Short and long-term results of percutaneous endoscopic gastrostomy

Abstract

Aim. Percutaneous endoscopic gastrostomy is the most common method of long-term enteral nutrition. The aim of this study is to evaluate the short and long term efficacy and complications of percutaneous endoscopic gastrostomy. Methods. We included 172 patients who underwent percutaneous endoscopic gastrostomy procedure between 2004 and 2010 in the Gastroenterology Clinic of Akdeniz University. Nutritional status was evaluated on the basis of albumin levels at the sixth month. Patients were evaluated for local and systemic complications of percutaneous endoscopic gastrostomy. Results. Sixty-nine (40.1%) patients who underwent percutaneous endoscopic gastrostomy procedures died due to their primary diseases. Percutaneous endoscopic gastrostomy was placed for stroke in 49 patients , for dementia in 32 patients, for posttraumatic encephalopathy in 53 patients, for post-anoxic encephalopathy in 6 patients, for malignant disorders in 30 patients , and for menigoencephalitis in 2 patients. Patients were evaluated for local and systemic percutaneous endoscopic gastrostomy tube complications. The systemic complications consisted of three cases with peritonitis, two bleeding episodes, nine cases with aspiration pneumonia, four cases with dislocation of catheter, and six cases with abscess of abdominal wall. The local complications consisted of seventeen cases with local wound erythema; fifteen patients had leakage of gastric contents, four cases with granuloma formation, and three cases with pain at percutaneous endoscopic gastrostomy site. Mean albumin level of patients at the six month was 3.2 gr/dL. Removal of percutaneous endoscopic gastrostomy due to return of ability to swallow was observed in ten patients. Conclusion. Percutaneous endoscopic gastrostomy is a safe and effective method which accesses to the gastrointestinal tract when performed according to the guidelines. Complications associated with percutaneous endoscopic gastrostomy are well described and are usually local, but major rare events require surgery or result in death. It is safe in terms of complications. Indications and introduction procedures should be standardized. Follow-up by a dietician or specialist nurse could potentially bridge the gap between primary care and hospitals.

Keywords: Gastrostomy, indications, complications

Özet

Amaç. Perkutan endoskopik gastrostomi en sık kullanılan uzun dönem enteral beslenme metodudur. Bu çalışmanın amacı perkutan endoskopik gastrostominin kısa ve uzun dönem etkinliği ile komplikasyonlarını değerlendirmektir. Yöntemler. Çalışmaya Akdeniz Üniversitesi Gastroenteroloji Kliniği’ nde 2004-2010 yılları arasında perkutan endoskopik gastrostomi takılmış 172 hasta dahil edildi. Hastaların beslenme yeterliliği 6.aydaki serum albumin düzeylerine göre değerlendirildi. Hastalar perkutan endoskopik gastrostominin lokal ve sistemik komplikasyonları açısından değerlendirildi. Bulgular. Perkutan endoskopik gastrostomi takılan hastaların 69(% 40.1)’unun ölümü primer hastalığına bağlıydı. . Hastaların 49’una inme, 32’sine demans, 53’üne postravmatik ensefalopati, 6’sına postanoksik ensefalopati, 30’una malignite, ve 2’sine meningoensefalit nedeniyle perkutan endoskopik gastrostomi işlemi uygulandı. Hastalarda lokal ve sistemik perkutan endoskopik gastrostomi tüpü komplikasyonları değerlendirildi. Sistemik komplikasyon olarak; 3 hastada peritonit, 2 hastada periton boşluğuna kanama, 9 hastada aspirasyon pnömonisi, 4 hastada perkutan endoskopik gastrostomi dislokasyonu, ve 6 hastada karın duvarı absesi gelişti. Lokal komplikasyonlar; 17 hastada lokal yara yeri eritemi, 15 hastada perkutan endoskopik gastrostomi yerinde sızıntı, 3 hastada perkutan endoskopik gastrostomi yerinde ağrı, 4 hastada granulom oluşumu ve 11 hastada balon inmesi nedeniyle perkutan endoskopik gastrostomi çıkması gerçekleşti. Hastaların 6. ayda ortalama serum albumin değeri 3.2 gr/dL olarak saptandı. 10 hastanın yutkunma refleksi geri geldiği için’ perkutan endoskopik gastrostomileri çekildi. Sonuç. Perkutan endoskopik gastrostomi rehberlerde belirtilen kurallara uygun şekilde yapıldığında gastrointestinal traktüse erişim sağlayan güvenli ve etkin bir yöntemdir. Perkutan endoskopik gastrostomi yerleştirilmesine bağlı komplikasyonlar iyi tanımlanmış olup genellikle lokaldir ancak bazı nadir durumlar cerrahi gerektirebilir veya ölümle sonuçlanabilir. Komplikasyonlar açısından işlem güvenlidir. Endikasyonlar ve giriş işlemleri standardize edilmelidir Hastaların bir diyetisyen ya da özel bir hemşire tarafından izlemi; birinci basamak sağlık hizmetleri ve hastaneler arasında potansiyel bir köprü kurulmasını sağlayabilir.

ABSTRACT

Objective: Percutaneous endoscopic gastrostomy (PEG) is commonest method of long-term enteral nutrition.The aim of this study is to evaluate the short and long term efficacy and complications of PEG.

Maternal and methods: We analysed 172 patients who undervent PEG procedure between 2004 and 2010 in endoscopic unit of medical faculty of Akdeniz Univercity in Antalya.

Results: A total of 69(40.1%) of the patients who were undervent PEG procedures died  due to their primary diseases. PEG were placed in 49 patients for stroke, 32 patients for demantia, 53 patients for posttraumatic encephalopathy, 6 patients for postanoxic encephalopathy, 30 patient  for malign disorders, and 2 patients for menigoencephalitis. Patients were evaluated for local and systemic PEG tube complications. The systemic complications  consisted of tree cases of peritonitis, two bleeding episodes, nine cases of aspiration pneumonia, four dislocation of catheter, and six abscess of abdominal wall.  The local complication consisted of seventeen cases of local infection, fiveteen patients had leakage of gastric contents, four cases of granuloma formation, and three cases of pain at PEG site.

Discussion: PEG tube placement is a safe  and effective method access to the gastrointestinal tract when performed according to strict guidelines. Complications associated with PEG placement are well described and are usually local, but major events requiring surgery or resulting in death. Indication and introduction procedures should be standardized. Follow-up by a dietician or specialist nurse could potentially bridge the gap between primary care and hospitals.

Key Words: Gastrostomy, indications, complications.