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The complications of percutaneous endoscopic gastrostomy
Julien Bordes, Emmanuel Hornez, Nadia Kenane, Christophe Carrere, Yves Asencio, Philippe Goutorbe
Critical Care , 2008, DOI: 10.1186/cc6962
Abstract: A 59-year-old man was admitted to our hospital with intracerebral hemorrhage. On day 40, a PEG was performed in the intensive care unit using the 'pull' technique as previously described [5]. The needle puncture of the stomach was accomplished only on the second attempt, although the rest of the procedure was completed uneventfully. The material used was the Bard?Fastrac? Pull PEG Kit (Bard Access Systems, Salt Lake City, USA). One hour after the end of the procedure, the patient presented a tachycardia (120 beats per minute), with cardiovascular collapse (arterial pressure 70/50 mmHg). Physical examination revealed a distended abdomen. The hemoglobin concentration was 5.5 g/dL. Abdominal echography showed the presence of intraperitonal liquid. An emergency laparotomy was performed, revealing a massive hemoperitoneum due to active bleeding from a small vessel of the minor curvature. X-sutures were applied and the bleeding stopped. A gastrostomy was recreated at the end of surgery.The massive hemoperitoneum we described is a rare complication in relation to its rapidity and its severity. We think that the initial, unsuccessful passage of the needle could have caused the gastric artery branch laceration. Indeed, such a mechanism of injuries has already been suggested as an explanation for a fatal retroperitoneum due to breaches in the splenic and superior mesenteric veins [4]. In the patient we described, prompt recognition could minimize morbidity.Although generally considered safe, PEG can be associated with life-threatening bleeding, especially when multiple needle punctures have been made. It presents with unexplained postprocedure hypotension. Intensivists who are used to performing PEG should be aware of this complication because early recognition and treatment are essential.PEG = percutaneous endoscopic gastrostomy.The authors declare that they have no competing interests.Written consent for publication was obtained from the patient's relatives.
Madrigal-Revuelta M,Zegarra-Molina O.M,Martín-Batista S,Enterría-González A
Revista de la Sociedad Otorrinolaringológica de Castilla y León, Cantabria y La Rioja , 2011,
Abstract: INTRODUCTION: Gastrostomy is a very useful technique to maintain an adequate nutritional status in patients with head and neck cancer. It presents very good acceptability and complete adherence of treatments.DISCUSSION: PEG is a good nutritional option for our oncological patients. It is a minimally invasive method with low morbility and mortality rates, low economical cost and very good social acceptability.We summarize the main ENT indications of this technique. CONCLUSION: Our department indicate the percutaneous endoscopic gastrostomy in patients with head and neck cancer who are unable to maintain an adequate nutritional status and need enteral nutrition for more than 8 weeks. Its acceptability is very good and complications are generally minor ones.Percutaneous endoscopic gastrostomy should replace to nasogastric feeding tubes and to open gastrostomy in patients with short life expectancy.
Use of percutaneous endoscopic gastrostomy in acute dysphagic stroke  [cached]
Bola Kamath
Saudi Journal of Gastroenterology , 2001,
Abstract: Background: Percutaneous endoscopic gastrostomy (PEG) is a widely used method for insertion of gastrostomy tube for patients with dysphagia due neuromuscular disorders. Aim : this article highlights the role of PEG for such patients, how safe, effective than standard gastrostomy in providing long -term nutritional support for patients with dysphagic stroke. Methods: Over a four-year period (1995-1998), 27 patients had percutaneous endoscopic gastrostomy performed for neuromuscular dysphagia. A Wilson Cook (24G) gastrostomy tube was used and it was inserted with Ponsky-Gauderer pull technique. Results: All the patients tolerated the procedure well. Stroke (81%) was the most common indication for PEG. Major gastroscopic finding was found in eight patients (29%). Minor complication was seen in only three patients (11%). Conclusion PEG Feeding is safe, simple and effective procedure with no serious side effects. Patients and their relatives accept PEG better than nasogastric tube feeding. However, the ideal timing at which to institute gastrostomy feeding after dysphagic stroke is still not clear.
