Üçüncü Basamak Yoğun Bakımında Perkütan Endoskopik Gastrostomi Deneyimlerimiz

Amaç: Perkütan endoskopik gastrostomi (PEG), gastrointestinal sistemfonksiyonlarını sürdüren hastalarda beslenme için kullanılan yöntemlerden biridir.Bu çalışmada amacımız, kliniğimizde tedavi edilen ve PEG işlemi uygulananhastaların değerlendirilmesidir. Gereç ve Yöntemler: Kasım 2013 ile Kasım 2015 arasında PEG prosedürü uygulanan18 yaşından büyük hastalar çalışmaya dahil edildi. Hastaların takip formları vehastane elektronik kayıtları retroskopik olarak incelendi. Bulgular: Çalışmaya 117 hasta dahil edildi, hastaların 47’si (%40) erkekti. OrtalamaAkut Fizyoloji ve Kronik Sağlık Değerlendirme II (APACHE II) skoru 20±8, ortalamayaş 72±15 yıl, ortalama yoğun bakım yatış süresi 43±42 gün ve ortalama işlem süresi14±5 gündü. Hastaların %35’i demans, %23,9’u malignite, %22,3’ü serebrovaskülerhastalık tanısı ile yoğun bakımda takip edilmekteydi. Toplam komplikasyon oranı%17’ydi. Sonuç: PEG güvenli bir işlemdir, enteral beslenme fonksiyonlarını sürdüren hastalardakonfor sağlar. Uzun vadede ağızdan beslenemeyen hastaların beslenmesinde etkilibir yöntem olduğunu düşünüyoruz.

Percutaneous Endoscopic GastrostomyExperience in A Tertiary IntensiveCare 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.

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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.