Is percutaneous endoscopic gastrostomy tube placement safe in patients with ventriculoperitoneal shunts?

Table 1 Baseline patient characteristics n (%)

	PEG/VP (n = 7)	Control (n = 48)	P value
Age (yr)	55.3 ± 12.3	61.0 ± 16.6	0.387
Sex (M/F)	5/2	31/17	1.000
Primary diagnosis			0.897
Cerebrovascular disease	7 (100)	36 (75)
Amyotrophic lateral sclerosis		4 (8.3)
Hypoxic brain damage		2 (4.2)
Parkinson’s disease		2 (4.2)
Malignancy		2 (4.2)
Aspiration pneumonia		1 (2.1)
Pharyngeal paralysis		1 (2.1)
Diabetes mellitus	2 (28.6)	10 (20.8)	0.639
Tracheostomy	6 (85.7)	25 (52.1)	0.122
Mean number of PEG placements	1.3 ± 0.5	1.6 ± 1.1	0.459
Charlson’s index score	3.0 ± 1.6	3.5 ± 1.9	0.504

PEG: Percutaneous endoscopic gastrostomy; VP: Ventriculoperitoneal; PEG/VP: Patients with PEG tubes and VP shunts; Control: Patients with PEG tubes alone.

Table 2 Diagnosis of complications n (%)

	PEG/VP (n = 7)	Control (n = 48)	P value
Complications	1 (14.3)	6 (12.5)	1.000
Wound infection	1	3
Stomal leakage		1
Bleeding		1
Gastroesophageal reflux disease		1
VP shunt infection	No	-

Table 3 Long-term outcomes in patients with PEG tubes and VP shunts

No. of case	Sex/age (yr)	PEG-VP shunt interval (d)	Position of abdominal shunt catheter	DM	Complication	Follow-up (mo)	Outcome
1	F/67	409	Right	-	Wound infection	7	Doing well
2	M/57	65	Right	+	-	15	Doing well
3	M/57	256	Left	+	-	8	PEG change due to self-removal
4	F/62	831	Right	-	-	6	PEG change due to self-removal
5	F/67	274	Right	-	-	5	Doing well
6	F/36	259	Right	-	-	1	Doing well
7	F/42	67	Left	-	-	3	PEG removal

Table 4 Summary of published data on infections related to gastrostomy placement in patients with ventriculoperitoneal shunts

Investigator	Study design	Method of gastrostomy	Order of PEG & VP shunt	n	VP shunt infection rate	Interval between PEG & VP shunt	Control group	VP shunt infection rate in control group	Antibiotic used
Graham et al[17]	Prospective	Percutaneous endoscopic	VP→PEG	15	0%	2.2 wk	None	-	Cefazolin
Sane et al[18]	Retrospective	Fluoroscopic	VP→PEG	23	9% (2/23)	At least 4 wk	None	-	None
Taylor et al[19]	Retrospective	Percutaneous endoscopic	Simultaneous	16	50% (8/16)	-	VP shunt and tracheostomy without PEG	0% (0/21)	Yes (unspecified)
Baird et al[20]	Retrospective	Percutaneous endoscopic	VP→PEG	6	0%	33 d	None	-	Cefazolin
Schulman et al[21]	Retrospective	Percutaneous endoscopic	VP→PEG	39	5% (2/39)	43.1 d	None	-	72% received (unspecified)
Nabika et al[22]	Retrospective	Percutaneous endoscopic	Both	23	17.4% (4/23)	29.3 d	Only VP shunt	4.9%	Cefazolin
			PEG→VP	12	25% (3/12)	27.2 d		(6/123)
			VP→PEG	11	9.1% (1/11	39.2 d		(P = 0.0519)
Roeder et al[23]	Retrospective	Percutaneous endoscopic and surgical	Both	55	12.7% (7/55)	-	Only PEG	-	90.9% received (unspecified)
			PEG→VP	30	16.6% (5/30)
			VP→PEG	25	8% (2/25)
This study	Retrospective	Percutaneous endoscopic	VP→PEG	7	0% (0/7)	308.7 d	Only PEG	-	Yes (unspecified)