经皮内镜胃造瘘术的临床应用

经皮内镜胃造瘘术（percutaneous endoscopic gastrotomy，PEG）是一项无需外科手术及全身麻醉的胃造瘘术，在国外已普遍推广应用，并代替外科开腹胃造瘘术，近年来，在我国经皮内镜胃造瘘术也已广泛开展。我院于1999年9月以来，先后为5例患者施行了内镜下胃造瘘术，取得了满意的效果。现总结资料报告如下。     

经皮内镜胃造瘘术1例

经皮内镜胃造瘘术１例山东医科大学附属医院（２５００１２）赵幼安，姜希安，张尚忠，陈建我院于１９９６年４月２７日成功地为１例鼻胃管饲营养４５９天的高龄患者施行了经皮内镜胃造瘘术（ＰＥＧ）．现报告如下。患者男，８１岁。因突然昏迷３小时入院。ＣＴ确诊为多发...     

经皮内镜胃造瘘术的临床价值

借助于内镜经皮置入胃造瘘管以进行肠内营养，可以避免传统胃造瘘术的开腹手术这项技术安全、有效、经济，称为经皮内镜胃造瘘术（pmrutaneous endoscopic gastrostomy，PEG），目前已成为胃造瘘肠内营养的首选方法。我院对2000年2月至2004年10月间施行PEG的11例患者进行随访观察，疗效满意.     

内镜下经皮胃造瘘患者的护理

经皮内镜胃造瘘术(PEG)是一项无需手术的胃造瘘技术。1997～2001年，我院选用美国Cook公司生产的24型蘑菇头式胃造瘘管为12例患者实施PEG胃造瘘术，取得满意效果。现将护理体会报告如下。     

经皮内镜胃造瘘术的临床应用

经皮内镜胃造瘘术（ｐｅｒｃｕｔａｎｅｏｕｓ　ｅｎｄｏｓｃｏｐｉｃ　ｇａｓｔｒｏｓｔｏｍｙ，ＰＥＧ）是一项无需外科手术及全身麻醉的胃造瘘术，由于它具有简单易行、经济实惠、安全快捷等优点，近年来，国内也日益推广应用，已部分地替代了手术胃造瘘术，我院自１９９８年以来先后为２７例脑外伤或脑血管意外的患者施行了手术，效果满意，现总结报告如下。一、临床资料１９９８年２月至２００１年１月住院患者２７例，男２１例，女６例，年龄１８～７９岁，平均５１岁，所有病例均为心脑疾病造成昏迷或神志不清者，在行ＰＥＧ之前大多…     

经皮内镜胃造瘘术的临床应用

经皮内镜胃造瘘术的临床应用赵幼安张尚忠陈建经皮内镜胃造瘘术（ｐｅｒｃｕｔａｎｅｏｕｓｅｎｄｏｓｃｏｐｉｃｇａｓ－ｔｒｏｓｔｏｍｙ，ＰＥＧ）是一项无需外科手术及全身麻醉的胃造瘘技术。我院用美国产的ＰＲＧ２４蘑菇头式胃造瘘管先后为４例患者施行手术，取得满...     

Pull和Introducer两种经皮内镜下胃造瘘方法的比较

目的介绍和比较Pull和Introducer两种胃造瘘方法的特点和应用价值。方法对8例连续住院需胃造瘘病人分别施行Pull(5例)和Introducer(3例)经皮内镜下胃造瘘。比较两种方法操作的时间、安全性和并发症。在术后第2～3周,在床边无内镜监视下对Introducer胃造瘘患者更换造瘘管。结果采用两种方法进行胃造瘘均取得了成功。胃造瘘的时间Pull法平均为(17±2.3)min,Introducer法平均为(17±3.6)min。两组均无并发症。对Introducer胃造瘘患者更换胃造瘘管平均用时(5±1.3)min,患者无任何不适。结论Pull和Introducer两种胃造瘘法都是安全的。Introducer法在更换胃营养管时不需要再次内镜监视,特别适于各种原因所致食管上段或咽喉部狭窄的患者。     

