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Wang R, Cai L, Liu Y, Zhang J, Ou X, Xu J. Machine learning algorithms for prediction of ventilator associated pneumonia in traumatic brain injury patients from the MIMIC-III database. Heart Lung 2023; 62:225-232. [PMID: 37595390 DOI: 10.1016/j.hrtlng.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Ventilator associated pneumonia (VAP) is a common complication and associated with poor prognosis of traumatic brain injury (TBI) patients. OBJECTIVES This study was conducted to explore the predictive performance of different machine-learning algorithms for VAP in TBI patients. METHODS TBI patients receiving mechanical ventilation more than 48 hours from the Medical Information Mart for Intensive Care-III (MIMIC-III) database were eligible for the study. The VAP was confirmed based on the ICD-9 code. Included patients were separated to the training cohort and the validation cohort with a ratio of 7:3. Predictive models based on different machine learning algorithms were developed using 5-fold cross validation in the training cohort and then verified in the validation cohort by evaluating the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy and F score. RESULTS 786 TBI patients from the MIMIC-III were finally included with the VAP incidence of 44.0%. The random forest performed the best on predicting VAP in the training cohort with a AUC of 1.000. The XGBoost and AdaBoost were ranked the second and the third with a AUC of 0.915 and 0.789 in the training cohort. While the AdaBoost performed the best on predicting VAP in the validation cohort with a AUC of 0.706. The XGBoost and random forest were ranked the second and the third with the AUC of 0.685 and 0.683 in the validation cohort. Generally, the random forest and XGBoost were likely to be over-fitting while the AdaBoost was relatively stable in predicting the VAP. CONCLUSIONS The AdaBoost performed well and stably on predicting the VAP in TBI patients. Developing programs using AdaBoost in portable electronic devices may effectively assist physicians in assessing the risk of VAP in TBI.
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Affiliation(s)
- Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
| | - Linrui Cai
- Institute of Drug Clinical Trial·GCP, West China Second University Hospital, Sichuan University, Chengdu, China; Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yan Liu
- Laboratory Animal Center of Sichuan University, Chengdu, China
| | - Jing Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan province, China
| | - Xiaofeng Ou
- Department of Critical care medicine, West China Hospital, Sichuan University, Chengdu, Sichuan province, China.
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan province, China.
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Parr H, Thomas L, Singh P, Mohammed S, Nu K, Kane JS, Lee F, Welbank T, Hopper AD, McAlindon ME, Williams EA, Sanders DS. A retrospective study of outcomes and the validation of the Sheffield Gastrostomy Score in PEGs, RIGs and PIGs. Scand J Gastroenterol 2023; 58:1542-1546. [PMID: 37415447 DOI: 10.1080/00365521.2023.2229928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION There are limited studies comparing the safety and effectiveness of Radiologically Assisted Gastrostomies (RAGs) against Percutaneous Endoscopic Gastrostomies (PEGs). The Sheffield Gastrostomy Score (SGS) can be used to help predict 30-day mortality, more information is needed on its validity in RAGs. Our aim is to compare mortality between RAGs (Radiologically Inserted Gastrostomies (RIGs) and Per-oral Image Guided Gastrostomies (PIGs)) with PEGs and validate the SGS. METHOD Data on gastrostomies newly inserted in three hospitals from 2016-2019 were retrospectively collected. Demographics, indication, insertion date, date of death, inpatient status and blood tests (albumin, CRP and eGFR) were recorded. RESULTS 1977 gastrostomies were performed: Gastrostomy mortality at 7 days was 1.3% and at 30 days was 6%. There was a 5% 30-day mortality for PEGs, 5.5% RIGs, 7.2% PIGs (p = 0.215). Factors increasing 30 day mortality were age ≥60 years (p = 0.039), albumin <35 g/L (p = 0.005), albumin <25 g/L (p < 0.001) and CRP ≥10 mg/L (p < 0.001). For patients who died within 30 days; 0.6% had an SGS of 0, 3.7% = 1, 10.2% = 2 and 25.5% = 3, with similar trends for RAGs and PEGs. ROC curves showed the area under the curve for all gastrostomies, RAGs and PEGs as 0.743, 0.738, 0.787 respectively. DISCUSSION There was no significant difference between 30-day mortality for PEGs, RIGs and PIGs. Factors predicting risk include age ≥60 years, albumin <35 g/L, albumin <25 g/L and CRP ≥10 mg/L. The SGS has been validated in this study for PEGs and for the first time in RAGs as well..
