Department of Internal Medicine and Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ji Young Chang
- Department of Internal Medicine and Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine and Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Chang Mo Moon
- Department of Internal Medicine and Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Seong Eun Kim
- Department of Internal Medicine and Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hye Kyung Jung
- Department of Internal Medicine and Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sung Ae Jung
- Department of Internal Medicine and Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
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Clarke E, Pitts N, Latchford A, Lewis S. A large prospective audit of morbidity and mortality associated with feeding gastrostomies in the community. Clin Nutr 2017; 36:485-490. [DOI: 10.1016/j.clnu.2016.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/23/2015] [Accepted: 01/14/2016] [Indexed: 01/30/2023]
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James MK, Ho VP, Tiu SP, Tom RJ, Klein TR, Melnic GM, Schubl SD. Low Abdominal Wall Thickness May Predict Percutaneous Endoscopic Gastrostomy Complications. Am Surg 2017. [DOI: 10.1177/000313481708300219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although percutaneous endoscopic gastrostomy (PEG) tube placement is a common and safe procedure to provide enteral feeding, some patients develop complications. The aim of this study was to identify risk factors for the development of post-PEG complications. We hypothesized that patients with low albumin, diabetes, higher body mass index (BMI), thicker abdominal walls, or psychomotor agitation would have more complications. A 2-year retrospective review was performed on patients who received a PEG tube at a single institution. Variables collected included age, preoperative albumin, BMI, abdominal wall thickness (AWT), psychomotor agitation, pre-operative diabetes mellitus, and mortality. A total of 91 patients (70.3% male) were identified (mean age 58.7 years, SD 18.6). Seventeen patients (18.7%) had post-PEG complications and the 30-day mortality rate was 14.3 per cent. Mortality was not attributable to tube placement. Patients with complications weighed less (P = 0.005) and had a lower BMI (P = 0.010) than patients without complications. Additionally, patients with complications had significantly lower AWT (P = 0.02), mean AWT was 21.6 mm (SD 7.6) versus 27.6 mm (SD 8.1) in the noncomplication patients. AWT was the only factor independently associated with post-PEG complications (P = 0.047). There was no significant association between complications and mortality. Continued investigation on how to limit post-PEG complications remains imperative. In our population, lower AWT was independently associated with complications. Preoperative measurement of AWT by pre-procedural imaging can potentially be used to predict the risk of post-PEG complications.
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Affiliation(s)
- Melissa K. James
- Department of Surgery, Division of Trauma, Jamaica Hospital Medical Center, Jamaica, New York
| | - Vanessa P. Ho
- Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Simon P. Tiu
- Surgery Residency Program, Weill Cornell Medicine, New York, New York
| | | | - Taylor R. Klein
- Department of Surgery, Division of Trauma, Jamaica Hospital Medical Center, Jamaica, New York
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Bechtold ML, Mir FA, Boumitri C, Palmer LB, Evans DC, Kiraly LN, Nguyen DL. Long-Term Nutrition. Nutr Clin Pract 2016; 31:737-747. [DOI: 10.1177/0884533616670103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
| | - Fazia A. Mir
- Department of Medicine, University of Missouri, Columbia, Missouri, USA
| | | | - Lena B. Palmer
- Department of Medicine, Loyola University, Chicago, Illinois, USA
| | - David C. Evans
- Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Laszlo N. Kiraly
- Department of Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Douglas L. Nguyen
- Department of Medicine, University of California, Irvine, California, USA
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31
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Abdelhadi RA, Rahe K, Lyman B. Pediatric Enteral Access Device Management. Nutr Clin Pract 2016; 31:748-761. [DOI: 10.1177/0884533616670640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Ruba A. Abdelhadi
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Katina Rahe
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Beth Lyman
- Nutrition Support Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
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Souza EC. SURGICAL GASTROSTOMY BASED ON ENDOSCOPIC CONCEPTS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 29:50-2. [PMID: 27120741 PMCID: PMC4851152 DOI: 10.1590/0102-6720201600010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/15/2015] [Indexed: 11/21/2022]
Abstract
Background : Until the early 1980s, Stamm technique was considered standard method to gastrostomy. After description of the endoscopic technique, due to its efficiency and speed, quickly became the method of choice for long-term enteral access. Aim: Describe a technique that combines direct view of the stomach from open surgery with the simplicity and less traumatic endoscopic gastrostomy method. Method : In patient supine under spinal anesthesia the technique stars with small epigastric incision to pull up the stomach. A 3 mm incision in the left hypochondrium is made to pass needle puncture to guidewire passage. The stomach is drilled, guidewire is seizured, connection to catheter and percutaneous approach is made with traction of the stomach to the abdominal wall. Purse suture on the anterior gastric wall is not needed. Results : Twenty-eight patients underwent gastrostomy using endoscopy devices; six had local minor complications without the need for re-intervention; there was no death. Conclusion : The surgical gastrostomy with minimal incision in the stomach to pull off the catheter using endoscopic gastrostomy devices, proved to be safe, easy to perform, less traumatic, quick, simple and elegant.