5例经皮内镜下胃造瘘术的护理——詹红

采用经皮内镜下胃造瘘术行胃造瘘5例,效果满意。其护理要点为：术前加强心理护理;术中严密监测生命体征：术后细致的护理。保持造瘘管通畅,预防感染。减少并发症的发生。     

75例经皮内镜下胃造瘘术的护理体会

目的探讨经皮内镜下胃造瘘术(PEG)的配合护理。方法采用PEG技术对75例肿瘤病人进行胃造瘘术，重新建立消化道营养通道。结果75例均造瘘成功，治疗后营养状况改善，体重增加，精神状况好转。结论PEG是一种操作简单、安全、有效的新方法，术前、术中、术后的细致护理是保证PEG成功及预防和减少并发症的关键。     

胃造瘘术与食管支架植入术对危重症气管食管瘘患者的疗效评估

目的评估内镜下食管覆膜自膨式金属支架植入术与经皮内镜下胃造瘘术（PEG）在气管食管瘘治疗中的应用价值。方法19例良性气管食管瘘患者,9例行PEG留置造瘘管、10例行内镜下食管覆膜自膨式金属支架植入术,2个月后经内镜将金属支架取出,以吞咽一咳嗽征检测气管食管瘘是否完全愈合。结果两组患者肺部感染的治愈率与治疗失败率方面差异无显著性,但PEG留置胃造瘘管组患者气管食管瘘黏膜的愈合率显著高于行内镜下食管覆膜自膨式金属支架植入术患者（P〈0．05）。结论经PEG留置胃造瘘管对于治疗气管食管瘘显著优于行内镜下食管自膨式覆膜金属支架植入术。     

Possibility of oral feeding after induction of percutaneous endoscopic gastrostomy

Background and Aim: Although percutaneous endoscopic gastrostomy (PEG) has become established as a useful enteral nutrition technique, the associated risks must always be kept in mind. Recently, we experienced several patients who could orally ingest after PEG. To avoid unnecessary PEG, we investigated patients who could orally ingest after PEG, and analyzed predictive factors of postoperative oral feeding. Methods: We retrospectively analyzed data of 302 patients who underwent PEG at our hospital. After all patients were divided according to postoperative oral feeding status, we assessed factors of patients' backgrounds. In patients who could orally ingest after PEG, we investigated the course of oral feeding status. We attempted to identify predictive factors for postoperative oral feeding using logistic regression analysis. Results: Mean age was high in both groups, and overall condition was markedly poor. Forty‐four patients (15%) were able to ingest orally after PEG. Enteral nutrition could be avoided during our observation period in 15 cases, because sufficient oral intake was achieved. Conversely, oral feeding was reduced or discontinued in 14 cases. Multivariate analysis identified the following independent predictive factors for postoperative oral feeding: (i) absence of dysphagia or aphagia; (ii) younger age; (iii) favorable performance status; (iv) presence of post‐traumatic encephalopathy; and (v) preoperative swallowing training. Conclusions: A total of 15% of PEG cases were able to ingest orally after PEG. In patients showing positive predictive factors, indications for PEG should be carefully considered.     

Enteral nutrition via percutaneous endoscopic gastrostomy and nutritional status of patients: five-year prospective study

BACKGROUND: Since it was described in 1980, percutaneous endoscopic gastrostomy (PEG) has been a widely used method for insertion of a gastrostomy tube in patients who are unable to swallow or maintain adequate nutrition. The aim of the present paper was to determine the complications of PEG insertion and to study pre- and post-procedural nutritional status. METHODS: During the period of March 1999-September 2004, placement of PEG tube was performed in 85 patients (22 women and 63 men). Patient nutritional status was assessed before and after PEG insertion via anthropometric measurements. RESULTS: The most frequent indication for PEG insertion was neurological disorders (65.9%). Thirty patients died due to primary disease and two patients due to PEG-related complications within 5 years. There were 14 early complications in 10 patients (15.2%; <30 days), and 18 late complications in 12 patients (19.6%). Total mortality was 37.6%. All complications other than four were minor. Before PEG insertion, patients were assessed with subjective global assessment and it was determined that 43.2% of them had severe, and 41.9% of them had mild malnutrition. After PEG insertion, significant improvements on patient nutrition levels was observed. CONCLUSION: Percutaneous endoscopic gastrostomy is a minimally invasive gastrostomy method with low morbidity and mortality rates, is easy to follow up and easy to replace when clogged.     

