MURAT ÇAKIR, Ahmet TEKİN, Tevfik KÜÇÜKKARTALLAR, İLHAN ÇİFTCİ, Celalettin VATANSEV, Faruk AKSOY, Adil KARTAL

Long-term results of percutaneous endoscopic gastrostomies

Amaç: Oral gıda alamayan, özellikle yoğun bakım ünitelerinde yatmakta olan hastalara enteral beslenme desteği sağlamak amacıyla minimal invaziv bir metod olan perkutan endoskopik gastrostomi (PEG) deneyimimizi sunmayı amaçladık. Gereç ve yöntem: Bu çalışmada kliniğimizde Ocak 2000 - Haziran 2010 tarihleri arasında en az 4 hafta süreyle oral beslenemeyeceği öngörülerek PEG yerleştirilen 700 olgu retrospektif olarak incelendi. Hasta kayıtları endikasyonlar, komplikasyonlar ve sonuçları açısından değerlendirildi. Bulgular: Hastaların 400’ (% 57) ü erkek, 300’ ü (%43) bayandı. Olguların büyük çoğunluğu nörolojik nedenli patolojilerdi. Tüm hastalarda beslenme problemi vardı. PEG sonrası 50 (%7.1) hastada cilt altı infeksiyonu, 18 (%2.5) hastada PEG kenarından kaçak, 16 (%2.0) hastada PEG kenarından kanama görüldü. Sonuç: PEG, minimal invaziv bir girişim ile yapılabilmesi, mortalite ve morbiditesinin çok az olması nedeniyle yoğun bakım hastaları için basit, emniyetli ve etkili bir beslenme yöntemidir.

Perkütan endoskopik gastrostomi uyguladığımız hastalarda uzun dönem sonuçlarımız

Objectives: In order to provide enteral nutrition for patients in intensive-care units who cannot be fed orally, we aimed to present our percutaneous endoscopic gastrostomy (PEG) experience, which is a minimally invasive method. Materials and methods: In this study, 700 patients who applied to our clinic between January 2000 and June 2011 and who had a PEG because they could not be fed orally were retrospectively assessed in terms of indications, complications, and results. Results: Among these patients, 400 (57%) were male and 300 (43%) were female. Most of the patients with feeding problems had also neurologically caused pathologies. After the PEG, 50 (7.1%) patients had under-skin infections, 18 (2.5%) patients had leakage from the edge of the PEG, and 16 (2.0%) patients had bleeding from the edge of the PEG. Conclusion: PEG is a secure and effective nutrition method as it can be performed with a minimally invasive procedure and it has low mortality and morbidity.

PDF

___

1. Hamidon BB, Abdullah SA, Zawawi MF, Sukumar N, Aminuddin A, Raymond AA. A prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with acute dysphagic stroke. Med J Malaysia 2006;61(1):59-66.
2. Cantwell CP, Gervais DA, Hahn PF, Mueller PR. Feasibility and safety of infracolic fluoroscopically guided percutaneous radiologic gastrostomy. J Vasc Interv Radiol 2008;19(1):129-32.
3. Gauderer MW, Ponsky JL, Izant RJ Jr.Gastrostomy without laparotomy: a percutaneous endoscopic technique. 1980. Nutrition 1998;14(9):736-8.
4. Nicholson FB, Korman MG, Richardson MA. Percutaneous endoscopic gastrostomy: a review of indications, complications and outcome. J Gastroenterol Hepatol 2000;15(1):21- 5.
5. Rabeneck L, Wray NP, Petersen NJ. Long-term outcomes of patients receiving percutaneous endoscopic gastrostomy tubes. J Gen Intern Med 1996;11(5):287-93.
6. Stockeld D, Fagerberg J, Granström L, Backman L. Percutaneous endoscopic gastrostomy for nutrition in patients with oesophageal cancer. Eur J Surg 2001;167(11):839-44.
7. Potochny JD, Sataloff DM, Spiegel JR, Lieber CP, Siskind B, Sataloff RT. Head and neck cancer implantation at the percutaneous endoscopic gastrostomy exit site. A case report and a review. Surg Endosc 1998;12(11):1361-5.
8. Saadeddin A, Freshwater DA, Fisher NC, Jones BJ. Antibiotic prophylaxis for percutaneous endoscopic gastrostomy for non-malignant conditions: a double-blind prospective randomized controlled trial. Aliment Pharmacol Ther 2005;22(6):565-70.
9. Robins G, Hull M. Antibiotic prophylaxis for percutaneous endoscopic gastrostomy insertion in patients with non-malignant disease. Aliment Pharmacol Ther 2006;23(8):1276- 7; author reply 1277.
10. Sturgis TM, Yancy W, Cole JC, Proctor DD, Minhas BS, Marcuard SP. Antibiotic prophylaxis in percutaneous endoscopic gastrostomy. Am J Gastroenterol 1996;91(11):2301- 4.
11. Rey JR, Axon A, Budzynska A, Kruse A, Nowak A. Guidelines of the European Society of Gastrointestinal Endoscopy (E.S.G.E.) antibiotic prophylaxis for gastrointestinal endoscopy. European Society of Gastrointestinal Endoscopy. Endoscopy 1998;30(3):318-24.
12. Hameed H, Khan YI.Metastasis of carcinosarcoma of oesophagus to gastrostomy site. Br J Oral Maxillofac Surg 2009;47(8):643-4.
13. Vatansev C, Aksoy F, Belviranlı M, Yosunkaya A, Özer S. Yoğun bakım hastalarında perkütan endoskopik gastrostomi. Endoskopik Laparoskopik ve Mminimal İnvaziv Cerrahi 2002;9(4):69-72.
14. Stein J, Schulte-Bockholt A, Sabin M, Keymling M. A randomized prospective trial of immediate vs. next-day feeding after percutaneous endoscopic gastrostomy in intensive care patients. Intensive Care Med 2002;28(11):1656-60.