Efficacy of preventive treatment for complications in percutaneous endoscopic gastrostomy in elderly

From September 1995 through May 1999, percutaneous endoscopic gastrostomy (PEG) was performed in 47 elderly patients, aged 65 to 93 (average 78.9). Several treatments were additionally performed to prevent serious complications in these cases, and their usefulness and problems were investigated. Gastropexy was performed to prevent peritonitis in cases of self-removal of tubes in the acute stage. Intraoperative fluoroscopy was used prevent perforation of the intestines. However, re-insertion of the endoscopic, which was necessary with the push method, was omitted to reduce the burden on the patients. In patients with tube troubles in the chronic stage such as the buried bumper syndrome or self-removal, the existing fistula was preserved and the gastrostomy was reconstructed using a narrow polyvinyl chloride tube and a flexible guide wire to prevent peritonitis by erroneous insertion of the tube. In terms of results, gastropexy was useful to prevent peritonitis in one patient with early self-removal of the tube. Data to evaluate the usefulness of fluoroscopy in preventing perforation of the intestine were insufficient, so more patients need to be studied in the future. Even when confirmation of the location of the internal bumper by endoscopy was omitted, there was no case of poor traction of the bumper, so this procedure seems unnecessary. Review of tube troubles, in the chronic stage revealed no case of peritonitis caused by erroneous insertion of tubes or erroneous injection of nutrients with our reconstruction methods, and complete reconstruction of the gastrostomy with preservation of the existing fistula appeared to be possible. However, those additional treatments require extension of the operation time and rise in cost with increased use of medical instruments, so the indications should be carefully considered.     

The safety and feasibility of percutaneous endoscopic gastrostomy placement

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is now becoming increasingly popular. However, an increasing number of complications has also been reported. Regarding such complications, iatrogenic perforation of the colon is considered to be the most dangerous. METHODOLOGY: We routinely check the course of the colon using preoperative abdominal computed tomography with air injected into the stomach (pre-PEG CT), and thereafter the patients are classified into two groups, consisting of a Low-risk group and High-risk group, according to the locations of the stomach and colon. The patients in the High-risk group underwent PEG in combination with contrast radiography of the large intestine. We evaluated the safety and feasibility of PEG placement using a Pre-PEG CT and contrast radiography of the large intestine. RESULTS: A Pre-PEG CT showed a Low-risk type in 84.4% and a High-risk type in 15.6%. High-risk type patients underwent contrast radiography on the large intestine in conjunction with PEG. As a result, we were able to perform PEG safely with no iatrogenic perforation in any patients. CONCLUSIONS: A pre-PEG CT and contrast radiography of the large intestine combination with PEG are thus considered to be an effective modality for reducing the incidence of serious complications of PEG.     

老年人经皮内镜下胃造瘘和小肠造瘘术后长期肠内营养支持的应用

目的评价经皮内镜下胃造瘘术(PEG)和经皮内镜下胃空肠造瘘术(PEGJ)后长期肠内营养支持在老年患者的临床应用。方法对72例行PEG／PEGJ的老年患者进行随访,观察患者的死亡率、造瘘管拔管情况、血清生化指标、营养指标及细胞免疫指标的变化。结果72例中,术后1个月死亡11例(15．3％);4年总死亡率44例(61．1%),主要死亡原因是肺炎;PEG相关的死亡1例,死亡率1．4%。患者术前及术后各点的血清生化指标和营养状况差异无统计学意义,但细胞免疫指标术后各点均高于术前(P<0．01),术前CD4+／CD8+为1．86±1．19,术后1、2、3、4年分别为1．89±1．0、2．21±1．05、2．18±0．93、1．97±0．58,差异有统计学意义(P<0．01)。结论对有吞咽障碍的老年患者长期应用PEG/PEGJ,在维持营养、提高免疫方面是有益的。     

Complications of percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) has become the method of choice for mid-to long-term enteral feeding. The majority of complications that occur are minor, but the rare major complications may be life threatening. Some complications occur soon after tube placement, others develop later, when the gastrostomy tract has matured. Older patients with comorbidities and infections appear to be at a greater risk of developing complications. Apart from being aware of indications and contraindications, proper technique of PEG placement, including correct positioning of the external fixation device, and daily tube care are important preventive measures. Adequate management of anticoagulation and antithrombotic agents is important to prevent bleeding, and administration of broad spectrum antibiotics prior to the procedure helps prevent infectious complications. Early recognition of complications enables prompt diagnosis and effective therapy.     