Long‐term prognosis and satisfaction after percutaneous endoscopic gastrostomy in a general hospital*

Background: Percutaneous endoscopic gastrostomy (PEG) has been widely acknowledged as a safer method for enteral feeding; however, its long‐term impact on prognosis and quality of life in elderly patients is not sufficiently understood. There are issues still to be studied regarding the indications for PEG, due to the lack of convincing evidence that it reduces expected complications such as aspiration pneumonia or for improving the prognosis of patients with severe dementia. Method: In this study we investigated the survival rate after PEG and the families’ satisfaction in 78 inpatients who underwent PEG. We conducted the investigation by sending questionnaires to the families. Results: The results for the 69 cases (88%) in which the patient recovered showed that the 1‐year survival rate was 64.0%, and the 2‐year survival rate was 55.5%. Fifty‐three per cent of patients’ families indicated overall satisfaction regarding of PEG. Conclusions: The survival rates were relatively higher than those from previously reported studies. This may be attributed to variations in patients’ clinical, socio‐economic, or cultural backgrounds in therapeutic interventions. We recognized the importance of clarifying factors that would affect the living and functional prognosis and quality of life in elderly patients who underwent PEG. The indications for PEG are based on a comprehensive assessment of the relevant factors in individual cases, and by taking patients’ and families’ wishes into consideration.     

Percutaneous Endoscopic Gastrostomy for Elderly Patients; A Comparative Study with Nasogastric Feeding

Abstract: Elderly patients who are unable to swallow due to disorders of the central nervous system and other disorders require parenteral alimentation for nutritional maintenance. Nasogastric feeding (NGF) which is widely employed for this purpose often causes problems such as the removal of the tube by the patient, difficulty of insertion or changing of the tube, and the induction of wheezing or even aspiration pneumonia. To avoid these difficulties, we performed a percutaneous endoscopic gastrostomy (PEG) on 10 patients, aged 80.7±19.3 years, who had previously been managed by nasogastric feeding for an average period of 10.8±19.3 months. No severe complications occurred during or after the operation. A comparison between 10 patients receiving gastrostogavage (PEG) and another 20 on NGF also revealed that PEG resolved the problems associated with NGF and achieved alimentary effects similar to NFG in the serum levels of albumin and hemoglobin. The autopsies of two elderly PEG patients who died of cardiac disease demonstrated that the serosa of their stomach and anterior abdominal wall firmly adhered. Our observations suggest that PEG is a safe and beneficial means of feeding for certain aged patients.     

经皮内镜下胃造瘘术应用进展

经皮内镜下胃造瘘术(PEG)是20世纪80年代开始应用于临床的一种新的内镜介入技术,主要用于胃肠减压和肠内营养,在国外已广泛应用。此文就其方法、适应症、并发症及禁忌症等作一综述。     

BURIED BUMPER SYNDROME AS A COMPLICATION OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN CANCER PATIENTS: THE BRAZILIAN EXPERIENCE

Background: Buried bumper syndrome (BBS) is a major complication of percutaneous endoscopic gastrostomy (PEG) in which the internal bumper migrates from the gastric lumen into the gastrostomy tract. The aim of the present study was to describe the frequency and characteristics of BBS in cancer patients. Methods: Retrospective chart review of cancer patients submitted to PEG placement. Results: Thirteen cases of BBS were diagnosed among 213 PEG procedures, with an incidence of 6.1%. The interval between PEG and BBS varied from 7 to 630 days (mean 217.5 days). All patients were treated on an outpatient basis. There were six partial, four subtotal and three total BBS. Three partial and four subtotal BBS were treated by external traction and replacement with a balloon‐tipped tube. In three cases of partial BBS the PEG tube was not removed, just repositioned. In three cases of total BBS it was necessary to redo the PEG procedure. Conclusion: BBS is an uncommon and usually late complication of PEG. Most of our cases were detected early, due to instructions provided to patients and caregivers and regular follow up. Early diagnosis permits simple treatment consisting of replacement of the original PEG tube by a balloon‐tube or repositioning the original system.     