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Bishop S, Reed WM. The provision of enteral nutritional support during definitive chemoradiotherapy in head and neck cancer patients. J Med Radiat Sci 2015; 62:267-76. [PMID: 27512573 PMCID: PMC4968562 DOI: 10.1002/jmrs.132] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/15/2015] [Accepted: 07/28/2015] [Indexed: 02/05/2023] Open
Abstract
Combination chemoradiation is the gold standard of management for locally advanced squamous cell carcinomas of the head and neck. One of the most significant advantages of this approach to treatment is organ preservation which may not be possible with radical surgery. Unfortunately, few treatments are without side-effects and the toxicity associated with combined modality treatment causes meaningful morbidity. Patients with head and neck cancer (HNC) may have difficulties meeting their nutritional requirements as a consequence of tumour location or size or because of the acute toxicity associated with treatment. In particular, severe mucositis, xerostomia, dysgeusia and nausea and vomiting limit intake. In addition to this, dysphagia is often present at diagnosis, with many patients experiencing silent aspiration. As such, many patients will require enteral nutrition in order to complete chemoradiotherapy (CRT). Feeding occurs via catheters placed transnasally (nasogastric tubes) or directly into the stomach through the anterior abdominal wall (percutaneous gastrostomy tubes). In the absence of clear evidence concerning the superiority of one method over another, the choice of feeding tube tends to be dependent on clinician and patient preference. This review examines key issues associated with the provision of enteral nutritional support during definitive CRT in HNC patients, including feeding methods, patient outcomes and timing of tube insertion and use.
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Affiliation(s)
- Sarah Bishop
- Illawarra Cancer Care CentreDepartment of Radiation Oncology, Wollongong HospitalWollongongNew South WalesAustralia
- Radiation Oncology DepartmentNelune Comprehensive Cancer CentrePrince of Wales HospitalRandwickNew South WalesAustralia
| | - Warren Michael Reed
- Medical Image Optimisation and Perception GroupDiscipline of Medical Radiation SciencesFaculty of Health SciencesThe University of SydneyLidcombeNew South WalesAustralia
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Chang AD, Thota D, Liang JM. Silent killer: case report of acute gastrostomy tube erosion. West J Emerg Med 2015; 16:318-9. [PMID: 25834679 PMCID: PMC4380388 DOI: 10.5811/westjem.2015.1.25321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 01/15/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Allen D. Chang
- Naval Medical Center San Diego, Department of Emergency Medicine, San Diego, California
| | - Darshan Thota
- Naval Medical Center San Diego, Department of Emergency Medicine, San Diego, California
| | - James M. Liang
- Naval Medical Center San Diego, Department of Emergency Medicine, San Diego, California
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Abstract
Percutaneous endoscopic gastrostomy (PEG) is the standard modality for long-term enteral nutrition; however, complications are common. To avoid these complications, we introduce laparoscopic-assisted PEG (LAPEG) and describe its advantages. The aim of this study was to describe the advantages of LAPEG relative to other procedures. We retrospectively reviewed the records of 19 patients who underwent LAPEG at our institution from June 2008 to February 2013. They were thought to be difficult cases for PEG. LAPEG was successfully performed in 18 patients (average age, 78.5 years; range, 50-98 years). The average surgical duration was 32.4 ± 6.2 minutes. No major intraoperative or postoperative complications were observed. Feeding tubes were successfully placed in all patients within some days. LAPEG is a safe, effective, and simple procedure. The strongest advantage of LAPEG is the possibility of observing the intraperitoneal condition and the ability to perform PEG safely without any complications. LAPEG should be the first-choice procedure if it is difficult to accomplish conventional PEG.
