Percutaneous gastrostomy tube placement in patients with ventriculoperitoneal shunts

Sane, Shashikant M.; Towbin, Alexander J.; Bergey, Elizabeth A.; Kaye, Robin; Fitz, Charles R.; Albright, Leland; Towbin, Richard B.

doi:10.1007/s002470050401

Cited by 39 publications

(24 citation statements)

References 3 publications

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“…Other studies, including those published by Baird et al and Graham et al demonstrated no shunt infections [4,5]. Shunt infection occurred in a total of seven patients (12.7%) in our study, similar to the 9% incidence of shunt infection noted in a study of PEG tube placement in children with VP shunts by Sane et al [7]. This rate of infection is similar to that reported in published literature for VP shunts in patients without PEG tube placement, which has ranged from 3 to 29% [8,[12][13][14][15].…”

Section: Infectionsupporting

confidence: 90%

“…Indeed, review of the literature reveals four studies reporting experience with this combination of procedures. However, the four completed studies encompass a total of only 60 patients [4][5][6][7]. As such, percutaneous G-tube placment, VP shunt prior to G-tube, or G-tube prior to VP shunt or in shunt infection rates within the first year after placement several questions regarding the placement of PEG tubes in patients with VP shunts persist.…”

Section: Discussionmentioning

confidence: 94%

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Placement of Gastrostomy Tubes in Patients with Ventriculoperitoneal Shunts Does Not Result in Increased Incidence of Shunt Infection or Decreased Survival

et al. 2006

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The objective of this study was to examine if G-tube (G-tube) placement in patients with ventriculoperitoneal (VP) shunts results in shunt infection or impacts patient survival. We performed a retrospective cohort study. Patients underwent VP shunt and G-tube placement. Incidence of shunt infection and patient survival were calculated. Fifty-five patients qualified for the study. Shunt infection occurred in seven patients (12.5%). The incidence of shunt infection did not differ between surgically placed G-tubes (2/7=29%) and PEG tubes (5/7=71%; P=0.69). There was no difference in the risk of VP infection based on the order of placement (OR=0.61 [0.12-3.02]; P=0.69). No predictors for shunt infection were identified. Kaplan-Meier mortality estimates demonstrated a 21% 1-year mortality rate. There were no predictors of patient survival. We conclude that placement of G-tubes in patients with shunts is safe. The order of placement of G-tube and VP shunt does not affect the incidence of shunt infection or survival.

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Section: Infectionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 94%

Placement of Gastrostomy Tubes in Patients with Ventriculoperitoneal Shunts Does Not Result in Increased Incidence of Shunt Infection or Decreased Survival

et al. 2006

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“…Sane et al [14] reported a 9% incidence of peritonitis and subsequent VP shunt infection with CSF cultures positive for Streptococcus viridans and S. aureus. However, there were no prophylactic antibiotics given prior to the procedure and all PEGs were inserted by the antegrade technique.…”

Section: Discussionmentioning

confidence: 99%

Risk of Ventriculoperitoneal Shunt Infections due to Gastrostomy Feeding Tube Insertion in Pediatric Patients with Brain Tumors

et al. 2006

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Objective: To determine the risk of ventriculoperitoneal (VP) shunt infections after percutaneous retrograde gastrostomy feeding tube (GT) placement in children with brain tumors. Patients and Methods: All children (age 0–18 years) with primary brain tumors diagnosed and treated at the Hospital for Sick Children, Toronto, Canada, were subjected to a retrospective analysis. Two groups were identified: the study group included children with a VP shunt and a GT; the control group included children with VP shunts only. Each study patient was matched with 2 controls to compare the rate of infections (cohort comparative study). Results: There were 1,167 children diagnosed and treated with primary brain tumors during the study period (1988–2003); 174 (15%) had a VP shunt and 23 (2%) children had both, a VP shunt and a GT. In the study group (n = 17), GTs were inserted at a median time of 80 days (range 6–204 days) after VP shunts. VP shunt infection rate was 23.5% (4/17) compared to 8.8% (3/34) in the control group (OR 3.18; 95% CI 0.622–16.54, p = 0.16). Three (75%) of the infection episodes in the study group presented with an ascending VP shunt infection directly related to the GT insertion or manipulation in the first 6 weeks. These GTs were inserted at 13, 47 and 49 days after VP shunt insertion. Conclusion: Placement of percutaneous retrograde GTs, in the acute phase, in children with brain tumors and VP shunts may increase the risk of ascending meningitis especially if there are early GT-related complications.

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“…The infective complications of PEG include stoma site infection in 3-9% and peritonitis in 1-7% [9]. The standard pull-through technique of PEG insertion exposes the gastrostomy tube to oropharyngeal bacterial flora.…”

Section: Discussionmentioning

confidence: 99%

Complications of video-assisted gastrostomy in children with or without a ventriculoperitoneal shunt

et al. 2007

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The aim of the study was to test the hypothesis that the presence of a ventriculoperitoneal shunt (VPS) influences the frequency of postoperative complications after video-assisted gastrostomy (VAG) in children. When using a power of 80%, a critical value for significance of 5% and an assumed population-based standard deviation of 0.4, it will be required to have a sample size of at least 14 children to show that a difference of 0.6 is significant when using Student's t test for paired samples. Thus, 15 consecutive children with VPSs were included in the present study. All the children had nutritional problems and underwent a VAG operation at a tertiary care university hospital. After the operation, the children were prospectively followed up. Specially trained nurses documented all complications according to a protocol. For the purpose of comparison, we had a control group of neurologically disabled children without VPSs, matched for age and operated with VAG. The children did not present with any serious postoperative intra-abdominal complications or central nervous system infection. There was no significant difference in the frequency of minor complications between the studied group and the control group. This study did not reveal that children with VPSs who undergo a VAG button placement are at high risk for infection and subsequent shunt malfunction. They did not have more postoperative problems than a matched control group of neurologically disabled children.

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Percutaneous gastrostomy tube placement in patients with ventriculoperitoneal shunts

Abstract: Our study indicates children with ventriculoperitoneal shunts who undergo percutaneous gastrostomy are at greater risk for infection and subsequent shunt malfunction. Therefore, we recommend prophylactic antibiotic therapy to cover for skin and oral flora.

Cited by 39 publications

References 3 publications

Placement of Gastrostomy Tubes in Patients with Ventriculoperitoneal Shunts Does Not Result in Increased Incidence of Shunt Infection or Decreased Survival

Placement of Gastrostomy Tubes in Patients with Ventriculoperitoneal Shunts Does Not Result in Increased Incidence of Shunt Infection or Decreased Survival

Risk of Ventriculoperitoneal Shunt Infections due to Gastrostomy Feeding Tube Insertion in Pediatric Patients with Brain Tumors

Complications of video-assisted gastrostomy in children with or without a ventriculoperitoneal shunt

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