Yahya ÇELİK, Ozan Andaç ERBİL, Tarık Gandi ÇİNÇİN, Sema YILDIZ, Yasemin ÖZKAN, Fırat DEMİRCAN

ENTERAL BESLENME AMAÇLI PERKUTAN ENDOSKOPİK GASTROSTOMİ UYGULAMALARIMIZ Percutaneous Endoscopic Gastrostomy Applications For Enteral Nutrition

ÖZET Amaç: Oral yolla yeterli beslenmeyi sağlayamayan hastalarda metabolik gereksinimleri karşılamak için enteral veya parenteral beslenme yolları kullanılmaktadır. Perkutan endoskopik gastrostomi (PEG), gastrointestinal sistem fonksiyonları normal olan ve oral yolla beslenemeyen hastalarda uzun süreli enteral beslenme için tercih edilen bir işlemdir. Amacımız PEG işlemi yaptığımız hastaların sonuçlarını literatür eşliğinde incelemektir. Gereç ve Yöntemler: 2012-2018 yılları arasında hastanemiz genel cerrahi endoskopi ünitesinde perkutan endoskopik gasrostomi tüpü takılan 128 hastanın kayıtları retrospektif olarak incelendi. Hastaların yaşı, cinsiyeti, işlem tarihi, primer hastalığı (peg endikasyonu) gibi bilgiler ile işlem sonrası gelişen komplikasyonlar değerlendirildi. Bulgular: Çalışmaya 52 erkek (%40,63) ve 76 kadın (%59,4) olmak üzere toplam 128 hasta katılmıştır. Hastaların 97’si (%75,8) yatan hasta, 31’ si (%24.2) hasta ayaktan gelen hastalardı. Yatan hastalardan 90 (% 92,8) yoğun bakım ünitesinde 7(% 7,2) si nöroloji kliniğinde yatmaktadır. PEG takılan hastaların tamamında primer tanı SVO idi. Majör komplikasyon gelişmedi. Minör komplikasyolar 6 hastada (%4,69) yara enfeksiyonu ve 5 hastada (%3,91) PEG kenarından sızdırma vardır. Bütün hastalar semptomatik tedaviden fayda gördü. Sonuç: PEG deneyimli ekip tarafından yapıldığı takdirde basit, güvenli, komplikasyon oranı düşük, etkili bir enteral beslenme yöntemidir. Uygun hastalarda, uzun süreli enteral beslenme için öncelikle başvurulması gereken beslenme şeklidir. Anahtar Kelimeler: Endoskopi; Gastrostomi; Teknik; Komplikasyon ABSTRACT Aim : In patients with inadequate oral feeding enteral and parenteral feeding are used in order to maintain metabolic needs. Percutaneous endoscopic gastrostomy is a procedure preferred for long-term enteral feeding of patients with normal gastrointestinal system functions but unable to get oral feeding. Our aim is to assess the results of our patients who have undergone PEG procedure in association with literature review. Material and method: Patients charts of 128 patients who have undergone percutaneous endoscopic gastrostomy tube placement in general surgery department of Gebze Kocaeli Fatih State Hospital between 2012- 2018 were retrospectively reviewed. Data such as age and sex of patients, procedure date and primary disease (indication for PEG) along with complications following the procedure were assessed. Results: The series consisted from 52 male (40,63%) and 76 female (59,4%) patients totalling 128 patients. 97 (75,8%)of them were inpatients and 31 (24.2%) of them were outpatients. 90 (92.8%) of the inpatients were staying at intensive care unit and 7 (7.2%) of them were in neurology ward. Primary diagnosis was CVA in all of the patients with PEG. There was no major complications. And minor complications were wound infection in 6 patients (4.69%) and leakage from PEG in 5 patients (3.91%). All of the patients benefited from semptomatic treatment. Conclusion: PEG is a simple, safe and effective enteral feeding technique with low complication rate when accomplished by an experienced surgical team. In appropriate patients, it’s a preferential technique for long term enteral feeding. Key words: Enteral nutrition; Endoscopy; Gastrostomy; Technique; Complication

Anahtar Kelimeler:

ENTERAL BESLENME AMAÇLI PERKUTAN ENDOSKOPİK GASTROSTOMİ UYGULAMALARIMIZ Percutaneous Endoscopic Gastrostomy Applications For Enteral Nutrition

PDF

___

1. Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World Journal of Gastroenterology: WJG. 2014;20(24):7739. 2. Alverdy J, Chi HS, Sheldon GF. The effect of parenteral nutrition on gastrointestinal immunity. The importance of enteral stimulation. Annals of surgery. 1985;202(6):681. 3. Deitch EA, Winterton J, Li M, Berg R. The gut as a portal of entry for bacteremia. Role of protein malnutrition. Annals of surgery. 1987;205(6):681. 4. Strijbos D, Keszthelyi D, Bogie RM, Gilissen LP, Lacko M, Hoeijmakers JG, et al. A Systematic Review and Meta-Analysis on Outcomes and Complications of Percutaneous Endoscopic Versus Radiologic Gastrostomy for Enteral Feeding. Journal of ClinicalGastroenterology. 2018. 5. Endoscopy ASfG. Role of PEG/PEJ in enteral feeding. Gastrointest Endosc. 1998;48(6):69-701. 6. Kirby DF, DeLegge MH, Fleming CR. American Gastroenterological Association technical review on tube feeding for enteral nutrition. Gastroenterology. 1995;108(4):1282-301. 7. Gauderer MW, Ponsky JL, Izant RJ. Gastrostomy without laparotomy: a percutaneous endoscopic technique. Journal of pediatric surgery. 1980;15(6):872-5. 8. Friginal-Ruiz A, Gonzalez-Castillo S, Lucendo A. Endoscopic percutaneous gastrostomy: an update on the indications, technique and nursing care. Enfermeria clinica. 2011;21(3):173-8. 9. Loser C, Aschl G, Hebuterne X, Mathus-Vliegen E, Muscaritoli M, Niv Y, et al. ESPEN guidelines on artificial enteral nutrition--percutaneous endoscopic gastrostomy (PEG). Clin Nutr. 2005;24(5):848-61. 10. Ekin N, Uçmak F, Oruç M, Tuncer ET, Yalçin K. Perkutan endoskopik gastrostomi uygulama sonuçlarimiz: 113 olgunun degerlendirilmesi/The results of the percutaneous endoscopic gastrostomy insertion: Analysis of 113 cases. Dicle Tip Dergisi. 2015;42(3):346. 11. Tokunaga T, Kubo T, Ryan S, Tomizawa M, Yoshida Si, Takagi K, et al. Long‐term outcome after placement of a percutaneous endoscopic gastrostomy tube. Geriatrics & gerontology international. 2008;8(1):19-23. 12. Ahmad I, Mouncher A, Abdoolah A, Stenson R, Wright J, Daniels A, et al. Antibiotic prophylaxis for percutaneous endoscopic gastrostomy— a prospective, randomised, double‐blind trial. Alimentary pharmacology & therapeutics. 2003;18(2):209-15. 13. Fagundes RB, Cantarelli JC, Fontana K, Motta GL. Percutaneous endoscopic gastrostomy and peristomal infection: an avoidable complication with the use of a minimum skin incision. Surgical Laparoscopy Endoscopy & Percutaneous Techniques. 2011;21(4):275-7.