Percutaneous endoscopic gastrostomy in advanced head and neck cancer
Campoli, Paulo Moacir de Oliveira;Ejima, Flávio Hayato;Cardoso, Daniela Medeiros Milhomem;Barreto, Paulo Adriano de Queiroz;Pires, Rafael de Deus;Meneghini, Alexandre Jo?o;Curado, Maria Paula;Oliveira, José Carlos de;Mota, Orlando Milhomem da;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2007, DOI: 10.1590/S0102-67202007000200007
Abstract: background: percutaneous endoscopic gastrostomy performed as proposed by gauderer et al. in 1980, has been used quite frequently in patients with head and neck tumors. some authors believe that this so-called pull technique would be associated to the risk of a tumor implantation in the wound as well as high levels of peristomal wound infection. although some alternative techniques provide better results, doubts about their technical applicability in daily practice still persists. aim: to assess the feasibility, safety and morbidity of percutaneous endoscopic gastrostomy performed through a well-defined and standardized technique in patients with nonresectable or advanced head and neck cancer. methods: a consecutive series of patients who had either nonresectable or advanced tumors and were unable to be fed orally were submitted to an oncologic-hospital-based tertiary-referral endoscopy practice. tubes were implanted through an introducer technique comprised of two main stages. the first consisted of the application of two stitches aiming to fixate the anterior gastric wall to the abdominal wall, and the second being the inserting of the gastrostomy tube. results: between february 2003 and may 2004, 129 percutaneous endoscopic gastrostomies were performed. this study included 60 patients. they were all able to receive food on the same day. operative morbidity was observed in six patients (10%) and one procedure-related mortality was also observed (1.6%). conclusion: percutaneous endoscopic gastrostomy is both feasible and safe, associated to low morbidity, and to acceptable mortality rates.
Time for the world to move beyond the percutaneous endoscopic gastrostomy  [cached]
Ah San Pang
World Journal of Gastroenterology , 2011, DOI: 10.3748/wjg.v17.i23.2877
Abstract: Percutaneous endoscopic gastrostomy (PEG) is a proven feeding tube, just as the nasogastric tube is proven to be able to deliver enteral nutrition. For long-term use, both patient and caregiver want neither. What is desired is the LOOPPEG 3G tube, more secure than the PEG, and less risky to change than the nasogastric tube. Future clinical research should focus on this high-comfort low-risk tube.
Indications for percutaneous endoscopic gastrostomy and survival in old adults  [cached]
Anna Malmgren,Gunnel W?rn Hede,Brita Karlstr?m,Tommy Cederholm
Food & Nutrition Research , 2011, DOI: 10.3402/fnr.v55i0.6037
Abstract: Background : Many diseases striking old adults result in eating difficulties. Indications for selecting individuals for percutaneous endoscopic gastrostomy (PEG) are unclear and everybody may not benefit from the procedure. Objective : The aim of this study was to evaluate indications for and survival after PEG insertion in patients older than 65 years. Design and Methods : A retrospective analysis including age, gender, diagnosis, indication, and date of death was made in 201 consecutive individuals, 94 male, mean age 79±7 years, who received a nutritional gastrostomy. Results: Dysphagia was present in 86% of the patients and stroke was the most common diagnosis (49%). Overall median survival was 123 days and 30-day mortality was 22%. Patients with dementia and Mb Parkinson had the longest survival (i.e. 244 and 233 days), while those with other neurological diseases, and head and neck malignancy had the shortest (i.e. 75 and 106 days). There was no difference in mortality in patients older or younger than 80 years, except in patients with dementia. Conclusions: Old age should not be a contraindication for PEG. A high 30-day mortality indicates that there is a need of better criteria for selection and timing of PEG insertion in the elderly.
