Enteral Long-Term Nutrition via Percutaneous Endoscopic Gastrostomy (PEG) in 210 Patients A Four-Year Prospective Study

After PEG placement at the Medical Department ofthe University Hospital in Kiel, 210 patients (mean age61.3 years; 137 men, 73 women) were prospectivelyfollowed-up for 133 ± 181 days. Close-meshed evaluations of the development of nutritionalstatus, long-term outcome, complications, subjectiveacceptability, patient care after discharge from thehospital, survival, and nutritional long-term problems were performed. The PEG procedure (duration13.3 ± 4.2 min) was carried out for neurological(42%), ear-nose-throat (28%), and internal medical (30%)indications. Procedure-related mortality was 0%, while altogether 3.8% severe and 20.0% mildcomplications were observed. Body weight decreased by amean of 11.4 ± 1.5 kg in the three months beforeand increased by 3.5 ± 1.7 kg one year after PEGplacement with no significant differences betweenmalignant or benign underlying diseases. Individualsubjective acceptability was excellent in 83%,sufficient in 15%, and poor in 2% of patients only.One-year survival rate was 34.3%. The various results of thepresent prospective study demonstrate that long-termenteral feeding via PEG is a safe, effective,easy-topractice, and highly acceptable method withexcellent long-term results and distinct improvement ofnutritional status. Individual decisions for PEGplacement should be considered much earlier and morefrequently in appropriate patients.     

Percutaneous Endoscopic Gastrostomy: A Preferred Method of Feeding Tube Gastrostomy

Percutaneous endoscopic gastrostomy was attempted in 16 patients using local anesthesia and intravenous meperidine and diazepam sedation. The procedure was shown to be safe, easy to perform, and avoided the need for laparotomy. We suggest percutaneous endoscopic gastrostomy be the preferred route of alimentation in those patients requiring feeding gastrostomy.     

Long-Term Survival in Patients Undergoing Percutaneous Endoscopic Gastrostomy and Jejunostomy

Percutaneous endoscopic gastrostomy (PEG) used to supply enteral nutrition has supplanted surgically placed feeding tubes in many institutions. These tubes are currently placed in: 1) patients with reversible disease with potential for recovery (stroke, Guillain-Barré syndrome); 2) patients with incurable disease with potential for extended survival (head and neck cancer, amyotrophic lateral sclerosis); or 3) patients who are terminal or seriously debilitated (head trauma, systemic malignancies). Few data are currently available regarding long-term survival, survival difference between various patient populations, and incidence of recovery of oral intake with subsequent PEG tube removal. In this study, records of 191 patients in whom PEG tubes were placed were retrospectively reviewed and information collected regarding underlying diseases (malignant vs nonmalignant), survival, and incidence of subsequent tube removal. Of the patients, 68 (36%) had cancer, and 123 (64%) had benign disease (usually stroke or other neurologic disorder). Survival curve analysis demonstrated that one-third of patients were dead within 60 days of PEG placement, and half were dead in the first 6 months. Total deaths were 115 (60%) at a median time of 164 days. No mortality was directly related to acute or subsequent PEG tube complications. Feeding tubes were removed in 41 patients (21%), 10 with cancer (5%), and 31 without (16%, p less than 0.05). These data on limited patient survival and low incidence of recovery of oral intake suggest that facilitation of hospital discharge into a less expensive home care or step-down facility is the most likely goal to be realized after PEG placement. Further, these results raise questions regarding the appropriateness of PEG placement in patients with anticipated early mortality or low likelihood of hospital discharge.     

Endoscopic Clips Prevent Displacement of Intestinal Feeding Tubes: A Long-Term Follow-Up Study

Background Displacement of jejunal feeding tubes is a major problem in enteral feeding. Although endoscopic clips have been used to prevent migration of the tube during placement, the long-term effect of the clips on tube displacement is unknown. Objectives The purpose of this study was to examine the long-term effect of endoscopic clips on preventing displacement of the jejunal feeding tube. Design A retrospective study. Setting A single tertiary medical center. Main outcome measurements The success rate of the procedure and the functional duration of the feeding tube. Results About 93% of patients had a percutaneous endoscopic gastrostomy jejunal (PEGJ) tube successfully placed with use of endoscopic clips. About 7% had tube migration and repeat procedures were successful. The mean functional duration of the tube was 55 days. Limitations Retrospective, single-center. Conclusions Use of endoscopic clips can prevent migration during placement of the feeding tube and can also reduce tube displacement in the long term.     

Comparison of Percutaneous Endoscopic Gastrostomy with Surgical Gastrostomy at a Community Hospital

The results of percutaneous endoscopic gastrostomies in 100 patients in a community hospital were compared with those of surgically placed gastrostomies in 50 patients. The morbidity rate for the percutaneous endoscopic gastrostomy group was 4%, compared with 30% for the patients with surgically placed gastrostomies. The procedure-related mortality for percutaneous endoscopic gastrostomy was 1%, compared with 16% for surgically placed gastrostomies. Patients admitted to the hospital for percutaneous endoscopic gastrostomy stayed an average of 4 days compared with 10 days for the surgical patients; 14 patients had the percutaneous endoscopic gastrostomy performed as an outpatient procedure. There were no complications in this group, suggesting that percutaneous endoscopic gastrostomy can be safely performed as an outpatient. In this community hospital, percutaneous endoscopic gastrostomy was both substantially safer and far less expensive than surgically placed gastrostomy.     