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Schneider AS, Schettler A, Markowski A, Luettig B, Kaufmann B, Klamt S, Lenzen H, Momma M, Seipt C, Lankisch T, Negm AA. Complication and mortality rate after percutaneous endoscopic gastrostomy are low and indication-dependent. Scand J Gastroenterol 2014; 49:891-8. [PMID: 24896841 DOI: 10.3109/00365521.2014.916343] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Percutaneous endoscopic gastrostomy (PEG) is often used for the feeding of patients with malnutrition due to dysphagia, and despite more than 30 years experience, numerous questions on its benefit remain. This was a prospective observational study to assess the safety of PEG. MATERIAL AND METHODS One hundred and nineteen patients mean age 63 years (21-91 years) who were admitted to the Hannover Medical School between November 2010 and March 2012 and had an indication for PEG according to the German guidelines were included. Primary endpoints were the following: reason for indication, date of in-hospital mortality after PEG insertion, death within 3 months after PEG placement, and complications. RESULTS Most patients (54.6%) received PEG for dysphagia caused by tumors and second (29.4%) for neurologic diseases with a minor proportion of dementia (3%). About 73% of our patients had no complications at all and only 10% suffered severe effects. We saw only 1 case of aspiration, which did not lead to pneumonia. The 30-day mortality was 10%, and no patient died as a result of the PEG procedure. Significantly more patients with neurologic disorders died within 24 weeks of PEG placement than tumor patients (60% versus 27.7%, respectively, p = 0.002, n = 100). CONCLUSION It is important to select patients receiving PEG very carefully. The patients' indications, their primary disease, and their capability for mental cooperation are essential. If these aspects are taken into account, PEG is a safe method with few mainly mild complications.
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Affiliation(s)
- Andrea S Schneider
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School , Hannover , Germany
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Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol 2014; 20:7739-7751. [PMID: 24976711 PMCID: PMC4069302 DOI: 10.3748/wjg.v20.i24.7739] [Citation(s) in RCA: 333] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/26/2014] [Accepted: 04/08/2014] [Indexed: 02/06/2023] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. Besides its well-known advantages over parenteral nutrition, PEG offers superior access to the gastrointestinal system over surgical methods. Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide, knowing its indications and contraindications is of paramount importance in current medicine. PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish. Broadly, the two main indications of PEG tube placement are enteral feeding and stomach decompression. On the other hand, distal enteral obstruction, severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients. Although generally considered to be a safe procedure, there is the potential for both minor and major complications. Awareness of these potential complications, as well as understanding routine aftercare of the catheter, can improve the quality of care for patients with a PEG tube. These complications can generally be classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use and wound care. In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance. Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the "pull" technique being the most common method. In the last section of this review, the reader is presented with a brief discussion of these procedures, techniques and related issues. Despite the mentioned PEG tube placement complications, this procedure has gained worldwide popularity as a safe enteral access for nutrition in patients with a functional gastrointestinal system.
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Repeat PEG placement is safe for head and neck cancer patients. Am J Otolaryngol 2014; 35:89-92. [PMID: 24411136 DOI: 10.1016/j.amjoto.2013.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/08/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE Percutaneous endoscopic gastrostomy (PEG) provides durable nutritional access for head and neck (HNC) patients as they undergo treatment. Continuing treatment of HNC may necessitate repeat PEG placement. We report our outcomes with repeat PEG compared to first-time PEG in HNC patients. MATERIALS AND METHODS A retrospective chart review identified morbidity, mortality, and possible risk factors for complications. RESULTS Repeat PEG tubes constituted 17% of PEG procedures. Morbidity was rare and similar complication rates were found between the initial PEG and repeat PEG groups (2% vs. 11%, p=0.131). There were no mortalities. CONCLUSIONS Repeat PEG plays an important role in the care of HNC patients and can be considered a safe means to establish durable enteric feeding access for patients with recurrent cancer or treatment complications.
