Endoscopic management of enteral tubes in adult patients – Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Arvanitakis, Marianna; Gkolfakis, Paraskevas; Despott, Edward J.; Ballarin, Asuncion; Beyna, Tors﻿ten; Boeykens, Kurt; Peter, Elbe; Gisbertz, I. A. M.; Hoyois, Alice; Moşteanu, Ofelia; Sanders, David S.; Schmidt, Peter T.; Schneider, Stéphane; Hooft, Jeanin E. van

doi:10.1055/a-1303-7449

Cited by 65 publications

(52 citation statements)

References 92 publications

(129 reference statements)

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“…30 The European Society of Gastrointestinal Endoscopy (ESGE) also recommends refraining from PEG placement in patients with a life expectancy shorter than 30 days. 31 Furthermore, it is important to select patients properly based on medical and ethical indications. Older patients with severe comorbidities have lower quality of life after the PEG insertion.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with 30-Day Mortality in Patients after Percutaneous Endoscopic Gastrostomy

Lima¹,

Miranda²,

Penha³

et al. 2021

JSLS

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Introduction: Percutaneous endoscopic gastrostomy (PEG) is the main accepted method for long-term tube feeding. The aim of this study is to investigate the risk factors associated with early mortality after PEG. Methods: It is a retrospective survival analysis in a tertiary-level hospital. We reviewed the medical records of 277 patients with PEG placement. The data were analyzed by the Kaplan-Meier method. Multivariable Cox proportional regression models were also built to test the effects of PEG on mortality. Results: A total of 277 patients who submitted to PEG were studied. One-hundred and sixty (58%) were female, mean age of 73.3 ± 15.7 years. Ninety-three patients (33.6%) had diabetes mellitus and 165 (59.6%) had blood hypertension. The indications for PEG placement were chronic neurologic dysphagia in 247 (89.5%) patients and tumors and other diseases in 29 (10.5%). The 30 days proportional mortality probability rate was 13%. In a multivariate Cox proportional regression model, preoperative ICU hospitalization (HR 1.79, 95% CI 1.36–2.36, P = 0.000) and hemoglobin (HR 0.91, 95% CI 0.85–0.98, P = 0.015) were predictors of early mortality. Conclusion: In patients who had underwent PEG tube insertion for long-term nutrition, anemia and previous ICU admission were predictors of mortality at four weeks. These factors may guide physicians to discourage the indication for PEG.

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Section: Discussionmentioning

confidence: 99%

Factors Associated with 30-Day Mortality in Patients after Percutaneous Endoscopic Gastrostomy

Lima¹,

Miranda²,

Penha³

et al. 2021

JSLS

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“…Alternatives to esophageal stent placement include oral nutritional supplements, nasogastric tube placement, percutaneous feeding tube placement, and parenteral nutrition. In general, the use of percutaneous feeding tube placement (i. e. percutaneous endoscopic gastrostomy or endoscopic jejunostomy) is recommended when enteral feeding is expected to be continued for at least 4 weeks [64][65][66]. In surgical candidates, percutaneous endoscopic gastrostomy is considered by some surgical teams to be a contraindication as it may compromise the construction of a gastric conduit created during distal esophageal/proximal stomach reconstruction.…”

