Covid-19 Enfeksiyonunda Perkütan Endoskopik Gastrostomi Zamanlaması: Endoskopik Cerrahi Ünite Deneyimi

Öz

Amaç: COVID-19 pandemisi tüm dünyayı ve sağlık sistemlerini olumsuz şekilde etkisi altına almıştır. Literatürde COVID-19 hastalarında Perkütan endoskopik gastrostomi (PEG) zamanlaması ile ilgili öneriler yer alsa da henüz önemli bir klinik çalışma bulunmamaktadır. Bu konudaki verilerimizi paylaşarak literatüre katkı sağlamayı amaçlıyoruz.
Gereç ve Yöntem: Mart 2020-Mart 2021 tarihleri arasında PEG takılan hastalar geriye dönük olarak değerlendirildi. Hastalar yaş, cinsiyet, tıbbi endikasyonlar, eşlik eden hastalıkları, kan testleri ve müdahale sonrası komplikasyonlar ile işlem sırasında hastanın yoğun bakım ünitesinde olup olmadığı kaydedildi. PCR negatif hastalarda rutin olarak PEG yapıldı. PEG uygulanan hastalar ayaktan ve yoğun bakım ünitesinde yatan hastalar olarak karşılaştırıldı. Daha sonra yoğun bakım ünitesinde yatarken PEG uygulanan hastalar, COVID-19 enfeksiyonu varlığına göre iki gruba ayrıldı. ( grup-1 ve grup-2)
Bulgular: Pandemi sırasında uygun endikasyonları olan 66 hastaya PEG yerleştirildi. Bu hastalar ağırlıklı olarak SVH, Alzheimer veya travmatik beyin hasarı olanlardan oluşuyordu. Çalışmada otuziki (%48.5) hasta kadındı ve yaş ortalaması 69.4±17.6 idi. Ayrıca, kırkyedi hastaya yoğun bakımdayken PEG uygulandı; bu hastalardan 11'i COVID-19 enfekte hasta grubuydu (grup-2). Grup-1 ve grup-2 arasında kan albümin düzeyleri, CRP, hemogram sonuçları ve 30 günlük mortalite sonuçları açısından istatistiksel fark yoktu (P>0.05)
Sonuç: Minimal invaziv bir işlem olan peg enteral beslenme amacıyla yaygın olarak kullanılmaktadır. COVID- 19 enfekte hastalara işlemin zamanlaması önemlidir. En uygun zamanlama enfeksiyon sürecinden sonraki 30. gün olmakla birlikte uygun hastalarda 10. Gün peg uygulanabilceğini düşünmekteyiz.

Anahtar Kelimeler

• Perkütan Endoskopik Gastrostomi
• COVID-19
• enfeksiyon
• Serebrovasküler hastalık
• minimal invaziv

Timing of Percutaneous Endoscopic Gastrostomy in Covid-19 Infection: Endoscopic Surgery Unit Experience

Abstract

Objective: The Covid-19 pandemic has affected the whole world and health systems worldwide have had to revise their working methods. Although the literature includes recommendations regarding the timing of Percutaneous endoscopic gastrostomy (PEG) in Covid-19 patients, there are no significant clinical studies as yet. We aim to contribute to the literature by sharing our data on this subject. Materials and Methods: Patients who underwent PEG between March 2020-March 2021 were retrospectively evaluated and divided into two groups: patients noninfected with COVID-19 (Group 1) and COVID-19 infected patients (Group 2). Patient age, gender, medical indications, comorbid diseases, blood tests and post–intervention complications were recorded, as was whether or not the patient was in the ICU at the time of the procedure. PEG was carried out routinely in PCR-negative patients. Results: During the pandemic, PEG was placed in 67 patients who had appropriate indications. These patients predominantly consisted of those with SVH, Alzheimer's, or traumatic brain injury. Thirty-three (49.3%) patients were female with a mean age of 69.4 ± 17.6. 48 patients underwent PEG while in the intensive care unit; 11 of these patients positive for covid-19, and one had active covid-19 infection. The results of appropriately timed PEG procedures in intensive care unit patients diagnosed with Covid-19 were compared with those of other hospitalized patients and blood albumin levels, CRP, hemogram results and 30-day mortality results were found to be similar. Conclusion: The timing of the intervention for virus-infected patients is crucial. Although the most appropriate timing is the 30th day after the infection process, PEG may be performed on the 10th day in eligible patients.

Keywords

• Percutaneous Endoscopic Gastrostomy
• COVID-19
• infection
• Cerebrovascular disease
• minimally invasive

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