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.     

A New Complication of Percutaneous Endoscopic Gastrostomy

Two cases of complications of percutaneous endoscopic gastrostomy are described that have not been reported previously. Each had misplacement of a gastrostomy tube in the intestine, one in the transverse colon resulting in profuse diarrhea and metabolic acidosis, and the other in the jejunum causing adhesions with subsequent small bowel obstruction. An explanation of these complications and suggestions for prevention are presented.     

Percutaneous Endoscopic Gastrostomy (PEG) for Enteral Nutrition in Patients with Stroke

Background: The use of percutaneous endoscopic gastrostomy (PEG) for enteral nutrition in patients admitted for stroke is difficult, varying and needs specific consideration. There is therefore need for more data on this patient group. We examined the indications, survival, tube removal and time with PEG in stroke patients and in other patients with PEG with the aim of providing guidance for the management of enteral nutrition via PEG in stroke patients. Methods: Retrospective assessment of data from all stroke patients and patients with other diseases (control group) who had received PEG for enteral nutrition during a period of 8.5 years. Results: Eighty-three stroke patients with dysphagia received PEG after unsuccessful use of nasogastric tubes or long-term tube feeding. Early mortality rate was 19% in the stroke group, 26% in the older group (>74 years) and 12% in the younger group (60-74 years). The PEG tubes were later removed due to swallowing recovery in 20% of the older group and in 31% of the younger group. At 90 days, 50%-60% still needed PEG. The stroke patients were older compared to the control group ( n &#114 = &#114 115); 30-day mortality was similar but more patients recovered the ability to swallow. Conclusions: Stroke patients are older than other patients who receive PEG; 27% have swallowing recovery and more than 75% have long-term need for PEG. Nasogastric tubes often fail, and the need for early PEG placement (within 2 weeks) must be assessed in appropriate patients. The patient's prognosis, the objective of nutritional treatment, duration of dysphagia, age and comorbidity should all be taken into consideration.     

Successful Control of Peristomal Infection by Introducer-Type Percutaneous Endoscopic Gastrostomy: A Retrospective Historical Control Study

Background  

The techniques of percutaneous endoscopic gastrostomy are classified as the pull and introducer methods. Peristomal infection is the most common procedure-related complication in the pull method.     

Randomized Prospective Trial of Early Versus Delayed Feeding After Percutaneous Endoscopic Gastrostomy Placement

Objective : By convention, most clinicians delay feeding through the gastrostomy tube until 24 h after placement. However, evidence is lacking to support the rationale for such a delay in PEG use. This randomized, prospective study was designed to assess the safety of early feeding after PEG placement. Methods : One hundred-twelve patients referred for PEG were randomized to begin tube feedings at 4 h (group A) or at 24 h (group B) after placement. All patients received prophylactic antibiotics. Full-strength Isocal was administered with the following schedule: day 1,100 ml every 4 h for six feedings; day 2, 200 ml every 4 h for six feedings. Immediately before each scheduled feeding, gastric residual volume was recorded and the next feeding was withheld if the residual volume was > 50 percent (gastric retention). Patients were evaluated on day 1, day 2, day 7, and day 30 for major and minor complications. Results : The two groups were similar with regard to age, gender, baseline nutritional status, and indications for PEG placement. On the first day of feeding, 14 of 57 patients (25%) in group A, but only five of 55 patients (9%) in group B, had evidence of gastric retention,   p × 0.029  . The proportion of patients with high gastric residual volumes was not significantly different on day two. In group B, one death occurred because of aspiration of gastric contents on day 2. All other complications were minor and did not differ significantly between the two groups. Conclusions : Early initiation of PEG feedings is safe, well tolerated, and reduces cost by decreasing hospital stay.     

Percutaneous Endoscopic Gastrostomy with Jejunal Extension: A New Technique

Percutaneous endoscopic gastrostomies (PEG) with jejunal extensions are placed in patients at risk for aspiration of gastric contents. Current methods used are difficult and often ineffective in preventing aspiration, and frequently result in substantial morbidity and mortality. In this study, a new method of jejunal extension from a PEG was evaluated with regard to efficacy and prevention of aspiration of gastric contents while providing adequate enteral nutrition. Twelve patients with recent aspiration pneumonitis underwent PEG placement with a jejunal extension by this new method. The technique was accomplished rapidly and without difficulty in an average time of 26.2 min (range 17-31 min). In all instances, the jejunal extension remained functional for the first 8 wk after placement, and there were no instances of aspiration of gastric contents while nutritional requirements were met. None of the patients died from complications of the procedure. The method described was effective in preventing aspiration of gastric contents, was easily performed, and was associated with minimal complications.     

When Push Comes to Shove: A Comparison between Two Methods of Percutaneous Endoscopic Gastrostomy

Percutaneous endoscopic gastrostomy has supplanted surgical gastrostomy in a number of medical centers. A variety of makeshift or commercially available gastrostomy kits has been used, as have several insertion techniques. Despite widespread use, however, there are conflicting reports regarding the best method of gastrostomy tube insertion. Studying 30 patients, 15 of whom underwent percutaneous endoscopic gastrostomy with the "push" and 15 with the "pull" technique, we found both methods successful, and associated with an acceptable complication rate. In the authors' bands, the "pull" technique was technically easier.