Section: Bridge To Surgerymentioning

confidence: 99%

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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Main recommendations Malignant disease 1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass.Strong recommendation, high quality evidence. 2 ESGE recommends brachytherapy as a valid alternative, alone or in addition to stenting, in esophageal cancer patients with malignant dysphagia and expected longer life expectancy.Strong recommendation, high quality evidence. 3 ESGE recommends esophageal SEMS placement for sealing malignant tracheoesophageal or bronchoesophageal fistulas. Strong recommendation, low quality evidence. 4 ESGE does not recommend SEMS placement as a bridge to surgery or before preoperative chemoradiotherapy because it is associated with a high incidence of adverse events. Other options such as feeding tube placement are preferable. Strong recommendation, low quality evidence. Benign disease 5 ESGE recommends against the use of SEMSs as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and their cost. Strong recommendation, low quality evidence. 6 ESGE suggests consideration of temporary placement of self-expandable stents for refractory benign esophageal strictures. Weak recommendation, moderate quality evidence. 7 ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures because of their very low risk of embedment and ease of removability. Weak recommendation, low quality evidence. 8 ESGE recommends the stent-in-stent technique to remove partially covered SEMSs that are embedded in the esophageal wall. Strong recommendation, low quality evidence. 9 ESGE recommends that temporary stent placement can be considered for the treatment of leaks, fistulas, and perforations. No specific type of stent can be recommended, and the duration of stenting should be individualized. Strong recommendation, low quality of evidence. 10 ESGE recommends considering placement of a fully covered large-diameter SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive bleeding. Strong recommendation, moderate quality evidence.

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“…There should also be documentation of antibiotic cover; type and dose of local anesthetic infiltrated into the skin or abdominal wall; and clear documentation of the internal bumper-to-skin distance, for reference. 4 Post-procedural management…”

Section: Appropriate Documentation Of Endoscopic Insertion Of Enteralmentioning

confidence: 99%

“…Several post-procedural PEG AEs have been described in detail elsewhere [4,60,62]. They include infection-related AEs, namely wound infection and necrotizing fasciitis; complications related to dysfunction of the enteral access tract, namely buried bumper syndrome (BBS); peristomal leakage; PEG site herniation; tube dislodgment; gastric outlet obstruction; and fistula formation.…”

Section: Post-procedural Aes Related To Enteral Tube Insertionmentioning

confidence: 99%

“…This is the second of the two parts of the Guideline, and is dedicated to peri-and post-procedural considerations including adverse events (AEs) and their management. The first part, published as a separate manuscript [4] focused on definitions, enteral access and tube modalities, and preprocedural considerations, including preprocedural assessment and indications and contraindications for enteral tube insertion.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2020

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Main recommendationsESGE recommends the “pull” technique as the standard method for percutaneous endoscopic gastrostomy (PEG) placement.Strong recommendation, low quality evidence.ESGE recommends the direct percutaneous introducer (“push”) technique for PEG placement in cases where the “pull” method is contraindicated, for example in severe esophageal stenosis or in patients with head and neck cancer (HNC) or esophageal cancer.Strong recommendation, low quality evidence.ESGE recommends the intravenous administration of a prophylactic single dose of a beta-lactam antibiotic (or appropriate alternative antibiotic, in the case of allergy) to decrease the risk of post-procedural wound infection.Strong recommendation, moderate quality evidence.ESGE recommends that inadvertent insertion of a nasogastric tube (NGT) into the respiratory tract should be considered a serious but avoidable adverse event (AE).Strong recommendation, low quality evidence.ESGE recommends that each institution should have a dedicated protocol to confirm correct positioning of NGTs placed “blindly” at the patient’s bedside; this should include: radiography, pH testing of the aspirate, and end-tidal carbon dioxide monitoring, but not auscultation alone.Strong recommendation, low quality evidence.ESGE recommends confirmation of correct NGT placement by radiography in high-risk patients (intensive care unit [ICU] patients or those with altered consciousness or absent gag/cough reflex).Strong recommendation, low quality evidence.ESGE recommends that EN may be started within 3 – 4 hours after uncomplicated placement of a PEG or PEG-J.Strong recommendation, high quality evidence.ESGE recommends that daily tube mobilization (pushing inward) along with a loose position of the external PEG bumper (1 – 2 cm from the abdominal wall) could mitigate the risk of development of buried bumper syndrome.Strong recommendation, low quality evidence.

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Endoscopic management of enteral tubes in adult patients – Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Cited by 65 publications

References 92 publications

Factors Associated with 30-Day Mortality in Patients after Percutaneous Endoscopic Gastrostomy

Factors Associated with 30-Day Mortality in Patients after Percutaneous Endoscopic Gastrostomy

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

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