Risk Factors for Aspiration Pneumonia after Percutaneous Endoscopic Gastrostomy

Abstract

Background: Percutaneous endoscopic gastrostomy (PEG) is generally used for long-term enteral nutrition. Patients who require PEG placement are often very sick, and postoperative complications, especially aspiration pneumonia, can be fatal. Objective: In this study we investigated the risk factors for aspiration pneumonia after PEG using a simple two-step swallowing provocation test (S-SPT), as reported in 1999 by Teramoto et al. Methods: The study included 29 patients (10 men, 19 women; mean age 84.6 years) who underwent S-SPT before PEG. We evaluated the presence of reflux esophagitis (RE) and esophageal hiatal hernia (EHH) with PEG. According to the S-SPT results, a normal response to the 1st step S-SPT was given a score of 0, a normal response to the 2nd step S-SPT was given a score of 1, and an abnormal response to the 2nd step S-SPT was given a score of 3. In addition to S-SPT, the presence of RE was given a score of 3, the absence of RE was given a score of 0, the presence of EHH was given a score of 2, and the absence of EHH was given a score of 0. We evaluated the association between the presence of aspiration pneumonia, as an early and critical complication, up to 1 month after PEG and determined the total risk score (score of S-SPT+ score of RE+ score of EHH). Results: The group with an abnormal response to the 2nd step S-SPT and the group with RE both exhibited aspiration pneumonia. The patients with aspiration pneumonia all achieved total scores ≧3, and 8 of 13 patients without aspiration pneumonia achieved scores ≤2. Conclusions: S-SPT is particularly useful in PEG patients. The scores provided by S-SPT and endoscopic examination can be very useful for aspiration pneumonia after PEG. The patients with scores ≤2 appear to be at very low risk for aspiration pneumonia, and patients with the scores ≧3 should be carefully followed up.

Dysphagia in Inclusion Body Myositis

“…Whether earlier PEG placement would have been beneficial remains conjectural as PEG does not completely prevent aspiration. 26 The Mendelsohn maneuver was recommended in only three patients and seemed beneficial in this small sample in maintaining oral intake. This maneuver is designed to prolong the UES opening during swallowing by voluntarily extending laryngeal elevation 23,27 and in comparison with other swallowing maneuvers such as the supraglottic and supersupraglottic swallows is associated with increased pharyngeal peak contraction and contraction duration and significantly longer bolus transit time.…”

“…Among the 62 patients with inflammatory myopathy and dysphagia, 14 26 (6 men and 20 women) met the diagnostic criteria of definite (10) and possible (16) IBM. 6 Mean age at presentation to our institution was 72.2 yrs (range, 54.6 -84.5), and the mean age at IBM diagnosis was 68.7 yrs (range, 53.8 -84.3).…”

Investigation and prediction of enteral nutrition problems after percutaneous endoscopic gastrostomy

“…Previous studies have shown that aspiration is a complication of esophageal hiatal hernia and gastroesophageal reflux disease [16] . Recently, Kitamura et al reported that esophageal hiatal hernia was a risk factor for aspiration pneumonia after PEG [17] . Our results indicate that preoperative upper gastrointestinal endoscopy is important for predicting enteral nutrition problems after PEG.…”

Conceptual Model for Reducing Infections and Antimicrobial Resistance in Skilled Nursing Facilities: Focusing on Residents with Indwelling Devices

“…Patients with MRSA at other body sites are also more likely to have MRSA infection at the PEG tube site [34]. Although nutritional requirements are met, rates of reflux and aspiration of gastric contents increase with the use of feeding tubes, which can lead to aspiration pneumonia [36, 37]. …”