Malposition of percutaneous endoscopic-guided gastrostomy: Guideline and management  [cached]
Milanchi Siamak,Wilson Matthew
Journal of Minimal Access Surgery , 2008,
Abstract: Percutaneous endoscopic-guided gastrostomy (PEG) is done routinely on patients who suffer from inability to feed by mouth. PEG is generally considered a safe procedure with a low complication rate. A commonly underreported complication of PEG is malposition. This manuscript is a guideline to diagnosis and management of PEG malposition. We describe the different types of malposition, their diagnosis and management.
Mediastinitis complicating a percutaneous endoscopic gastrostomy: a case report
Kalliopi Papakonstantinou, Athanasios Karagiannis, Maria Tsirantonaki, Anastasios Konstantinidis, Spiros Spirou, Ion Skottis, Andreas Karabinis
BMC Gastroenterology , 2003, DOI: 10.1186/1471-230x-3-11
Abstract: A case of mediastinitis with concominant sepsis caused by a masked esophageal perforation after percutaneous endoscopic gastrostomy in a multi-traumatized, brain-injured patient is presented. Ten – fourteen days after the procedure, the patient became febrile and gradually septic with tenderness of the sternum and upper abdomen. Computerized tomography of the thorax revealed mediastinitis. An urgent left thoracotomy and laparotomy were performed for drainage of the mediastinum, removal of the gastrostomy and insertion of a jejunostomy tube. The patient improved soon after the surgery. He was successfully weaned off the ventilator and was discharged from the Intensive Care Unit.Perforating mediastinitis is a rare but potentially lethal complication of percutaneous endoscopic gastrostomy. When diagnosed and properly treated it may have a favourable outcome.Since its clinical introduction in 1980, percutaneous endoscopic gastrostomy (PEG) has become a widespread endoscopic technique for inserting feeding tube for long-term enteral nutrition. Although much has been reported about its complications, perforating mediastinitis has not been mentioned in the recent literature.Herein a case of mediastinitis complicating PEG in a multi-traumatized, brain-injured patient is presented. Mediastinitis is a rare but potentially lethal complication of PEG. In the sedated or comatose patient the diagnosis may be delayed. High clinical suspicion and early CT scan of the thorax are essential for accurate diagnosis, appropriate management and favourable outcome.A 33-year old male was transferred to the Intensive Care Unit (ICU) from the Emergency Room because of multiple trauma following a motor vehicle accident. He had suffered severe brain-injury (brain contusions, edema, subarachnoid haemorrhage, skull fractures) resulting to coma (Glasgow Coma Scale (GCS): 5/15), facial fractures, lung contusions, bilateral haemothorax and an open fracture of the tibia.The patient was intubated, sed
Revisiting the Use of Percutaneous Endoscopic Gastrostomy Tubes in Patients with Advanced Dementia
Ayesha K. Shaikh, Eric L. Hamilton, Parag Bharadwaj and Katherine T. Ward
Palliative Care: Research and Treatment , 2012,
Abstract: Mr. Smith is an 85-year-old nursing home patient who has suffered from dementia for the past eight years. He has been bed bound and uncommunicative for the last six months. He was admitted with aspiration pneumonia three times in the past year. Over the last few months he has lost weight due to poor dietary intake and has developed a decubitus ulcer. Mr. Smith’s family inquires about the advantages and disadvantages of the placement of a percutaneous endoscopic gastrostomy (PEG) tube to help improve his weight loss.
Revisiting the Use of Percutaneous Endoscopic Gastrostomy Tubes in Patients with Advanced Dementia
Ayesha K. Shaikh,Eric L. Hamilton,Parag Bharadwaj,Katherine T. Ward
Palliative Care: Research and Treatment , 2009,
Abstract: Mr. Smith is an 85-year-old nursing home patient who has suffered from dementia for the past eight years. He has been bed bound and uncommunicative for the last six months. He was admitted with aspiration pneumonia three times in the past year. Over the last few months he has lost weight due to poor dietary intake and has developed a decubitus ulcer. Mr. Smith’s family inquires about the advantages and disadvantages of the placement of a percutaneous endoscopic gastrostomy (PEG) tube to help improve his weight loss.
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