Our experience in percutaneous endoscopic gastrostomy

Öz

Background and Aims: Percutaneous endoscopic gastrostomy is the preferred route of enteral feeding in patients who require long-term enteral nutrition. The aim of this study was to perform a retrospective analysis characterizing patients with percutaneous endoscopic gastrostomy. Materials and Methods: We retrospectively evaluated the indications, complications, procedure details, and follow up of patients who underwent percutaneous endoscopic gastrostomy in Gulhane Military Medical Academy, Department of Gastroenterology between 1999 and 2014. Results: Of the 642 patients enrolled, 405 were male (63.1%), and 237 female (36.9%). Mean age was 64.2 (range, 18-97) years. Percutaneous endoscopic gastrostomy was successfully performed in all but 7 patients. The most common indication for percutaneous endoscopic gastrostomy tube placement was neurologic disorders in 495 (77.1%) patients. Other indications were oropharyngeal diseases in 109 (16.9%) patients, and eosophageal diseases in 38 (6%) patients. Percutaneous endoscopic gastrostomy related complications were seen in 123 patients (19.1%). Nine (1.4%) patients died within 1 month, 15 (2.3%) patients died within 3 months, and 38 (5.9%) patients died within 6 months after percutaneous endoscopic gastrostomy procedure. There were no percutaneous endoscopic gastrostomy insertion related mortalities. Conclusion: Percutaneous endoscopic gastrostomy placement to provide enteral access for nutrition support is a safe, minimally invasive, effective, and well-tolerated procedure with a low major complication rate.

Anahtar Kelimeler

• Percutaneous endoscopic gastrostomy,enteral nutrition,indication

Perkütan endoskopik gastrostomi uygulamalarındaki tecrübelerimiz

Öz

Giriş ve Amaç: Perkütan endoskopik gastrostomi uzun vadeli enteral nutrisyona gereksinim duyan hastalarda beslenme için tercih edilen yöntemdir. Bu çalışmanın amacı, perkütan endoskopik gastrostomi uygulanan hastaların özelliklerini retrospektif olarak analiz etmektir. Gereç ve Yöntem: Gülhane Askeri Tıp Akademisi, Gastroenteroloji Bilim Dalında 1999 ile 2014 yılları arasında perkütan endoskopik gastrostomi uygulanan hastaların endikasyonları, işlem detayları, takip süreleri ve gelişen komplikasyonlar retrospektif olarak değerlendirildi. Bulgular: Çalışmaya dahil edilen 642 hastanın 405’i (%63.1) erkek, 237’si (%36.9) kadındı. Hastaların ortalama yaşları 64.2 (18-97) yıl idi. Yedi hasta dışındaki tüm hastalara perkütan endoskopik gastrostomi başarıyla uygulandı. En sık perkütan endoskopik gastrostomi yerleştirme endikasyonu 495 (%77.1) hasta ile nörolojik hastalıklardı. Diğer endikasyonlar ise; 109 (%16.9) hastada orofaringeal hastalıklar ve 38 (%6) hastada özofageal hastalıklardı. Perkütan endoskopik gastrostomi prosedürüne bağlı 123 (%19.1) hastada komplikasyon gözlendi. Perkütan endoskopik gastrostomi sonrası 1 aylık dönem içinde 9 (%1.4) hasta, 3 ay içinde 15 (%2.3) hasta, 6 ay içinde ise 38 (%5.9) hasta ex oldu. Perkütan endoskopik gastrostomi yerleştirilmesine bağlı hiçbir hastada mortalite gözlenmedi. Sonuç: Perkütan endoskopik gastrostomi, beslenme desteğinin enteral olarak sağlanmasında güvenli, minimal invaziv, etkili, iyi tolere edilen ve düşük komplikasyon oranına sahip bir uygulamadır.

Anahtar Kelimeler

• Perkütan endoskopik gastrostomi,enteral beslenme,endikasyon

Kaynakça

1. 1. Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopictechnique. J Pediatr Surg 1980;15:872-5.
2. 2. Cantwell CP, Gervais DA, Hahn PF, Mueller PR. Feasibility and safety of infracolic fluoroscopically guided percutaneous radiologic gastrostomy. J Vasc Interv Radiol 2008;19:129-32.
3. 3. Ermis F, Ozel M, Oncu K, et al. Indications, complications and long-term follow-up of patients undergoing percutaneous endoscopic gastrostomy: A retrospective study. Wien Klin Wochenschr 2012;124:148-53.
4. 4. Nicholson FB, Korman MG, Richardson MA. Percutaneous endoscopic gastrostomy: a review of indications, complications and outcome. J Gastroenterol Hepatol 2000;15:21-5.
5. 5. Gauderer M. Twenty years of percutaneous endoscopic gastrostomy: origin and evolution of a concept and its expanded applications. Gastrointest Endosc 1999;50:879-83.
6. 6. Srinivasan R, Irvine T, Dalzell M. Indications for percutaneous endoscopic gastrostomy and procedure-related outcome. J Pediatr Gastroenterol Nutr 2009;49:584-8.
7. 7. Fortunato JE, Troy AL, Cuffari C, et al. Outcome after percutaneous endoscopic gastrostomy in children and young adults. J Pediatr Gastroenterol Nutr 2010;50:390-3.
8. 8. Cantez MS, Cantez S, Gerenli N, Durmaz Ö. Demographic findings of 104 patients with percutaneous endoscopic gastrostomy. Türk Ped Arş 2013;210-4.

9. 9. Yılmaz H, Alptekin H, Acar F, et al. Experience of percutaneous endoscopic gastrostomy. Selçuk Tıp Derg 2013;29:68-70.
10. 10. Herman LL, Hoskins WJ, Shike M. Percutaneous endoscopic gastrostomy for decompression of the stomach and small bowel. Gastrointest Endosc 1992;38:314-8.
11. 11. Sharma VK, Howden CW. Meta-analysis of randomized, controlled trials of antibiotic prophylaxis before percutaneous endoscopic gastrostomy. Am J Gastroenterol 2000;95:3133-6.
12. 12. Lipp A, Lusardi G. A systematic review of prophylactic antimicrobials in PEG placement. J Clin Nurs 2009;18:938-48.
13. 13. Jain NK, Larson DE, Schroeder KW, et al. Antibiotic prophylaxis for percutaneous endoscopic gatrostomy: A prospective, randomized controlled clinical trial. Ann Intern Med 1987;107:824-8.
14. 14. Pien ECT, Hume K, Pien FD. Gastrostomy tube infections in a community hospital. Am J Infect Control 1996;24:353-8.
15. 15. Gottfried EB, Plumser AB, Clair MR. Pneumoperitoneum following percutaneous endoscopic gastrostomy. A prospective study. Gastrointest Endosc 1986;32:397-9.
16. 16. Hull MA, Rawlings J, Murray FE, et al. Audit of outcome of long-term enteral nutrition by percutaneous endoscopic gastrostomy. Lancet 1993;341:869-72.
17. 17. Finocchiaro C, Galletti R, Rovera G, et al. Percutaneous endoscopic gastrostomy: a long-term follow-up. Nutrition 1997;13:520-3.
18. 18. Foutch P. Complications of percutaneous endoscopic gastrostomy and jejunostomy. Recognition, prevention and treatment. Gastrointest Endosc Clin N Am 1992;2:231-48.
19. 19. Şit M, Kahramansoy N, Tekelioğlu ÜY, Ocak, T. Our experience in percutaneous endoscopic gastrostomy. Journal of Academic Research in Medicine 2013;3:66-8.