Percutaneous Endoscopic Gastrostomy (PEG): Retrospective Analysis of a 7-year Clinical Experience - Zdravlje, medicina, lijecenje, zdravstveni portal

Percutaneous Endoscopic Gastrostomy (PEG): Retrospective Analysis of a 7-year Clinical Experience

Percutaneous Endoscopic Gastrostomy (PEG): Retrospective Analysis of a 7-year Clinical Experience
Nenad Vanis, Aida Saray, Srdjan Gornjakovic, Rusmir Mesihovic
Acta Inform Med. 2012; 20(4): 235-237

View PDF Fulltext

Abstract

Aims: Since its description in 1980, percutaneous endoscopic gastrostomy has become the modality of choice for providing enteral access to patients who require long-term enteral nutrition. This study aimed to evaluate current indications and complications associated with PEG feeding. Methods: We conducted a retrospective analysis of all patients who referred to our endoscopic unit of the Department of Gastroenterology and Hepatology of the Medical Center University of Sarajevo for PEG tube placement over a period of 7 years. Medical records of 359 patients dealing with PEG tube placement were reviewed to assess indications, technical success, complications and the need for repeat procedures. Results: The indications for enteral feeding tube placement were malignancy in 44% (n=158), of which 61% (n=97) patients were suffering of head and neck cancer and 39% (n=61) of other malignancy. Central nervous disease was the indication in 48.7 % (n=175) of patients. Cerebrovascular accidents (CVA) accounted for 20% (n=73), head injury for 16% (n=59) and cerebral palsy for 11% (n=38). In 6.13% (n=22) of patients minor complications occur which included wound infection (0.8%), inadvertent PEG removal (2.5%) and tube blockage (1.1%). 11 patients experienced major complications including hemorrhage, tube migration and perforation. There were no deaths related to PEG procedure placement and the overall 30-day mortality rate due to primary disease was 15.8%. Oral feeding was resumed in 23% of the patients and the tube was removed subsequently after 6 -12 months. Conclusions: Percutaneous endoscopic gastrostomy is a save and minimally invasive endoscopic procedure associated with a low morbidity (9.2%) rate, easy to follow-up and to replace when blockage occurs. Over a seven-year period we noticed an increase of 63% in PEG placement at our department.

REFERENCES

1. Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980; 15: 872-875.

2. Grant JP. Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy. Ann Surg. 1988 May; 207(5): 598-603.

3. Löser C. Clinical aspects of long-term enteral nutrition via percutaneous endoscopic gastrostomy (PEG). J Nutr Health Aging. 2000; 4(1): 47-50.

4. McClave SA, Ritchie CS. The role of endoscopically placed feeding or decompression tubes. Gastroenterol Clin North Am. 2006; 35: 83-100.

5. Disario J. Endoscopic approaches to enteral nutritional support. Best Pract Res Clin Gastroenterol. 2006; 20: 605-630.

6. Lin HS, Ibrahim HZ, Kheng JW, et al. Percutaneous endoscopic gastrostomy: strategies for prevention and management of complications. Laryngoscope. 2001; 111: 1847-1852.

7. Lee JH, Kim JJ, Kim YH, et al. Increased risk of peristomal wound infections after percutaneous endoscopic gastrostomy in patients with diabetes mellitus. Dig Liver Dis. 2002; 34: 857-861.

8. Gencosmanoglu R, Koc D, Tozun N. Percutaneous endoscopic gastrostomy: results of 115 cases. Hepatogastroenterology. 2003; 50: 886-888.

9. McClave SA, Chang WK. Complications of enteral access. Gastrointest Endosc. 2003; 58: 739-751.

10. Dormann AJ, Wigginghaus B, Risius H, et al. Antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG) – results from a prospective randomized multicenter trial. Z Gastroenterol. 2000; 38: 229-234.

11. Jafri NS, Mahid SS, Minor KS, Idstein SR, Hornung CA, Galandiuk S. Meta-analysis: antibiotic prophylaxis to prevent peristomal infection following percutaneous endoscopic gastrostomy. Aliment Pharmacol Ther. 2007; 25: 647-656.

12. Löser C, Aschl G, Hébuterne X, Mathus-Vliegen EM, Muscaritoli M, Niv Y, Rollins H, Singer P, Skelly RH.ESPEN guidelines on artificial enteral nutrition – percutaneous endoscopic gastrostomy (PEG). Clin Nutr. 2005 Oct; 24(5): 848-861.

13. Blacka J, Donoghue J, Sutherland M, et al. Dwell times and functional failure in percutaneous endoscopic gastrostomy tubes: a prospective randomized controlled comparison between silicon polymer and polyurethane percutaneous endoscopic gastrostomy tubes. Aliment Pharmacol Ther. 2004; 20: 875-882.

14. Rino Y, Tokunaga M, Morinaga S, et al. The buried bumper syndrome: an early complication of percutaneous endoscopic gastrostomy. Hepatogastroenterology. 2002; 49: 1183-1184.

15. Boyd JW, DeLegge MH, Shamburek RD, Kirby DF. The buried bumper syndrome: A new technique for safe endoscopic PEG removal. Gastrointest Endosc. 1995; 41: 508-511.

16. Braden B, Brandstaetter M, Caspary WF, Seifert H. Buried bumper syndrome: treatment guided by catheter probe US. Gastrointest Endosc. 2003; 57: 747-751.

17. Raykher A, Russo L, Schattner M, et al. Enteral nutrition support of head and neck cancer patients. Nutr Clin Pract. 2007; 22: 68-73.

18. Raykher A, Schattner M, Friedman A, et al. Safety and efficacy of pretreatment placement of PEG tubes in head and neck cancer patients undergoing chemoradiation treatment. Clin Nutr. 2004; 23: 757.

19. Senft M, Fietkau R, Iro H, et al. The influence of supportive nutritional therapy via percutaneous endoscopic guided gastrostomy on the quality of life of cancer patients. Support Care Cancer. 1993; 1: 272-275.

20. Light VL, Slezak FA, Porter JA, Gerson LW, McCord G. Predictive factors for early mortality after percutaneous endoscopic gastrostomy. Gastrointest Endosc. 1995; 42: 330-335.

21. Dharmarajan TS, Unnikrishnan D, Pitchumoni CS. Percutaneous endoscopic gastrostomy and outcome in dementia. Am J Gastroenterol. 2001; 96: 2556-2563.

22. Sanders DS, Carter MJ, D’Silva J, et al. Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol. 2000; 95: 1472–1475.

Leave a reply

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>