Percutaneous endoscopic gastrostomy: high mortality rates in hospitalized patients

Abuksis, Galia; Mor, Michael; Segal, N; Shemesh, Ilana; Plout, Shlomit; Sulkes, Jaqueline; Fraser, Gerald; Niv, Yaron

doi:10.1016/s0002-9270(99)00731-5

Cited by 70 publications

(93 citation statements)

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“…In our study the 30-day mortality rate was 12.5% lower then the reported in a large study in United States, in which all types of gastrostomy placement were included, the 30-day mortality was 23.9% and at 1 year was 63% (1) . This may reflect a careful selection of patients and the experience of the team.…”

Section: Discussioncontrasting

confidence: 64%

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Peristomal infection after percutaneous endoscopic gastrostomy: a 7-year surveillance of 297 patients

Duarte

Santos

Capelas

et al. 2012

Arq. Gastroenterol.

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-Context -Healthcare-associated infection represents the most frequent adverse event during care delivery. Medical advances like percutaneous endoscopic gastrostomy have brought improvement on quality of life to patients but an increased risk of healthcare-associated infection. Predictive risk factors for peristomal wound infection are largely unknown but evidence suggests that antibiotic prophylaxis and preventive strategies related to infection control may reduce infection rates. Objectives -The primary aim was to evaluate the global prevalence rate of peristomal infection. Secondary objectives were to characterise the positive culture results, to evaluate the prophylactic antibiotic protocol and to identify potential risk factors for peristomal infection. Methods -Retrospective study of 297 patients with percutaneous endoscopic gastrostomy performed at a general hospital between January 2004 and September 2010. Patients received prophylactic cefazolin before the endoscopic gastrostomy procedure. Medical records were reviewed for demographic data, underling disease conditions to percutaneous endoscopic gastrostomy and patient potential intrinsic risk factors. Statistical analysis was made with the statistical program SPSS 17.0. Results -A total of 297 percutaneous endoscopic gastrostomy tubes were inserted. Wound infection occurred in 36 patients (12.1%). Staphylococcus aureus methicillin resistant was the most frequently isolated microorganism (33.3%) followed by Pseudomonas aeruginosa (30.6%). The incidence rate had been rising each year and differ from 4.65% in 2004/2007 to 17.9% in 2008/2010. This finding was consistent with the increasing of prevalence global infection rates of the hospital. Most of the infections (55.6%) were detected in the first 10 days post procedure. There was no significant difference in age, body mass index values, mean survival time and duration of percutaneous endoscopic gastrostomy feeding between patients with and without periostomal infection. Institutional factors, namely global prevalence infection rates and the endemic character of Staphylococcus aureus methicillin resistant, play an important role in peristomal infection rates. Traditional antibiotic prophylaxis with cefazolin is not adequate due to the prevalence of resistant organisms. Conclusions -Peristomal infection is a frequent problem with clinical impact in percutaneous endoscopic gastrostomy patients and should be considered a healthcare associated infection. The antimicrobial prophylaxis regimens using cephalosporins are not adequate and need to be reviewed due to the high prevalence of Staphylococcus aureus methicillin resistant and other resistant organisms in hospitals and nursing homes.

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Section: Discussioncontrasting

confidence: 64%

“…Complications of percutaneous endoscopic gastrostomy (PEG) have been described in debilitated patients (6) and 30-day mortality rates of 4,1%-26% have been reported (1) . Rodriguez Ortega et al (17) , in a Spanish study, found a 30-day-mortality of 8,69%.…”

Section: Peristomal Infection After Percutaneous Endoscopic Gastrostomentioning

confidence: 99%

Peristomal infection after percutaneous endoscopic gastrostomy: a 7-year surveillance of 297 patients

Duarte

Santos

Capelas

et al. 2012

Arq. Gastroenterol.

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“…This group has a worse outcome than those from nursing homes, who have an elective outpatient procedure. 11 In addition, some of the lower mortality rates were reported in the initial studies and this may reflect less cautious selection in present practice. 12 It is ethically difficult to justify a controlled study of patients with dementia who have been referred for PEG insertion with randomisation to PEG feeding or no PEG feeding.…”

Section: Survival Analysismentioning

confidence: 99%

Percutaneous endoscopic gastrostomy: an effective strategy for gastrostomy feeding in patients with dementia

Sanders

Anderson

Bardhan³

2004

Clinical Medicine

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-Percutaneous endoscopic gastrostomy (PEG) is an accepted technique for longterm enteral feeding. Its use has increased because of its simplicity and low complication rate. The demands for gastrostomy insertion have risen and now encompass indications where the long-term outcomes are uncertain. Dementia has become one of the commonest indications for gastrostomy feeding. This article reviews the justification for PEG feeding in dementia and suggests a practical approach for this difficult clinical situation. The clinical strategy described in this paper can be applied to other neurodegenerative diseases and provides a framework for improving a PEG service.

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“…Common complications include pain at the insertion site, peristomal leak and infection, tube extrusion, transient ileus and cutaneous ulceration [2,3] . Major complications include gastric or colonic perforation, peritonitis, gastrocolic or colocutaneous fistula, peritonitis and necrotizing fascitis [4][5][6][7][8] .…”

Section: Discussionmentioning

confidence: 99%

Retrograde jejunoduodenogastric intussusception due to a replacement percutaneous gastrostomy tube presenting as upper gastrointestinal bleeding

Ibegbu

Relan

Vega

2007

WJG

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Percutaneous endoscopic gastrostomy (PEG) tube complications can be serious or life threatening. Retrograde intussusception is a very rare complication of PEG tubes with only 9 cases reported in the literature. We describe a case of retrograde intussusception, associated with the use of a Foley catheter as a replacement gastrostomy tube, presenting with upper gastrointestinal bleeding. To our knowledge, this is the first reported case of PEG-related retrograde intussusception successfully managed in a non-surgical manner. Retrograde intussusception likely occurred due to migration of the replacement tube with resultant securing and invagination of the proximal jejunum when the gastrostomy tube was anchored to the abdominal wall.

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Percutaneous endoscopic gastrostomy: high mortality rates in hospitalized patients

Cited by 70 publications

References 0 publications

Peristomal infection after percutaneous endoscopic gastrostomy: a 7-year surveillance of 297 patients

Peristomal infection after percutaneous endoscopic gastrostomy: a 7-year surveillance of 297 patients

Percutaneous endoscopic gastrostomy: an effective strategy for gastrostomy feeding in patients with dementia

Retrograde jejunoduodenogastric intussusception due to a replacement percutaneous gastrostomy tube presenting as upper gastrointestinal bleeding

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