Complications Following Percutaneous Endoscopic Gastrostomy: Acute Respiratory Infection and Local Skin Infection

Abstract: Few studies of percutaneous endoscopic gastrostomy (PEG) have evaluated the effects of antibiotic prophylaxis, PEG placement technique and early PEG feeding on acute postoperative complications. In this retrospective study, we investigated associations between postoperative management of PEG and complications of infection. The medical records of 271 patients were included in this study. Administration of antibiotics, early and delayed enteral feeding, and PEG placement technique were analyzed as risk factors for infectious complications. The rate of local skin infection correlated with early PEG feeding, but there was no difference in the rate of local skin infection due to postoperative administration of antibiotics. Early feeding with the usual enteral formula was a strong risk factor for local skin infection. The rate of local skin infection was higher in the “Push/Pull” technique than the “Introducer” technique. As for aspiration, the rate of complication was lower in groups with postoperative administration of antibiotics than in groups without administration of antibiotics, but there was no association between aspiration and early feeding or PEG placement technique. Local skin infection correlated with early postoperative feeding and was not correlated with antibiotic prophylaxis. However, the administration of antibiotics is recommended for the prevention of aspiration.     

CLINICAL INVESTIGATION OF UPPER GASTROINTESTINAL HEMORRHAGE AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY

Background: Upper gastrointestinal (GI) hemorrhage after percutaneous endoscopic gastrostomy (PEG) is sometimes reported as one of the serious complications. Our purpose was to clarify the cause of upper GI hemorrhage after PEG. Patients and Methods: We retrospectively investigated the causes of upper GI hemorrhage among a total of 416 patients out of 426 consecutive patients who underwent PEG in our institution, excluding 10 patients who showed upper GI tumors on PEG placement. Results: Among 17 patients who developed upper GI hemorrhage after PEG, three and four patients showed PEG tube placement and replacement‐related hemorrhage, respectively; these lesions were vascular or mucosal tears around the gastrostomy site. Ten patients experienced 12 episodes of upper GI hemorrhage during PEG tube feeding. The lesions showing bleeding were caused by reflux esophagitis (five patients), gastric ulcer (two patients), gastric erosion due to mucosal inclusion in the side hole of the internal bolster (two patients), and duodenal diverticular hemorrhage (one patient). Anticoagulants were administered in six patients, including four patients with replacement‐related hemorrhage and one patient each with reflux esophagitis and gastric ulcer. Conclusions: Reflux esophagitis was the most frequent reason for upper GI hemorrhage after PEG. The interruption of anticoagulants should be considered for the prevention of hemorrhage on the placement as well as replacement of a gastrostomy tube.     

Laparoscopy-assisted percutaneous endoscopic gastrostomy enables enteral nutrition even in patients with distorted anatomy

AIM:To analyzed whether laparoscopy-assisted percutaneous endoscopic gastrostomy(PEG)could be a valuable option for patients with complicated anatomy.METHODS:A retrospective analysis of twelve patients(seven females,five males;six children,six young adults;mean age 19.2 years)with cerebral palsy,spastic quadriparesis,severe kyphoscoliosis and interposed organs and who required enteral nutrition(EN)due to starvation was performed.For all patients,standard PEG placement was impossible due to distorted anatomy.All the patients qualified for the laparoscopyassisted PEG procedure.RESULTS:In all twelve patients,the laparoscopy-assisted PEG was successful,and EN was introduced four to six hours after the PEG placement.There were no complications in the perioperative period,either technical or metabolic.All the patients were discharged from the hospital and were then effectively fed using bolus methods.CONCLUSION:Laparoscopy-assisted PEG should become the method of choice for gastrostomy tube placement and subsequent EN if PEG placement cannot be performed safely.