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Affiliation(s)
- Heather Parr
- Academic Gastroenterology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Lloyd Thomas
- Gastroenterology Department, Leeds Teaching Hospitals, Leeds, UK
| | - Prabhsimran Singh
- Gastroenterology Department, Hull University Teaching Hospitals, Hull, UK
| | - Salma Mohammed
- Gastroenterology Department, Leeds Teaching Hospitals, Leeds, UK
| | - Khin Nu
- Gastroenterology Department, Hull University Teaching Hospitals, Hull, UK
| | - John S Kane
- Gastroenterology Department, Hull University Teaching Hospitals, Hull, UK
| | - Fred Lee
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Thomas Welbank
- Department of Enteral Nutrition, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Andrew D Hopper
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Mark E McAlindon
- Academic Gastroenterology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Elizabeth A Williams
- Department of Oncology and Metabolism, The Medical School, The University of Sheffield, Sheffield, UK
| | - David S Sanders
- Academic Gastroenterology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Kohli DR, Smith C, Chaudhry O, Desai M, DePaolis D, Sharma P. Direct Percutaneous Endoscopic Gastrostomy Versus Radiological Gastrostomy in Patients Unable to Undergo Transoral Endoscopic Pull Gastrostomy. Dig Dis Sci 2023; 68:852-859. [PMID: 35708794 DOI: 10.1007/s10620-022-07569-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/17/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS A subset of patients needing long-term enteral access are unable to undergo a conventional transoral "pull" percutaneous endoscopic gastrostomy (PEG). We assessed the safety and efficacy of an introducer-style endoscopic direct PEG (DPEG) and an interventional radiologist guided gastrostomy (IRG) among patients unable to undergo a pull PEG. METHODS In this single center, non-randomized, pilot study, patients unable to undergo a transoral Pull PEG were prospectively recruited for a DPEG during the index endoscopy. IRG procedures performed at our center served as the comparison group. The primary outcome was technical success and secondary outcomes included 30-day and 90-day all-cause mortality, procedure duration, dosage of medications, adverse events, and 30-day all-cause hospitalization. The Charlson comorbidity index was used to compare comorbidities. RESULTS A total of 47 patients (68.3 ± 7.13 years) underwent DPEG and 45 patients (68.6 ± 8.23 years) underwent IRG. The respective Charlson comorbidity scores were 6.37 ± 2 and 6.16 ± 1.72 (P = 0.59). Malignancies of the upper aerodigestive tract were the most common indications for DPEG and IRG (42 vs. 37; P = 0.38). The outcomes for DPEG and IRG were as follows: technical success: 96 vs. 98%; P = 1; 30-day all-cause mortality: 0 vs 15%, P < 0.01; 90-day all-cause mortality: 0 vs. 31%, P < 0.001; 30-day hospitalization: 19 vs. 38%; P = 0.06; procedure duration: 23.8 ± 1.39 vs. 29.5 ± 2.03 min, P = 0.02; midazolam dose: 4.5 ± 1.6 vs. 1.23 ± 0.6 mg; P < 0.001, and opiate dose: 105.6 ± 38.2 vs. 70.7 ± 34.5 µg, P < 0.001, respectively. Perforation of the colon during IRG was the sole serious adverse event. CONCLUSION DPEG is a safe and effective alternative to IRG in patients unable to undergo a conventional transoral pull PEG and may be considered as a primary modality for enteral support. CLINICALTRIALS gov Identifier: NCT04151030.
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Affiliation(s)
- Divyanshoo R Kohli
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, 4801 E Linwood Blvd, Kansas City, MO, 64128, USA.