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Lee HJ, Choung RS, Park MS, Pyo JH, Kim SY, Hyun JJ, Jung SW, Koo JS, Lee SW, Choi JH. Two cases of uncommon complication during percutaneous endoscopic gastrostomy tube replacement and treatment. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 63:120-4. [PMID: 24561699 DOI: 10.4166/kjg.2014.63.2.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We presented two interesting cases of gastrocolocutaneous fistula that occurred after percutaneous endoscopic gastrostomy (PEG) tube placement, and its management. This fistula is a rare complication that occurs after PEG insertion, which is an epithelial connection between mucosa of the stomach, colon, and skin. The management of the fistula is controversial, ranging from conservative to surgical intervention. Endoscopists should be aware of the possibility of gastrocolocutaneous fistula after PEG insertion, and should evaluate the risk factors that may contribute to the development of gastrocolocutaneous fistula before the procedure. We reviewed complications of gastrostomy tube insertion, symptoms of gastrocolocutaneous fistula, and its risk factors.
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Affiliation(s)
- Hyun Joo Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, 123 Jeokgeumro, Danwon-gu, Ansan 425-707, Korea
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Contemporary acute care surgery percutaneous endoscopic gastrostomy tube placement. J Trauma Acute Care Surg 2013; 75:859-63. [DOI: 10.1097/ta.0b013e3182a74b4d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Katsoulakis E, Solomon SB, Maybody M, Housman D, Niyazov G, Riaz N, Lovelock M, Spratt DE, Erinjeri JP, Thornton RH, Yamada Y. Temporary organ displacement coupled with image-guided, intensity-modulated radiotherapy for paraspinal tumors. Radiat Oncol 2013; 8:150. [PMID: 23800073 PMCID: PMC3702493 DOI: 10.1186/1748-717x-8-150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 06/01/2013] [Indexed: 12/03/2022] Open
Abstract
Background To investigate the feasibility and dosimetric improvements of a novel technique to temporarily displace critical structures in the pelvis and abdomen from tumor during high-dose radiotherapy. Methods Between 2010 and 2012, 11 patients received high-dose image-guided intensity-modulated radiotherapy with temporary organ displacement (TOD) at our institution. In all cases, imaging revealed tumor abutting critical structures. An all-purpose drainage catheter was introduced between the gross tumor volume (GTV) and critical organs at risk (OAR) and infused with normal saline (NS) containing 5-10% iohexol. Radiation planning was performed with the displaced OARs and positional reproducibility was confirmed with cone-beam CT (CBCT). Patients were treated within 36 hours of catheter placement. Radiation plans were re-optimized using pre-TOD OARs to the same prescription and dosimetrically compared with post-TOD plans. A two-tailed permutation test was performed on each dosimetric measure. Results The bowel/rectum was displaced in six patients and kidney in four patients. One patient was excluded due to poor visualization of the OAR; thus 10 patients were analyzed. A mean of 229 ml (range, 80–1000) of NS 5-10% iohexol infusion resulted in OAR mean displacement of 17.5 mm (range, 7–32). The median dose prescribed was 2400 cGy in one fraction (range, 2100–3000 in 3 fractions). The mean GTV Dmin and PTV Dmin pre- and post-bowel TOD IG-IMRT dosimetry significantly increased from 1473 cGy to 2086 cGy (p=0.015) and 714 cGy to 1214 cGy (p=0.021), respectively. TOD increased mean PTV D95 by 27.14% of prescription (p=0.014) while the PTV D05 decreased by 9.2% (p=0.011). TOD of the bowel resulted in a 39% decrease in mean bowel Dmax (p=0.008) confirmed by CBCT. TOD of the kidney significantly decreased mean kidney dose and Dmax by 25% (0.022). Conclusions TOD was well tolerated, reproducible, and facilitated dose escalation to previously radioresistant tumors abutting critical structures while minimizing dose to OARs.
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Affiliation(s)
- Evangelia Katsoulakis
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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