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Short and long-term results of percutaneous endoscopic gastrostomy

Year 2012, Volume: 34 Issue: 2, 183 - 188, 21.06.2012

Abstract

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.

Anahtar sözcükler: Gastrostomi, endikasyonlar, komplikasyonlar

References

  • James R, Gines D, Menlove A, Horn SD, Gassaway J, Smout RJ. Nutrition support (tube feeding) as a rehabilitation intervention. Arch Phys Med Rehabil 2005; 86: s82-s92.
  • Rimon E, Kagansky N, Levy S. Percutaneous endoscopic gastrostomy; evidence of different prognosis in various patient subgroups. Age Ageing 2005; 34: 353-7.
  • James A, Kapur K, Hawthorne AB. Long-term outcome of percutaneous endoscopic gastrostomy feeding in patients with dysphagic stroke. Age Ageing 1998; 27: 671-6.
  • Mazzini L, Corrà T, Zaccala M, Mora G, Del Piano M, Galante M. Percutaneous endoscopic gastrostomy and enteral nutrition in amyotrophic lateral sclerosis. J Neurol 1995; 242: 695-8.
  • Procaccini NJ, Nemergut EC. Percutaneous endoscopic gastrostomy in the patient with amyotrophic lateral sclerosis: risk vs benefit? Pract Gastroenterol 2008; 24- 34.
  • Wollman B, D'Agostino HB, Walus-Wigle JR, Easter DW, Beale A. Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta- analysis of the literature. Radiology 1995; 197: 699-704.
  • Patel PH, Thomas E. Risk factors for pneumonia after percutaneous endoscopic gastrostomy. J Clin Gastroenterol 1990; 12: 389-92.
  • Short TP, Patel NR, Thomas E. Prevalence of gastroesophageal reflux in patients who develop pneumonia following percutaneous endoscopic gastrostomy: a 24- hour pH monitoring study. Dysphagia 1996; 11: 87-9.
  • McGovern R, Barkin JS, Goldberg RI, Phillips RS. Duodenal obstruction: a complication of percutaneous endoscopic gastrostomy tube migration. Am J Gastroenterol 1990; 85: 1037-8.
  • Hogan RB, DeMarco DC, Hamilton JK, Walker CO, Polter DE. Percutaneous endoscopic gastrostomy--to push or pull. A prospective randomized trial. Gastrointest Endosc 1986; 32: 253-8.
  • Cortez-Pinto H, Correia AP, Camilo ME, Tavares L, De Moura MC. Long-term management of percutaneous endoscopic gastrostomy by a nutritional support team. Clin Nutr 2002; 21: 27-31.
  • Finocchiaro C, Galletti R, Rovera G, Ferrari A, Todros L, Vuolo A, Balzola F. Percutaneous endoscopic gastrostomy: a long-term follow-up. Nutrition 1997; 13: 520-3.
  • Amann W, Mischinger HJ, Berger A, Rosanelli G, Schweiger W, Werkgartner G, Fruhwirth J, Hauser H. ercutaneous endoscopic gastrostomy (PEG). 8 years of clinical experience in 232 patients. Surg Endosc 1997; 11: 741-4.
  • Larson DE, Burton DD, Schroeder KW, DiMagno EP. Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology 1987; 93: 48-52.
  • Aschl G, Kirchgatterer A, Allinger S, Hinterreiter M, Hubner D, Kranewitter W, Stadler B, Wimmer L, Knoflach P. Indications and complications of percutaneous endoscopic gastrostomy. Wien Klin Wochenschr 2003; 115: 115-20.
  • Payne KM, King TM, Eisenach JB. The technique of percutaneous endoscopic gastrostomy. A safe and cost-effective alternative to operative gastrostomy. J Crit Illn 1991; 6: 611.
  • Mitchell SL, Kiely DK, Lipsitz LA. The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment. Arch Intern Med 1997; 157: 327.
  • Mathus-Vliegen LM, Koning H. Percutaneous endoscopic gastrostomy and gastrojejunostomy: a critical reappraisal of patient selection, tube function and the feasibility of nutritional support during extended follow-up. Gastrointest Endosc 1999; 50: 746-54.
  • Dulabon GR, Abrams JE, Rutherford EJ. The incidence and significance of free air after percutaneous endoscopic gastrostomy. Am Surg 2002; 68: 590.
  • Fischer LS, Bonello JC, Greenberg E. Gastrostomy tube migration and gastric outlet obstruction following percutaneous endoscopic gastrostomy. Gastrointest Endosc 1987; 33: 381.
  • Printen KJ, Paulk SC, Mason EE. Acute postoperative wound complications after gastric surgery for morbid obesity. Am Surg 1975; 41:483-5.
  • Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Am Surg 1995; 61: 1001-5.
  • Abuksis G, Mor M, Segal N, Shemesh I, Plout S, Sulkes J, Fraser GM, Niv Y. Percutaneous endoscopic gastrostomy: high mortality rates in hospitalized patients. Am J Gastroenterol 2000; 95: 128-32.
  • Fay DE, Poplausky M, Gruber M, Lance P. Long-term enteral feeding: a retrospective comparison of delivery via percutaneous endoscopic gastrostomy and nasoenteric tubes. Am J Gastroenterol 1991; 86: 1604.
  • Cave DR, Robinson WR, Brotschi EA. Necrotizing fasciitis following percutaneous endoscopic gastrostomy. Gastrointest Endosc 1986; 32: 294.
  • Martindale R, Witte M, Hodges G, Kelley J, Harris S, Andersen C. Necrotizing fasciitis as a complication of percutaneous endoscopic gastrostomy. JPEN J Parenter Enteral Nutr 1987; 11: 583.
  • Honjo S. A mother's complaints of overeating by her 25-month-old daughter: a proposal of anorexia nervosa by proxy. Int J Eat Disord 1996; 20: 433.

