Do we know all about percutaneous endoscopic gastrostomy?

Öz

Objective: Percutaneous endoscopic gastrostomy (PEG) is a safe, easy-to-apply, frequently used and effective method for patients requiring long-term enteral nutrition. In recent years, it has become questionable in terms of its indications in the current literature due to the complication and mortality rates seen after the procedure. In our study, it was aimed to evaluate the morbidity and indications of the procedure by examining the PEG applications performed in our center. Material and Method: Patients who underwent PEG in our center between 2016 and 2020 were included in the study. All PEG procedures were performed by a single physician. The patients were analyzed in terms of demographic data, complications, American Society of Anesthesiologists (ASA) classification, survival, and underlying disease. The relationship between underlying disease, ASA score, age, sex and survey was evaulated. Underlying diseases were classified in 4 groups as dementia and other neurological diseases, head and neck malignancies, cerebrovascular disease, intensive care patients. Patients included in the group during the follow-up period were classified into 2 groups as ex and survivors. Chi-square test was used to compare sex, underlying disease and ASA score. Age factor was compared by student t test. Results: In the statistical studies conducted; it was observed that the survival time was significantly longer in the age range of 70 years and older. Apart from this, no statistically significant result was found between the underlying disease and ASA score, and life span and mortality. Conclusion: We think that consensus is needed in terms of the surveillance expectation and procedure indications stated in guidelines for the right patient selection under the light of literature discussions.

Anahtar Kelimeler

• Percutaneous endoscopic gastrostomy
• enteral nutrition
• gastrostomy

Kaynakça

1. Gauderer MW, Ponsky JL, Izant RJ Jr. Gastros-tomy without laparotomy: a percutaneous en-doscopic technique. 1980. Nutrition. 1998;14(9): 736-738.
2. Löser C, Aschl G, Hébuterne X, Mathus-Vliegen EM, Muscaritoli M, Niv Y, et al. ESPEN guide-lines on artificial enteral nutrition--percutaneous endoscopic gastrostomy (PEG). Clin Nutr. 2005; 24(5):848-861.
3. Pih GY, Na HK, Ahn JY, Jung KW, Kim DH, Lee JH, et al. Risk factors for complications and mortality of percutaneous endoscopic gastros-tomy insertion. BMC Gastroenterol. 2018;18(1): 101.
4. Sacks BA, Vine HS, Palestrant AM, Ellison HP, Shropshire D, Lowe R. A nonoperative tech-nique for establishment of a gastrostomy in the dog. Invest Radiol. 1983;18(5):485-487.
5. Russell TR, Brotman M, Norris F. Percutaneous gastrostomy. A new simplified and cost-effective technique. Am J Surg. 1984;148(1):132-137.
6. Löser C, Wolters S, Fölsch UR. Enteral long-term nutrition via percutaneous endoscopic gas-trostomy (PEG) in 210 patients: a four-year prospective study. Dig Dis Sci. 1998;43(11):2549-2557.
7. Lee C, Im JP, Kim JW, Kim SE, Ryu DY, Cha JM, et al. Small Intestine Research Group of the Korean Association for the Study of Intestinal Disease (KASID). Risk factors for complications and mortality of percutaneous endoscopic gas-trostomy: a multicenter, retrospective study. Surg Endosc. 2013;27(10):3806-3815.
8. Dietrich CG, Schoppmeyer K. Percutaneous endoscopic gastrostomy - Too often? Too late? Who are the right patients for gastrostomy? World J Gastroenterol. 2020;26(20):2464-2471.

9. van Bruchem-Visser RL, Mattace-Raso FUS, de Beaufort ID, Kuipers EJ. Percutaneous endo-scopic gastrostomy in older patients with and without dementia: Survival and ethical consid-erations. J Gastroenterol Hepatol. 2019;34(4):736-741.
10. ProGas Study Group. Gastrostomy in patients with amyotrophic lateral sclerosis (ProGas): a prospective cohort study. Lancet Neurol. 2015; 14(7):702-709.
11. Molina Villalba C, Vázquez Rodríguez JA, Gal-lardo Sánchez F. Percutaneous endoscopic gas-trostomy. Indications, care and complications. Med Clin (Barc). 2019;152(6):229-236.
12. Ayman AR, Khoury T, Cohen J, Chen S, Yaari S, Daher S, et al. PEG Insertion in Patients With Dementia Does Not Improve Nutritional Status and Has Worse Outcomes as Compared With PEG Insertion for Other Indications. J Clin Gas-troenterol. 2017;51(5):417-420.
13. DeLegge M, DeLegge R, Brady C. External bolster placement after percutaneous endoscop-ic gastrostomy tube insertion: is looser better? JPEN J Parenter Enteral Nutr. 2006;30(1):16-20.
14. Cyrany J, Rejchrt S, Kopacova M, Bures J. Buried bumper syndrome: A complication of percutaneous endoscopic gastrostomy. World J Gastroenterol. 2016;22(2):618-627.
15. Hindryckx P, Dhooghe B, Wannhoff A. A novel device for the endoscopic management of bu-ried bumper syndrome. Endoscopy. 2019;51(7):689-693.
16. Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percuta-neous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol. 2014;20(24):7739-7751.
17. de Sousa Magalhães R, Cúrdia Gonçalves T, Sousa-Pinto B, Rosa B, Marinho C, Cotter J. Percutaneous endoscopic gastrostomy: dealing with the issue of dislodgement. Scand J Gastro-enterol. 2020;55(4):485-491.
18. Kirby DF, Delegge MH, Fleming CR. American Gastroenterological Association technical re-view on tube feeding for enteral nutrition. Gas-troenterology. 1995;108(4):1282-1301.
19. Schneider AS, Schettler A, Markowski A, Luettig B, Kaufmann B, Klamt S, et al. *Conference presentation: 36th ESPEN Congress in Leipzig, Germany on August 31st – September 3rd, 2013. Complication and mortality rate after percutaneous endoscopic gastrostomy are low and indication-dependent. Scand J Gastroenter-ol. 2014; 49(7):891-898.
20. Leeds JS, McAlindon ME, Grant J, Robson HE, Lee FK, Sanders DS. Survival analysis after gas-trostomy: a single-centre, observational study comparing radiological and endoscopic inser-tion. Eur J Gastroenterol Hepatol. 2010;22(5): 591-596.
21. Lim JH, Choi SH, Lee C, Seo JY, Kang HY, Yang JI, et al. Thirty-day mortality after percu-taneous gastrostomy by endoscopic versus ra-diologic placement: a systematic review and meta-analysis. Intest Res. 2016;14(4):333-342.
22. Blomberg J, Lagergren J, Martin L, Mattsson F, Lagergren P. Complications after percutaneous endoscopic gastrostomy in a prospective study. Scand J Gastroenterol. 2012;47(6):737-742.
23. Ticinesi A, Nouvenne A, Lauretani F, Prati B, Cerundolo N, Maggio M, et al. Survival in older adults with dementia and eating problems: To PEG or not to PEG? Clin Nutr. 2016;35(6):1512-1516.
24. Lee YF, Hsu TW, Liang CS, Yeh TC, Chen TY, Chen NC, et al. The Efficacy and Safety of Tube Feeding in Advanced Dementia Patients: A Systemic Review and Meta-Analysis Study. J Am Med Dir Assoc. 2020:S1525-8610(20)30558-2.
25. Chang WK, Lin KT, Tsai CL, Chung CH, Chien WC, Lin CS. Trends regarding percutaneous en-doscopic gastrostomy: A nationwide popula-tion-based study from 1997 to 2010. Medicine (Baltimore). 2016;95(24):e3910.