Perkütan Endoskopik Gastrostomi: İkinci Basamak Hastanede Retrospektif Analiz

Abstract

Amaç: 2. Basamak hastanedeki perkütan endoskopik gastrostomi (PEG) takılma endikasyonlarını, işlem sonrası komplikasyon ve takipleri ile ilgili verileri ortaya koymaktır. Materyal ve Metot: 2018–2020 tarihleri arasında PEG takılma endikasyonu konulan 34 hastanın verileri retrospektif olarak değerlendirildi. Uzun süre oral alamayan ve enteral beslenemeyeceği düşünülerek PEG endikasyonu konulan hastaların yaşları, cinsiyetleri, primer tanıları, komorbidite durumu, işlem sonrası komplikasyonları, trakeostomi açılıp açılmadığı, ilk gastrostomi ya da değişim durumları değerlendirildi. Bulgular: Vakaların %74,2’si yoğun bakımda yatmakta olup, PEG endikasyonu olarak en sık %67,7 ile nörolojik hastalıklar, %22,6 ile malignite ve %9,7 ile travma ve elekrik yanığı gibi diğer nedenler şeklindeydi. PEG işlemine ait major komplikasyon olmayıp, iki hastada minor komplikasyon gelişti. PEG işlemine ait mortalite gözlenmedi. Sonuç: Enteral beslemenin 4–6 haftadan uzun süreceği durumlarda, malnütrisyonun önlenmesi için enteral beslenme desteğinin sağlanmasında PEG tercih edilen bir yöntemdir. Düşük morbidite ve mortalitesiyle PEG yöntemi güvenli ve pratik bir beslenme yöntemi olup, 2. basamak hastanede güvenle uygulanabilir.

Keywords

• gastrostomi
• perkütan endoskopik gastrostomi
• enteral beslenme
• beslenme tüpü; endoskopi

Percutaneous Endoscopic Gastrostomy: A Retrospective Analysis in a Secondary Care Hospital

Abstract

Aim: It was aimed to reveal data on indications of percutaneous endoscopic gastrostomy (PEG) insertion in a secondary care hospital, postoperative complications, and follow-up. Material and Method: The data of 34 patients with PEG insertion indication between 2018 and 2020 were evaluated retrospectively. The age, sex, primary diagnosis, comorbidity status, postoperative complications, whether tracheostomy was performed, and first gastrostomy or change status of the patients, who were given a PEG indication, considering they could not take food orally and would require to be fed enterally for a long time, were evaluated. Results: 74.2% of the cases were hospitalized in the intensive care unit, and the most common indications of PEG were neurological diseases with a rate of 67.7%, malignancy with a rate of 22.6%, and other causes such as trauma and electrical burns with a rate of 9.7%. There were no significant complications of the PEG procedure, and minor complications developed in two patients. No mortality was observed in the PEG procedure. Conclusion: In cases where enteral feeding will take longer than 4–6 weeks, PEG is a preferred method for providing enteral nutritional support to prevent malnutrition. With low morbidity and mortality, the PEG method is a safe and practical feeding method and can be safely applied in a secondary care hospital.

Keywords

• gastrostomy
• percutaneous endoscopic gastrostomy
• enteral nutrition
• feeding tube; endoscopy

References

1. 1. Demirkan K, Ekincioğlu EB. Enteral beslenme tüpünden ilaç uygulanmasında ilaç dozaj şekillerinin önemi. J Turk Soc Intens Care. 2016;14:1–8.
2. 2. Özbaş N, Baykara ZG. Hemşirelerin tüple enteral beslenme konusunda bilgi düzeylerinin belirlenmesi. Journal of Human Sciences. 2018;15:359–67.
3. 3. Ukleja A, Gilbert K, Mogensen KM, Walker R, WardCT, Ybarra J, et al. Standards for nutrition sup-port: Adult hospitalized patients. Nutr Clin Pract. 2018;33:906–20.
4. 4. McClave SA, DiBaise JK, Mullin EG, Martindale RG. ACG Clinical guideline. nutrition therapy in the adult. Am J Gastroenterol. 2016;111:315–34.
5. 5. Bechtold ML, Mir FA, Boumitri C, Palmer LB, Evans DC, Kiraly LN, et al. Long-term nutrition: A clinician’s guide to successful long-term enteral access in adults. Nutr Clin Pract. 2016;31:737–47.
6. 6. Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol. 2014;20:7739–51.
7. 7. Makwana HB, Kansal SV, Baldha M, Agarwal S. Percutaneous endoscopic gastrostomy: Four years of experience of general surgery department at a tertiary care center at Surat. Int J Sci Stud. 2016;4:171–4.
8. 8. Löser C. Clinical aspects of long-term enteral nutrition via percutaneous endoscopic gastrostomy (PEG). J Nutr Health Aging. 2000;4:47–50.

