Short and long-term results of percutaneous endoscopic gastrostomy

Amaç. Perkutan endoskopik gastrostomi en sık kullanılan uzun dönem enteral beslenmemetodudur. Bu çalışmanın amacı perkutan endoskopik gastrostominin kısa ve uzun dönemetkinliği ile komplikasyonlarını değerlendirmektir. Yöntemler. Çalışmaya Akdeniz ÜniversitesiGastroenteroloji Kliniği nde 2004-2010 yılları arasında perkutan endoskopik gastrostomi takılmış172 hasta dahil edildi. Hastaların beslenme yeterliliği 6. aydaki serum albumin düzeylerine göredeğerlendirildi. Hastalar perkutan endoskopik gastrostominin lokal ve sistemik komplikasyonlarıaçısından değerlendirildi. Bulgular. Perkutan endoskopik gastrostomi takılan hastaların 69(%40.1)unun ölümü primer hastalığına bağlıydı. Hastaların 49una inme, 32sine demans, 53ünepostravmatik ensefalopati, 6sına postanoksik ensefalopati, 30una malignite, ve 2sinemeningoensefalit nedeniyle perkutan endoskopik gastrostomi işlemi uygulandı. Hastalarda lokalve sistemik perkutan endoskopik gastrostomi tüpü komplikasyonları değerlendirildi. Sistemikkomplikasyon olarak; 3 hastada peritonit, 2 hastada periton boşluğuna kanama, 9 hastadaaspirasyon pnömonisi, 4 hastada perkutan endoskopik gastrostomi dislokasyonu, ve 6 hastadakarın duvarı absesi gelişti. Lokal komplikasyonlar; 17 hastada lokal yara yeri eritemi, 15 hastadaperkutan endoskopik gastrostomi yerinde sızıntı, 3 hastada perkutan endoskopik gastrostomiyerinde ağrı, 4 hastada granulom oluşumu ve 11 hastada balon inmesi nedeniyle perkutanendoskopik gastrostomi çıkması gerçekleşti. Hastaların 6. ayda ortalama serum albumin değeri 3.2gr/dL olarak saptandı. 10 hastanın yutkunma refleksi geri geldiği için perkutan endoskopikgastrostomileri çekildi. Sonuç. Perkutan endoskopik gastrostomi rehberlerde belirtilen kurallarauygun şekilde yapıldığında gastrointestinal traktüse erişim sağlayan güvenli ve etkin biryöntemdir. Perkutan endoskopik gastrostomi yerleştirilmesine bağlı komplikasyonlar iyitanımlanmış olup genellikle lokaldir ancak bazı nadir durumlar cerrahi gerektirebilir veya ölümlesonuçlanabilir. Komplikasyonlar açısından işlem güvenlidir. Endikasyonlar ve giriş işlemleristandardize edilmelidir Hastaların bir diyetisyen ya da özel bir hemşire tarafından izlemi; birincibasamak sağlık hizmetleri ve hastaneler arasında potansiyel bir köprü kurulmasını sağlayabilir.

Perkutan endoskop ik gastrostomi yerleştirilen hastaların kısa ve uzun dönem sonuçları

Aim. Percutaneous endoscopic gastrostomy is the most common method of long-term enteralnutrition. The aim of this study is to evaluate the short and long term efficacy and complications ofpercutaneous endoscopic gastrostomy. Methods. We included 172 patients who underwentpercutaneous endoscopic gastrostomy procedure between 2004 and 2010 in the GastroenterologyClinic of Akdeniz University. Nutritional status was evaluated on the basis of albumin levels at thesixth month. Patients were evaluated for local and systemic complications of percutaneousendoscopic gastrostomy. Results. Sixty-nine (40.1%) patients who underwent percutaneousendoscopic gastrostomy procedures died due to their primary diseases. Percutaneous endoscopicgastrostomy was placed for stroke in 49 patients , for dementia in 32 patients, for posttraumaticencephalopathy in 53 patients, for post-anoxic encephalopathy in 6 patients, for malignantdisorders in 30 patients , and for menigoencephalitis in 2 patients. Patients were evaluated for localand systemic percutaneous endoscopic gastrostomy tube complications. The systemiccomplications consisted of three cases with peritonitis, two bleeding episodes, nine cases withaspiration pneumonia, four cases with dislocation of catheter, and six cases with abscess ofabdominal 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 threecases with pain at percutaneous endoscopic gastrostomy site. Mean albumin level of patients at thesix month was 3.2 gr/dL. Removal of percutaneous endoscopic gastrostomy due to return of abilityto swallow was observed in ten patients. Conclusion. Percutaneous endoscopic gastrostomy is asafe and effective method which accesses to the gastrointestinal tract when performed according tothe guidelines. Complications associated with percutaneous endoscopic gastrostomy are welldescribed and are usually local, but major rare events require surgery or result in death. It is safe interms of complications. Indications and introduction procedures should be standardized. Follow-upby a dietician or specialist nurse could potentially bridge the gap between primary care andhospitals.

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1. 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.
2. Rimon E, Kagansky N, Levy S. Percutaneous endoscopic gastrostomy; evidence of different prognosis in various patient subgroups. Age Ageing 2005; 34: 353-7.
3. 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.
4. 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.
5. Procaccini NJ, Nemergut EC. Percutaneous endoscopic gastrostomy in the patient with amyotrophic lateral sclerosis: risk vs benefit? Pract Gastroenterol 2008; 24- 34.
6. 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.
7. Patel PH, Thomas E. Risk factors for pneumonia after percutaneous endoscopic gastrostomy. J Clin Gastroenterol 1990; 12: 389-92.
8. 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.
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.
10. 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.
11. 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.
12. 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.
13. 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.
14. 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.
15. 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.
16. 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.
17. 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.
18. 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.
19. Dulabon GR, Abrams JE, Rutherford EJ. The incidence and significance of free air after percutaneous endoscopic gastrostomy. Am Surg 2002; 68: 590.
20. Fischer LS, Bonello JC, Greenberg E. Gastrostomy tube migration and gastric outlet obstruction following percutaneous endoscopic gastrostomy. Gastrointest Endosc 1987; 33: 381.
21. Printen KJ, Paulk SC, Mason EE. Acute postoperative wound complications after gastric surgery for morbid obesity. Am Surg 1975; 41:483-5.
22. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Am Surg 1995; 61: 1001-5.
23. 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.
24. 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.
25. Cave DR, Robinson WR, Brotschi EA. Necrotizing fasciitis following percutaneous endoscopic gastrostomy. Gastrointest Endosc 1986; 32: 294.
26. 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.
27. 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.