Perkütan endoskopik gastrostomi: endikasyon ve komplikasyonlar
Giriş ve Amaç: Perkütan endoskopik gastrostomi, herhangi bir nedenle ağız yoluyla beslenemeyen gastrointestinal sistem fonksiyonları sağlam olan hastalarda uygulanan bir yöntemdir. Biz bu çalışmada perkütan endoskopik gastrostomi tüpü taktığımız hastaları retrospektif olarak inceleyerek perkütan endoskopik gastrostomi endikasyonları, erken ve geç komplikasyonları literatür eşliğinde irdelemeyi amaçladık. Gereç ve Yöntem: Erzurum Bölge Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği Endoskopi Ünitesinde Eylül 2008- Aralık 2014 tarihleri arasında perkütan endoskopik gastrostomi tüpü takılan hastalar retrospektif olarak incelendi. Bulgular: Perkütan endoskopik gastrostomi tüpü 64 hastaya takıldı, 4 hastaya ise takılamadı. En sık serebrovasküler hasta- lığı olan hastalara takıldı. Hastaların hastanede yattığı süre içerisinde 3 (%4,5) hastada kateter ile ilişkili komplikasyon meydana gelmişti. 2 hastada pariostomal enfeksiyon ve bir hastada da perkütan endoskopik gastrostomi tüpü yerinden kanama olmuştu. Uzun dönem takiplerinde ise polikliniğe müracaat eden 5 (%7,5) hastadan 3ünde perkütan en- doskopik gastrostomi tüpü yerinden çıkmıştı. 2 hastada da tüp tıkanmış- tı. Sonuç: Uzun dönem beslenmesi gerekli olan hastalarda parenteral beslenmenin komplikasyonlarından kaçınmak için enteral beslenmenin tercih edilmesi gerekmektedir. Enteral beslenmede perkütan endoskopik gastrostominin morbidite ve mortalitesinin daha az olması, gerektiğinde yatak başı yapılması, genel anestezi ihtiyacı olmaması, daha ucuz ve pratik olması nedeniyle cerrahi gastrostomiye tercih edilmelidir.
Percutaneous endoscopic gastrostomy: indications and complications
Background and Aims: Percutaneous endoscopic gastrostomy is a method used for patients who cannot be fed orally for any reason, but who exhibit intact gastrointestinal function. In this retrospective study, we aimed to examine patients receiving percutaneous endoscop- ic gastrostomy, and discuss indications and early and late complications with reports in the literature. Materials and Method: We performed a retrospective analysis of patients receiving a percutaneous endoscopic gastrostomy tube between September 2008 and December 2014 at our Center in Erzurum Regional Training and Research Hospital. Re- sults: Percutaneous endoscopic gastrostomy tubes were placed in 64 patients, but could not be applied in 4 patients. The most common indication was cerebrovascular disease. Three patients (4.5%) experi- enced procedure associated complications during hospitalization. Two patients experienced periostomal infection and one bled from the pro- cedure site. Five patients (7.5%) were seen in outpatient clinic for long term follow-up; three patients had their tubes displaced and two pa- tients had their tubes obstructed. Conclusion: Enteral nutrition is pre- ferred for patients who need long term feeding to avoid complications of parenteral nutrition. Percutaneous endoscopic gastrostomy should be selected over surgical gastrostomy because morbidity and mortality rates are less frequent; it can be done by the patients bedside; there is no need for general anesthesia; and, it is cheaper and more practical.
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- 1. Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic eview. Crit Care Med 2001;29:2264-70.
- 2. Pennington CR, Powell-Tuck J, Shaffer J. Review article: artificial nutritional support for improved patient care. Aliment Pharmacol Ther 1995;9:471-81.
- 3. Virnig DJ, Frech EJ, Delegge MH, Fang JC. Direct percutaneous en- doscopic jejunostomy: a case series in pediatric patients. Gastroin- test Endosc 2008;67:984-7.
- 4. Maple J, Petersen B, Baron TH, et al. Direct percutaneous endo- scopic jejunostomy: outcomes in 307 consecutive attempts. Am J Gastroenterol 2005;100:2681-8.