Short and Long-Term Results of Percutaneous Endoscopic Gastrostomy

Year 2012, Volume: 34 Issue: 2, 183 - 188, 21.06.2012

Abstract

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.

References

  • James R, Gines D, Menlove A, Horn SD, Gassaway J, Smout RJ. Nutrition support (tube feeding) as a rehabilitation intervention. Arch Phys Med Rehabil 2005; 86: s82-s92.
  • Rimon E, Kagansky N, Levy S. Percutaneous endoscopic gastrostomy; evidence of different prognosis in various patient subgroups. Age Ageing 2005; 34: 353-7.
  • James A, Kapur K, Hawthorne AB. Long-term outcome of percutaneous endoscopic gastrostomy feeding in patients with dysphagic stroke. Age Ageing 1998; 27: 671-6.
  • Mazzini L, Corrà T, Zaccala M, Mora G, Del Piano M, Galante M. Percutaneous endoscopic gastrostomy and enteral nutrition in amyotrophic lateral sclerosis. J Neurol 1995; 242: 695-8.
  • Procaccini NJ, Nemergut EC. Percutaneous endoscopic gastrostomy in the patient with amyotrophic lateral sclerosis: risk vs benefit? Pract Gastroenterol 2008; 24- 34.
  • Wollman B, D'Agostino HB, Walus-Wigle JR, Easter DW, Beale A. Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta- analysis of the literature. Radiology 1995; 197: 699-704.
  • Patel PH, Thomas E. Risk factors for pneumonia after percutaneous endoscopic gastrostomy. J Clin Gastroenterol 1990; 12: 389-92.
  • Short TP, Patel NR, Thomas E. Prevalence of gastroesophageal reflux in patients who develop pneumonia following percutaneous endoscopic gastrostomy: a 24- hour pH monitoring study. Dysphagia 1996; 11: 87-9.
  • McGovern R, Barkin JS, Goldberg RI, Phillips RS. Duodenal obstruction: a complication of percutaneous endoscopic gastrostomy tube migration. Am J Gastroenterol 1990; 85: 1037-8.
  • Hogan RB, DeMarco DC, Hamilton JK, Walker CO, Polter DE. Percutaneous endoscopic gastrostomy--to push or pull. A prospective randomized trial. Gastrointest Endosc 1986; 32: 253-8.
  • Cortez-Pinto H, Correia AP, Camilo ME, Tavares L, De Moura MC. Long-term management of percutaneous endoscopic gastrostomy by a nutritional support team. Clin Nutr 2002; 21: 27-31.
  • Finocchiaro C, Galletti R, Rovera G, Ferrari A, Todros L, Vuolo A, Balzola F. Percutaneous endoscopic gastrostomy: a long-term follow-up. Nutrition 1997; 13: 520-3.
  • Amann W, Mischinger HJ, Berger A, Rosanelli G, Schweiger W, Werkgartner G, Fruhwirth J, Hauser H. ercutaneous endoscopic gastrostomy (PEG). 8 years of clinical experience in 232 patients. Surg Endosc 1997; 11: 741-4.
  • Larson DE, Burton DD, Schroeder KW, DiMagno EP. Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology 1987; 93: 48-52.
