Percutaneous endoscopic gastrostomy: A review of indications, complications and outcome

Abstract

Percutaneous endoscopic gastrostomy (PEG) was first described in 1980 as an effective method of feeding via the stomach in situations where oral intake is not possible. Its simplicity has led to its potential use in areas of dubious clinical benefit. Our unit has faced a major increase in referrals for PEG insertion over the last 2 years. For this reason we decided to audit our PEG insertion procedures with regard to indications, complications, outcome and follow up. We studied 168 patients who had an initial PEG insertion during the period 1 February 1996–31 January 1998. The medical records of these patients were reviewed with regard to the procedure, antibiotic use and complications. All patients (or carers or next of kin) were contacted by telephone to provide details regarding late complications and follow up. There were 87 females and 81 males (aged 16–98 years, median age 70 years). At 2 years, 67% were alive. The most frequent indication for PEG insertion was a neurological condition, the commonest being stroke. Most patients received either ticarcillin/clavulanic acid or cephazolin antibiotic prophylaxis before and after the procedure. In six patients (3.6%) infection at the PEG site required intravenous antibiotics. Four of these six patients did not have antibiotic prophylaxis. Only two deaths could be directly related to the procedure. Three died within 7 days of the procedure due to unrelated medical complications. Sixteen patients died within 1 month, the majority of these patients did not leave hospital. One‐fifth of the patients (35/168) had their PEG removed due to the reestablishment of oral feeding, with median time of use, 4.3 months. It is a safe, effective feeding method in the elderly, but experience with case selection, the procedure and careful follow up remain essential. The use of prophylactic antibiotics resulted in few significant infections of the PEG site. Up to one‐fifth of patients will require their PEG only for a short term.

Acute Buried Bumper Syndrome with Gastric Perforation and Peritonitis: A Rare Complication of Percutaneous Endoscopic Gastrostomy: Case Report

“…Gastroenterohepatoloji gastrostomy insertion seems to be simple, but it is an invasive procedure and associated with a number of complications. 4 Wound infection, peristomal leak, tube occlusion and tube displacement are some of the most frequently seen complications. Other rare complications are peritonitis, gastrocolocutaneous fistula, aspiration pneumonia and buried bumper syndrome.…”

“…Other rare complications are peritonitis, gastrocolocutaneous fistula, aspiration pneumonia and buried bumper syndrome. [3][4][5][6][7] Buried bumper syndrome is an uncommon but serious complication of PEG with an incidence of 1.97%. 8 It occurs when the internal bumper of the PEG tube migrates and becomes lodged between the gastric wall and the skin along the PEG tube tract.…”

Investigation and prediction of enteral nutrition problems after percutaneous endoscopic gastrostomy

“…When perfor ming PEG, the associated risks must always be kept in mind. While various devices have been developed [4,5] , the frequency of adverse events is higher as compared to other nutritional methods, since PEG is based on a surgical technique [6][7][8] . Additionally, even if PEG is successful, patients often encounter enteral nutrition problems after surgery.…”

Modificação de dispositivo para gastrostomia endoscópica percutânea pela técnica de punção: utilização em pacientes com neoplasia maligna de cabeça e pescoço

“…Este procedimento, embora eficaz, está associado à morbidade não desprezível, alto custo, maior tempo de internação hospitalar e, ocasionalmente, mortalidade 33,34 .…”

“…Atualmente, o método para nutrição enteral mais usado é a gastrostomia endoscópica percutânea (GEP) [34][35][36] .…”