Endoscopic ultrasound-guided percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) is the method of choice for feeding and nutritional support in patients with a normal gastrointestinal function who require long-term enteral nutrition. We report our experience regarding an alternative endoscopic ultrasound (EUS)-guided PEG technique. A retrospective clinical experience case series study was conducted from January 2019 to November 2019 at a tertiary center. Adult patients deemed unfit for conventional PEG due to absence of transillumination or previous gastric surgery were enrolled. An EUS target was created by filling a glove with saline and placing it in the abdomen. EUS was performed and the target identified from the stomach. The abdominal wall was punctured from the stomach and a guidewire was advanced. The guidewire was knotted to a string, which was passed into the stomach and drawn back through the mouth. The procedure was continued following the traditional technique. Four patients underwent EUS-PEG in our center during the study period. Mean age was 65 years and 50% were male. Two patients (50%) had a body mass index over 30. PEG indications were tongue malignancies (50%), cerebrovascular disease (25%) and dementia (25%). One patient had a Roux-en-Y gastric bypass and percutaneous endoscopic jejunostomy was performed. Technical success rate was 100% and no complications occurred. This case series shows that the EUS-guided PEG technique is a safe alternative in patients deemed unfit for conventional PEG.     

Update on endoscopic percutaneous gastrostomy

Trans-endoscopic gastrostomy (TEG), after 25 years since it's introduction, is at present the most utilized method to gain access to the upper digestive tract, to place an enteral feeding tube. There are different modalities that must be known to be able to decide which alternative is the best according to our judgment and experience. The endoscopist is one more member of a multidisciplinary team caring for the patient who must have a pro-active role in the clinical management of each case. We must not forget that a good result is based on an adequate patient selection, keeping in mind the limitations, the complications and very importantly, the final care of each procedure.     

Complications of percutaneous endoscopic gastrostomy in the elderly: local skin infection and respiratory infection

We investigated post-operative management of acute complications of percutaneous endoscopic gastrostomy (PEG) which often caused respiratory infections and local skin infections. The subjects were a total of 341 patients (male 131, female 210, and the mean age was 80.3), they were classified into six groups by method of feeding and use of antibiotics. Patients were divided into three groups based on the time that feeding was started. In Group I, enteral feeding was not started within the first five days. In Group II, sterilized enteral feeding (lactated Ringer's solution for intravenous infusion) using sterilized intravenous infusion kit started within 24 hours after the procedure, and in Group III, feeding of the usual enteral formula started within 24 hours after the procedure. And as for the using of antibiotics, they were also divided into two groups, antibiotics administered[AB (+)] and no antibiotics administered[AB (-)]. Thus, the patients were divided into six groups according to the time of starting nutrition and the use of antibiotics. The rates of incidence of acute respiratory infections and local skin infections in the six groups were compared by the chi-square test and differences in the rates of incidence of complication were also compared between two PEG methods; the Pull/Push method and the Introducer method. The frequency of local skin infection in Group III was significantly higher than in Group I and Group II. As for the PEG methods, the frequency of local skin infection in the Pull/Push method was significantly higher than Introducer methods. Acute respiratory infections occurred significantly less in the AB (+) group than in the AB (-) group. Postoperative administration of antibiotics would seem to be appropriate for prophylaxis of respiratory infection in elderly patients after PEG. On the other hand, local skin infections are not related to administration of antibiotics, and are highly related to the method of feeding. We concluded that nutrition of sterilized enteral feeding immediately after operation using a sterilized intravenous infusion kit and administration of antibiotics are advisable to prevent major complications in elderly patients.     

胃镜下经皮胃造瘘的临床应用

1980 年非手术经皮内镜下胃造瘘术(percutaneous endoscopic gastrostomy, PEG)被介绍应用于临床, 其优点是操作简便、并发症少. 近30年来, PEG临床应用的范围不断扩展,越来越受到重视. 该项技术已在欧美、日本等国家替代外科胃造瘘. 目前PEG已经成为需要长期肠内营养支持患者的首选方法. 本文介绍了PEG技术, PEG的适应证、禁忌证、并发症以及处理方法.     

经皮内镜胃造瘘患者的循证治疗

目的:探讨经皮内镜胃造瘘临床上常见问题,并为患者制定合理的治疗方案,以控制患者症状,降低死亡率.方法:在充分评估患者的情况后,提出临床问题,从Cochrane图书馆(1995-2010)、MEDLINE(1990-12/2010)、EMBase (1990-12/2010)、SCIE(1990-12/2010)、中国知...