9. 9. Özgüç H, Gökçe E, Altınel Y, Kırdak T. Bir genel cerrahi kliniğinin perkütan endoskopik gastrostomi deneyimi. Ulusal Cerrahi Dergisi. 2011;27(3):145–8.
10. 10. Stockeld D, Fagerberg J, Granström L, Backman L. Percutaneous endoscopic gastrostomy for nutrition in patients with oesophageal cancer. Eur J Surg. 2001;167:839–44.
11. 11. Yakut M, Tiryaki HC. Percutaneous endoscopic gastrostomy: a single centerretrospective analysis. Maltepe Tıp Dergisi. 2019;11:3.
12. 12. Sharma VK, Howden CW. Meta-analysis of randomized, controlled trials of anti-biotic prophylaxis before percutaneous endoscopic gastrostomy. Am J Gastroenterol. 2000;95:3133–6.
13. 13. Roveron G, Antonini M, Barbierato M, Calandrino V, CaneseG, Chiurazzi LF, et al. Clinical practice guidelines for the nursing management of percutaneous endoscopic gastrostomy and jejunostomy (PEG/PEJ) in adult patients. J Wound Ostomy Continence Nurs. 2018;45:326–34.
14. 14. Löser C, Aschl G, Hebuterne X, Mathus-Vliegen EMH, Muscaritoli M, Niv Y, et al. ES-PEN guidelines on artificial enteral nutrition -Percutaneous endoscopic gastros-tomy (PEG). Clin Nutr. 2005;24:848–61. 15. Mello GFS, Lukashok HP, Meine GC, Small IA, Carvalho RLT, Guimarães DP, et al. Outpatient percutaneous endoscopic gastrostomy in selected head and neck cancer patients. Surg Endosc. 2009;23:1487–93.
15. 16. Ali T, Le V, Sharma T, Vega KJ, Srinivasan N, Tierney WM, Rizvi S, et al. Post-PEG feeding time: a web based national survey amongst gastroenterologists. Dig Liver Dis. 2011;43:768–71.
16. 17. Gauderer MWL. Percutaneous endoscopic gastrostomy and the evolution of contemporary long-term enteral access. Clinical Nutrition. 2002;21(2):103–10.
17. 18. Fröhlich T, Richter M, Carbon R, Barth B, Köhler H. Review article: percutaneous endoscopic gastrostomy in infants and children. Aliment Pharmacol Ther. 2010;31(8):788–801.
18. 19. Pulkkinen J, Rekola J, Asanti M, Grénman R. Prophylactic percutaneous endoscopic gastrostomy in head and neck cancer patients: results of tertiary institute. Eur Arch Otorhinolaryngol. 2014;271:1755–58.
19. 20. Sobotka L. Klinik Nütrisyon Temelleri. Çev. ed. Gündoğdu RH. 2017. Ankara, Bayt Yayın.
20. 21. Ljungdahl M, Sundbom M. Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrosto-my: a prospective, randomized trial. Surg Endosc. 2006;20:1248–51.
21. 22. Erdem D, Albayrak D, Akan B, Bagubek A, Gögüş N. Reanimasyon kliniğinde izlenen hasta-larda perkütan endoskopik gastrostomi uygulamaları. Van Tıp Dergisi. 2009;16:10–13.
22. 23. Varnier A, Iona L, Dominuttı MC, DeottoE, Bianchi L, Iengo A, et al. Percutaneous endoscopic gastrostomy: Complications in the short and long-term follow-up and efficacy on nutritional sta-tus. Eur Med Phys. 2006;42:23–26.