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

Yıl 2021, Cilt: 6 Sayı: 3, 158 - 161, 09.12.2021

Necattin Fırat , Mehmet Aziret , Barış Mantoğlu , Recayi Capoglu , Hakan Demir Enis Dikicier , Emrah Akın , Ahmet Tarık Harmantepe , Fatih Altıntoprak

https://doi.org/10.25000/acem.1005090

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. Del Rio C, Malani PN. 2019 Novel Coronavirus-Important Information for Clinicians. JAMA. 2020;323: 1039–1040. doi:10.1001/jama.2020.1490
• 2. Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. N Engl J Med. 2020;382: 970–971. doi:10.1056/NEJMc2001468
• 3. Karaca AS, Ozmen MM, Uçar AD, Yasti AÇ, Demi̇rer S. COVİD-19’lu Hastalarda Genel Cerrahi Ameliyathane Uygulamaları. Turk J Surg. 2020;36. doi:10.5578/turkjsurg.202002
• 4. Goyal H, Perisetti A, Tharian B. Percutaneous Endoscopic Gastrostomy tube placement in COVID-19 patients: Multidisciplinary approach. Dig Endosc. 2021;33:209. doi:10.1111/den.13873
• 5. Gauderer MW, Ponsky JL, Izant RJ. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980;15: 872–875. doi:10.1016/s0022-3468(80)80296-x
• 6. Özer Etik D, Suna N, Öcal S, Selçuk H. Percutaneous endoscopic gastrostomy in older patient population. Endoscopy Gastrointestinal 2018;26:6-11. doi:10.17940/endoskopi.434900
• 7. Hucl T, Spicak J. Complications of percutaneous endoscopic gastrostomy. Best Pract Res Clin Gastroenterol. 2016;30: 769–781. doi:10.1016/j.bpg.2016.10.002
• 8. Aziret M, Karaman K, Ercan M, Celebi F, Akdeniz Y, Ebiloglu T, et al. Assessment of risk factors on morbidity and mortality in patients undergoing percutaneous endoscopic gastrostomy. Ann Med Res. 2018;25: 400. doi:10.5455/annalsmedres.2018.05.077
• 9. Haqqi SAUH, Farrukh SZUI, Dhedhi AS, Siddiqui AR, Muhammad AJ, Niaz SK. Percutaneous endoscopic gastrostomy; success and outcome of a novel modality for enteral nutrition. JPMA J Pak Med Assoc. 2020;70: 1795–1798. doi:10.5455/JPMA.30413
• 10. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40: 159–211. doi:10.1177/0148607115621863
• 11. Stein DJ, Moore MB, Hoffman G, Feuerstein JD. Improving All-Cause Inpatient Mortality After Percutaneous Endoscopic Gastrostomy. Dig Dis Sci. 2021;66: 1593–1599. doi:10.1007/s10620-020-06396-y
• 12. Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: Techniques, problems and solutions. World J Gastroenterol WJG. 2014;20: 8505–8524. doi:10.3748/wjg.v20.i26.8505
• 13. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020;296: E32–E40. doi:10.1148/radiol.2020200642
• 14. Siepmann T, Sedghi A, Barlinn J, de With K, Mirow L, Wolz M, et al. Association of history of cerebrovascular disease with severity of COVID-19. J Neurol. 2021;268: 773–784. doi:10.1007/s00415-020-10121-0
• 15. Ejaz H, Alsrhani A, Zafar A, Javed H, Junaid K, Abdalla AE, et al. COVID-19 and comorbidities: Deleterious impact on infected patients. J Infect Public Health. 2020;13: 1833–1839. doi:10.1016/j.jiph.2020.07.014
• 16. Iacucci M, Cannatelli R, Labarile N, Mao R, Panaccione R, Danese S, et al. Endoscopy in inflammatory bowel diseases during the COVID-19 pandemic and post-pandemic period. Lancet Gastroenterol Hepatol. 2020;5: 598–606. doi:10.1016/S2468-1253(20)30119-9
• 17. Tian T, Bugaev N, Johnson BP, Mahoney E, Nilson J, Sekhar P, et al. Novel Tracheostomy and Percutaneous Endoscopic Gastrostomy Technique for COVID-19 Patients in a Nonnegative Pressure Environment. Am Surg. 2020; 3134820960072. doi:10.1177/0003134820960072
• 18. Sinonquel P, Roelandt P, Demedts I, Gerven LV, Vandenbriele C, Wilmer A, et al. COVID-19 and gastrointestinal endoscopy: What should be taken into account? Dig Endosc. 2020;32: 723–731. doi:https://doi.org/10.1111/den.13706
• 19. Micic D, Wall E, Semrad C. Nutrition Support in the ICU-A Refresher in the Era of COVID-19. Am J Gastroenterol. 2020;115: 1367–1370. doi:10.14309/ajg.0000000000000761
• 20. COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet Lond Engl. 2020;396: 27–38. doi:10.1016/S0140-6736(20)31182-X
• 21. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. Anaesthesia. 2021;76. doi:10.1111/anae.15458