Bronchoscope-Guided Percutaneous Endoscopic Gastrostomy Tube Placement by Interventional Pulmonologists: A Feasibility and Safety Study

Abstract

Background: Percutaneous endoscopic gastrostomy (PEG) tube placement is a procedure frequently done in the intensive care unit. The use of a traditional endoscope can be difficult in cases of esophageal stenosis and theoretically confers an increased risk of infection due to its complex architecture. We describe a technique using the bronchoscope, which allows navigation through stenotic esophageal lesions and also minimizes the risk of endoscopy-associated infections. Methods: Prospective series of patients who had PEG tube placement guided by a bronchoscope. Procedural outcomes including successful placement, duration of the entire procedure, time needed for passage of the bronchoscope from the oropharynx to the major curvature, PEG tube removal rate, and mortality were collected. Procedural adverse events, including infections and long-term PEG-related complications, were recorded. Results: A total of 84 patients underwent bronchoscope-guided PEG tube placement. Percutaneous endoscopic gastrostomy tube insertion was completed successfully in 82 (97.6%) patients. Percutaneous endoscopic gastrostomy tube placement was performed immediately following percutaneous tracheostomy in 82.1%. Thirty-day mortality and 1-year mortality were 11.9% and 31%, respectively. Overall, minor complications occurred in 2.4% of patients, while there were no major complications. No serious infectious complications were identified and no endoscope-associated hospital acquired infections were documented. Conclusions: The use of the bronchoscope can be safely and effectively used for PEG tube placement. The use of bronchoscope rather than a gastroscope has several advantages, which include the ease of navigating through complex aerodigestive disorders such as strictures and fistulas as well as decreased health-care utilization. In addition, it may have a theoretical advantage of minimizing infections related to complex endoscopes.

Use of Tracheostomy During the COVID-19 Pandemic

“…In addition, there are pre-COVID-19 data that suggest performing tracheostomy and gastrostomy procedures using a gastroscope and/or bronchoscope in the same sitting by a single specialty has a good safety profile with possible advantages of shorter ICU and hospital length of stay. [82][83][84][85] This could be considered in institutions with such expertise, but there might be concerns for the additional time required to perform percutaneous endoscopic gastrostomy placement, leading to extended exposure time.…”

Outcomes of Combined Percutaneous Tracheostomy and Endoscopic Gastrostomy Tube Placement in COVID-19 Patients

“…Gastrostomy tubes were placed via the endoscope-bronchoscope-guided percutaneous method using the 24-French Boston Scienti c Pull PEG kit (Boston Scienti c Corporation, Natick, Massachussetts) (14). Adequate transillumination and digital pressure in the abdomen served as con rmatory measures.…”

“…If longer term support is needed, gastrostomy tubes are frequently preferred over nasogastric or orogastric tubes for stability as well as to mitigate the risk of sinusitis, pharyngeal discomfort, epistaxis, and short-term aspiration (12,13). Gastrostomy tubes are placed by a wide array of physicians, including gastroenterologists, general surgeons, interventional pulmonologists, and interventional radiologists, and utilize various techniques, such as endoscopic, radiologic, or surgical placement (14). Endoscopic placement can be done at bedside in the ICU while surgical or radiologic placement is typically performed in the OR or procedural suite.…”

Combined Percutaneous Tracheostomy and Endoscopic Gastrostomy Tubes in COVID-19: A Prospective Series of Patient Outcomes

“…Gastrostomy tubes were placed via the endoscope-bronchoscope-guided percutaneous method using the 24-French Boston Scientific Pull PEG kit (Boston Scientific Corporation). 17 Adequate transillumination and digital pressure in the abdomen served as confirmatory measures. The endoscopic equipment used then underwent high-level disinfection as recommended by the manufacturer after each use.…”

“…15,16 Gastrostomy tubes are placed by a wide array of physicians, including gastroenterologists, general surgeons, interventional pulmonologists, and interventional radiologists, and utilize various techniques, such as endoscopic, radiologic, or surgical placement. 17 Endoscopic placement can be done at bedside in the ICU while surgical or radiologic placement is typically performed in the OR or procedural suite.…”