  • Aschl G, Kirchgatterer A, Allinger S, Hinterreiter M, Hubner D, Kranewitter W, Stadler B, Wimmer L, Knoflach P. Indications and complications of percutaneous endoscopic gastrostomy. Wien Klin Wochenschr 2003; 115: 115-20.
  • Payne KM, King TM, Eisenach JB. The technique of percutaneous endoscopic gastrostomy. A safe and cost-effective alternative to operative gastrostomy. J Crit Illn 1991; 6: 611.
  • Mitchell SL, Kiely DK, Lipsitz LA. The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment. Arch Intern Med 1997; 157: 327.
  • Mathus-Vliegen LM, Koning H. Percutaneous endoscopic gastrostomy and gastrojejunostomy: a critical reappraisal of patient selection, tube function and the feasibility of nutritional support during extended follow-up. Gastrointest Endosc 1999; 50: 746-54.
  • Dulabon GR, Abrams JE, Rutherford EJ. The incidence and significance of free air after percutaneous endoscopic gastrostomy. Am Surg 2002; 68: 590.
  • Fischer LS, Bonello JC, Greenberg E. Gastrostomy tube migration and gastric outlet obstruction following percutaneous endoscopic gastrostomy. Gastrointest Endosc 1987; 33: 381.
  • Printen KJ, Paulk SC, Mason EE. Acute postoperative wound complications after gastric surgery for morbid obesity. Am Surg 1975; 41:483-5.
  • Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Am Surg 1995; 61: 1001-5.
  • Abuksis G, Mor M, Segal N, Shemesh I, Plout S, Sulkes J, Fraser GM, Niv Y. Percutaneous endoscopic gastrostomy: high mortality rates in hospitalized patients. Am J Gastroenterol 2000; 95: 128-32.
  • Fay DE, Poplausky M, Gruber M, Lance P. Long-term enteral feeding: a retrospective comparison of delivery via percutaneous endoscopic gastrostomy and nasoenteric tubes. Am J Gastroenterol 1991; 86: 1604.
  • Cave DR, Robinson WR, Brotschi EA. Necrotizing fasciitis following percutaneous endoscopic gastrostomy. Gastrointest Endosc 1986; 32: 294.
  • Martindale R, Witte M, Hodges G, Kelley J, Harris S, Andersen C. Necrotizing fasciitis as a complication of percutaneous endoscopic gastrostomy. JPEN J Parenter Enteral Nutr 1987; 11: 583.
  • Honjo S. A mother's complaints of overeating by her 25-month-old daughter: a proposal of anorexia nervosa by proxy. Int J Eat Disord 1996; 20: 433.
There are 27 citations in total.

Details

Primary Language English
Journal Section Medical Science Research Articles
Authors

Yaşar Tuna

Adil Duman

Publication Date June 21, 2012
Published in Issue Year 2012Volume: 34 Issue: 2

Cite

AMA Tuna Y, Duman A. Short and long-term results of percutaneous endoscopic gastrostomy. CMJ. June 2012;34(2):183-188.