Abstract:BackgroundSince its introduction in the early 1980s, percutaneous endoscopic gastrostomy has become the most popular method for performing a gastrostomy for long-term enteral feeding. It has been associated, however, with a lot of minor and major complications.Case presentationA 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 … Show more
“…In a 3-mo-old boy weighing 3.7 kg, the pulling of a 18CH gastrostomy tube immediately led to esophageal intussusception towards the stomach and thus complete esophageal transection[ 49 ]. The other case was an obese, multi-trauma patient, on whom PEG procedure was difficult[ 50 ]. Without the help of transillumination, and only using finger pressure, 3 attempts, at a 45° angle, were made to insert the needle into the stomach.…”
Section: Resultsmentioning
confidence: 99%
“…The second case is a gastric volvulus, following insertion of the PEG into the posterior gastric wall, due to stomach over-inflation, finally causing compromised gastric emptying[ 51 ]. The third is the case of an obese, multi-trauma patient; without trans-illumination, 3 puncture attempts at a 45° angle, resulted in a gastrostomy placement but also an esophageal perforation which were fortunately recognized after 14 d of suffering mediastinitis[ 50 ].…”
BACKGROUND
Percutaneous endoscopic gastrostomy (PEG) is a well-established, minimally invasive, and easy to perform procedure for nutrition delivery, applied to individuals unable to swallow for various reasons. PEG has a high technical success rate of insertion between 95% and 100% in experienced hands, but varying complication rates ranging from 0.4% to 22.5% of cases.
AIM
To discuss the existing evidence of major procedural complications in PEG, mainly focusing on those that could probably have been avoided, had the endoscopist been more experienced, or less self-confident in relation to the basic safety rules for PEG performance.
METHODS
After a thorough research of the international literature of a period of more than 30 years of published “case reports” concerning such complications, we critically analyzed only those complications which were considered - after assessment by two experts in PEG performance working separately - to be directly related to a form of malpractice by the endoscopist.
RESULTS
Malpractice by the endoscopist were considered cases of: Gastrostomy tubes passed through the colon or though the left lateral liver lobe, bleeding after puncture injury of large vessels of the stomach or the peritoneum, peritonitis after viscera damage, and injuries of the esophagus, spleen, and pancreas.
CONCLUSION
For a safe PEG insertion, the overfilling of the stomach and small bowel with air should be avoided, the clinician should check thoroughly for the proper trans-illumination of the light source of the endoscope through the abdominal wall and ensure endoscopically visible imprint of finger palpation on the skin at the center of the site of maximum illumination, and finally, the physician should be more alert with obese patients and those with previous abdominal surgery.
“…In a 3-mo-old boy weighing 3.7 kg, the pulling of a 18CH gastrostomy tube immediately led to esophageal intussusception towards the stomach and thus complete esophageal transection[ 49 ]. The other case was an obese, multi-trauma patient, on whom PEG procedure was difficult[ 50 ]. Without the help of transillumination, and only using finger pressure, 3 attempts, at a 45° angle, were made to insert the needle into the stomach.…”
Section: Resultsmentioning
confidence: 99%
“…The second case is a gastric volvulus, following insertion of the PEG into the posterior gastric wall, due to stomach over-inflation, finally causing compromised gastric emptying[ 51 ]. The third is the case of an obese, multi-trauma patient; without trans-illumination, 3 puncture attempts at a 45° angle, resulted in a gastrostomy placement but also an esophageal perforation which were fortunately recognized after 14 d of suffering mediastinitis[ 50 ].…”
BACKGROUND
Percutaneous endoscopic gastrostomy (PEG) is a well-established, minimally invasive, and easy to perform procedure for nutrition delivery, applied to individuals unable to swallow for various reasons. PEG has a high technical success rate of insertion between 95% and 100% in experienced hands, but varying complication rates ranging from 0.4% to 22.5% of cases.
AIM
To discuss the existing evidence of major procedural complications in PEG, mainly focusing on those that could probably have been avoided, had the endoscopist been more experienced, or less self-confident in relation to the basic safety rules for PEG performance.
METHODS
After a thorough research of the international literature of a period of more than 30 years of published “case reports” concerning such complications, we critically analyzed only those complications which were considered - after assessment by two experts in PEG performance working separately - to be directly related to a form of malpractice by the endoscopist.
RESULTS
Malpractice by the endoscopist were considered cases of: Gastrostomy tubes passed through the colon or though the left lateral liver lobe, bleeding after puncture injury of large vessels of the stomach or the peritoneum, peritonitis after viscera damage, and injuries of the esophagus, spleen, and pancreas.
CONCLUSION
For a safe PEG insertion, the overfilling of the stomach and small bowel with air should be avoided, the clinician should check thoroughly for the proper trans-illumination of the light source of the endoscope through the abdominal wall and ensure endoscopically visible imprint of finger palpation on the skin at the center of the site of maximum illumination, and finally, the physician should be more alert with obese patients and those with previous abdominal surgery.
“…Morbidity rates of the procedure range from 9% to 17% but major complications are under 5% and mortality is lower than 1% [ 6 , 7 ]. Papakonstantinou et al divided the complications into three subgroups [ 8 ] ( Table 1 ).…”
Percutaneous endoscopic gastrostomy is a safe way for enteral nutrition in selected patients. Generally, complications of this procedure are very rare but due to patients general health condition, delayed diagnosis and treatment of complications can be life threatening. In this study, we present a PEG-related massive pneumoperitoneum and subcutaneous emphysema in a patient with neuro-Behçet.
“…Advantages of this technique include use of a smaller endoscope (e.g. in case of stenosis), or even transnasal endoscopy with an ultra-thin caliber endoscope (UTCE) (77,78). With UTCE, sedation is not necessary, which makes it feasible for patients with severe (pulmonary) comorbidities.…”
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