Percutaneous Endoscopic Gastrostomy in the Neurosurgical Intensive Care Unit: Complications and Outcome

Abstract

PEG is a safe and well-tolerated gastrostomy method for neurosurgical ICU patients with depressed neurologic state or severe lower cranial nerve palsies.

Gut access in critically ill and injured patients: Where have we gone thus far?

“…Dwyer et al [54] demonstrated the cost benefit of bedside PEG in surgical/trauma ICU patients, as well as its safety benefit in relation to SOG. The safety benefit has also been demonstrated by other studies [55,56].…”

“…Any associated mortality is always associated with the underlying disease [46]. The reported overall complication rate [46][47][48][49][50][51][52][53][54][55][56] can be as low as 0% [56] or as high as 16% [47], but interpreting those results is difficult because of the variation in sample sizes, in patient populations, and in definitions of complications. Schulenberg et al [64] reported PEG-related complications that required surgical intervention, over a 3-year period: of more than 1200 PEGs, the complication rate was just 2.1%.…”

“…The most common recognized complication of PEG is peristomal site infection [65]; the ranges from 0 to 47% [50][51][52][53][54][55][56][66][67][68][69][70][71]. Again, interpreting results can be difficult because of the variation in patient populations, in prophylactic antibiotic use, and in sample sizes.…”

Complications after percutaneous endoscopic gastrostomy in a prospective study

“…Less common complications include aspiration [22], bleeding [23][24][25][26], buried bumper syndrome [21], peritonitis [5], accidental removal of the catheter [27], colo-gastrocutaneus fistula [28], gastric volvulus [29], trans-or intrahepatic PEG placement [30], tumor seeding [31,32] and gastric outlet obstruction [33]. The PEG catheter is also a constant, visible reminder of disease, which might influence the patient's health-related quality of life [11].…”

Safety of percutaneous endoscopic gastrostomy after trauma laparotomy

“…Trauma patients frequently require long-term enteral access because of injuries to the head, neck, or gastrointestinal tract [1]. Enteral access methods include percutaneous, laparoscopic, or open gastrostomy or jejunostomy.…”