Percutaneous Endoscopic Gastrostomy Experience in A Tertiary Intensive Care Unit

Objective: Percutaneous endoscopic gastrostomy (PEG) is a procedure performed for nutrition in patients whose gastrointestinal system functions are impaired. This study aimed to evaluate patients who were treated in our clinic and underwent PEG. Materials and Methods: Patients older than 18 years who underwent PEG between November 2013 and November 2015 were studied. Patient follow-up forms and hospital electronic records were analysed retrospectively. Results: Overall, 117 patients were enrolled, including 47 (40%) male patients. The mean Acute Physiology and Chronic Health Evaluation II score was 20±8; mean age, 72±15 years; mean length of stay, 43±42 days and mean procedure day, 14±5 days. About 35% of patients had dementia, 23.9% had malignancy and 22.3% had cerebrovascular disease. The total complication rate was 17%. Conclusion: PEG is a safe procedure and provides patient comfort while maintaining enteral nutrition. Therefore, it is an effective method in feeding patients who cannot be fed orally in the long term.

Üçüncü Basamak Yoğun Bakımında Perkütan Endoskopik Gastrostomi Deneyimlerimiz

Amaç: Perkütan endoskopik gastrostomi (PEG), gastrointestinal sistem fonksiyonlarını sürdüren hastalarda beslenme için kullanılan yöntemlerden biridir. Bu çalışmada amacımız, kliniğimizde tedavi edilen ve PEG işlemi uygulanan hastaların değerlendirilmesidir. Gereç ve Yöntemler: Kasım 2013 ile Kasım 2015 arasında PEG prosedürü uygulanan 18 yaşından büyük hastalar çalışmaya dahil edildi. Hastaların takip formları ve hastane elektronik kayıtları retroskopik olarak incelendi. Bulgular: Çalışmaya 117 hasta dahil edildi, hastaların 47’si (%40) erkekti. Ortalama Akut Fizyoloji ve Kronik Sağlık Değerlendirme II (APACHE II) skoru 20±8, ortalama yaş 72±15 yıl, ortalama yoğun bakım yatış süresi 43±42 gün ve ortalama işlem süresi 14±5 gündü. Hastaların %35’i demans, %23,9’u malignite, %22,3’ü serebrovasküler hastalık tanısı ile yoğun bakımda takip edilmekteydi. Toplam komplikasyon oranı %17’ydi. Sonuç: PEG güvenli bir işlemdir, enteral beslenme fonksiyonlarını sürdüren hastalarda konfor sağlar. Uzun vadede ağızdan beslenemeyen hastaların beslenmesinde etkili bir yöntem olduğunu düşünüyoruz

PDF

___

1. Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980; 15: 872-5.

2. Koçak E, Levent F. Perkütan endoskopik gastrostomi. Endoskopi 2009; 17: 124-7.

3. Lucendo AJ, Friginal-Ruiz AB. Percutaneous endoscopic gastrostomy: An update on its indications, management, complications, and care. Rev Esp Enferm Dig 2014; 106: 529-39.

4. Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol 2014; 20: 7739-51.

5. Bannerman E, Pendlebury J, Phillips F, Ghosh S. A cross-sectional and longitudinal study of health-related quality of life after percutaneous gastrostomy. Eur J Gastroenterol Hepatol 2000; 12: 1101-9.

6. Ljungdahl M, Sundbom M. Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: a prospective, randomized trial. Surg Endosc 2006; 20: 1248-51.

7. Braunschweig CL, Levy P, Sheean PM, Wang X. Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr 2001; 74: 534-42.

8. Löser C, Wolters S, Fölsch UR. Enteral long-term nutrition via percutaneous endoscopic gastrostomy (PEG) in 210 patients: a four-year prospective study. Dig Dis Sci 1998; 43: 2549-57.

9. Chang WK, Huang HH, Lin HH, Tsai CL. Percutaneous Endoscopic Gastrostomy versus Nasogastric Tube Feeding: Oropharyngeal Dysphagia Increases Risk for Pneumonia Requiring Hospital Admission. Nutrients 2019; 11: 2969.

10. Feinberg J, Nielsen EE, Korang SK, Halberg Engell K, Nielsen MS, Zhang K, et al. Nutrition support in hospitalised adults at nutritional risk. Cochrane Database Syst Rev 2017; 5: 11598.

11. Mekhail TM, Adelstein DJ, Rybicki LA, Larto MA, Saxton JP, Lavertu P. Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube? Cancer 2001; 91: 1785-90.

12. Golestanian E, Liou JI, Smith MA. Long-term survival in older critically ill patients with acute ischemic stroke. Crit Care Med 2009; 37: 3107-13.

13. Oud L. Intensive Care Unit (ICU) - Managed Elderly Hospitalizations with Dementia in Texas, 2001-2010: A Population-Level Analysis. Med Sci Monit 2016; 22: 3849-59.

14. Doğu C, Kayır S, Doğan G, Akdağlı Ekici A, Özçiftçi S, Yağan Ö. Tracheotomy among patients in geriatric age group treated in intensive care units. Turkish J Geriatr 2019; 22: 172-80.

15. Ozguc H, Gokce E, Altınel Y, Kırdak T. Percutaneous endoscopic gastrostomi experience in a general surgery clinic. Turkish J Surg 2011; 27: 145-8.

16. Kahramanoğlu Aksoy E, Sapmaz F, Akpınar M, Göktaş Z, Uzman M, Nazlıgül Y. Long-term Follow-up Results of Patients with Percutaneous Endoscopic Gastrostomy and Factors Affecting Survival. J Ankara Univ Fac Med 2019; 72: 179-83.

17. Schneider AS, Schettler A, Markowski A, Luettig B, Kaufmann B, Klamt S, et al. Complication and mortality rate after percutaneous endoscopic gastrostomy are low and indication-dependent. Scand J Gastroenterol 2014; 49: 891-8.