- 5. Harbrecht BG, Moraca RJ, Saul M, Courcoulas AP. Percutaneus en- doscopic gastrostomy reduces total hospital costs in head-injured patients. Am J Surg 1998;176:311-4.
- 6. Norton B, Homer-Ward M, Donelly MT, et al. A randomized com- parison of percutaneous gastrostomy and nasogastric feeding af- ter acute dysphagic stroke. BMJ 1996;312:13-6.
- 7. Cosentini EP, Sautner T, Gnant M, et al. Outcomes of surgical, percutaneous endoscopic, and percutaneous radiologic gastrosto- mies. Arch Surg 1998;133:1076-83.
- 8. Ponsky JL, Gauderer MW. Percutaneous endoscopic gastrosto- my: indications, limitations, techniques, and results. World J Surg 1989;13:165-70.
- 9. Ermiş F, Özel M, Öncü K, et al. Indications, complications and long-term follow-up of patients undergoing percutaneous endo- scopic gastrostomy: A retrospective study. Wien Klin Wochenschr 2012;124:148-53.
- 10. Nadir I, Türkay C. Uzun süreli enteral beslenmede etkili ve güvenilir yaklaşım: perkütan endoskopik gastrostomi. Güncel Gastroentero- loji 2011;15:95-7.
- 11. Mello GFS, Lukashok HP, Meine GC, et al. Outpatient percutaneous endoscopic gastrostomy in selected head and neck cancer patients. Surg Endosc 2009; 23:1487-93.
- 12. Tuncer K, Kılınçsoy N, Lebe E, et al. Perkütan endoskopik gas- trostomi sonuçlarımız: 49 olgunun irdelenmesi. Akademik Gastro- enteroloji Dergisi 2003;2:64-8.
- 13. Löser C1, Aschl G, Hébuterne X, Mathus-Vliegen EM, et al. ESPEN guidelines on artificial enteral nutrition Percutaneous endoscopic gastrostomy (PEG). Clin Nutr 2005;24:848-61.
- 14. Akçan Y, Arslan M, Arslan S, et al. Percutaneous endoscopic gas- trostomy; the Hacettepe University Hospital experience. Turkiye Klinikleri J Gastroenterohepatol 1999;10:23-7.
- 15. Ali T, Le V, Sharma T, et al. Post-PEG feeding time: a web based national survey amongst gastroenterologists. Dig Liver Dis 2011;43:768-71.
- 16. Tokunaga T, Kubo T, Ryan S, et al. Long-term outcome after place- ment of a percutaneous endoscopic gastrostomy tube. Geriatr Gerontol Int 2008;8:19-23.
- 17. Alper E, Baydar B, Arı FÖ, et al. Perkütan endoskopik gastrostomi uygulama deneyimlerimiz: endikasyon ve komplikasyonlar. Akade- mik Gastroenteroloji Dergisi 2009;8:74-6.
- 18. Foutch PG. Complications of percutaneous gastrostomy and jeju- nostomy. Recognition, prevention and treatment. Gastrointest En- dosc Clin N Am 1992;2:231-48.
- 19. Gottfried EB, Plumser AB, Clair MR. Pneumoperitoneum follow- ing percutaneous endoscopic gastrostomy. Gastrointest Endosc 1986;32:397-9.
- 20. Preclick G, Grüne S, Leser HG, et al. Prospective, randomized, dou- ble blind trial of prophylaxis with single dose of co-amoxiclav be- fore percutaneous endoscopic gastrostomy. BMJ 1999;319:881-4.
- 21. Erdil A, Tüzün A, Saka M, et al. Perkütan endoskopik gastrostomi uygulamalarımız ve sonuçları. Gülhane Tıp Dergisi 2001;43:379-83.
- 22. Nicholson FB, Korman MG, Richardson MA. Percutaneous endo- scopic gastrostomy: a review of indications, complications and out- come. J Gastroenterol Hepatol 2000;15:21-5.
- 23. Skelly RH, Kupfer RM, Metcalfe ME, et al. Percutaneous endo- scopic gastrostomy (PEG): change in practice since 1988. Clin Nutr 2002;21:389-94.
- 24. Kobayashi K, Cooper GS, Chak A, et al. A prospective evaluation of outcome in patients referred for PEG placement. Gastrointest Endosc 2002;55:500-6.