- Pancreas and Liver Clinic, Providence Sacred Heart Medical Center, Spokane, WA, USA.
| | - Craig Smith
- Division of Interventional Radiology, Kansas City VA Medical Center, Kansas City, MO, USA
| | - Omer Chaudhry
- Division of Interventional Radiology, Kansas City VA Medical Center, Kansas City, MO, USA
| | - Madhav Desai
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, 4801 E Linwood Blvd, Kansas City, MO, 64128, USA
| | - Dion DePaolis
- Division of Interventional Radiology, Kansas City VA Medical Center, Kansas City, MO, USA
| | - Prateek Sharma
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, 4801 E Linwood Blvd, Kansas City, MO, 64128, USA
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Ismail MK, Shrestha S. Gastrointestinal Complications of Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lima DL, Miranda LEC, da Penha MRC, Lima RNCL, Dos Santos DC, Eufrânio MS, Miranda ACG, Pereira LMMB. Factors Associated with 30-Day Mortality in Patients after Percutaneous Endoscopic Gastrostomy. JSLS 2021; 25:JSLS.2021.00040. [PMID: 34456551 PMCID: PMC8372986 DOI: 10.4293/jsls.2021.00040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Percutaneous endoscopic gastrostomy (PEG) is the main accepted method for long-term tube feeding. The aim of this study is to investigate the risk factors associated with early mortality after PEG. Methods: It is a retrospective survival analysis in a tertiary-level hospital. We reviewed the medical records of 277 patients with PEG placement. The data were analyzed by the Kaplan-Meier method. Multivariable Cox proportional regression models were also built to test the effects of PEG on mortality. Results: A total of 277 patients who submitted to PEG were studied. One-hundred and sixty (58%) were female, mean age of 73.3 ± 15.7 years. Ninety-three patients (33.6%) had diabetes mellitus and 165 (59.6%) had blood hypertension. The indications for PEG placement were chronic neurologic dysphagia in 247 (89.5%) patients and tumors and other diseases in 29 (10.5%). The 30 days proportional mortality probability rate was 13%. In a multivariate Cox proportional regression model, preoperative ICU hospitalization (HR 1.79, 95% CI 1.36–2.36, P = 0.000) and hemoglobin (HR 0.91, 95% CI 0.85–0.98, P = 0.015) were predictors of early mortality. Conclusion: In patients who had underwent PEG tube insertion for long-term nutrition, anemia and previous ICU admission were predictors of mortality at four weeks. These factors may guide physicians to discourage the indication for PEG.
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Affiliation(s)
- Diego L Lima
- Department of Surgery, Montefiore Medical Center, The Bronx, New York, USA
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Abstract
Importance Hyperemesis gravidarum (HEG) affects 0.3% to 3% of pregnancies and requires additional therapies beyond those commonly used for less severe instances of nausea and vomiting of pregnancy (NVP). Differentiating between NVP and HEG is a vital yet challenging function for any obstetrician. The literature for management of HEG is lacking compared with that of NVP. Objective Review etiology of NVP/HEG highlights key considerations in the workup of HEG as they compare to NVP and explore management options for recalcitrant HEG focusing principally on how they affect maternal and fetal outcomes and secondarily on where data are nonprescriptive. Evidence Acquisition This was a literature review primarily using PubMed and Google Scholar. Results Short-course corticosteroids and treatment for Helicobacter pylori have the most favorable risk-reward profiles of the 4 pharmacologic therapies evaluated. Mirtazapine and diazepam may have a place in highly selected patients. If nutritional supplementation is required, enteral nutrition is strictly preferred to parenteral nutrition. Postpyloric feeding approaches are less likely to induce vomiting. Surgically placed feeding tubes are less likely to be dislodged and may be worth the invasive insertion procedure if nasogastric or nasojejunal tubes are not tolerated. Conclusions and Relevance Hyperemesis gravidarum is a diagnosis reserved for refractory cases of NVP and therefore by definition poses treatment challenges. Any clinical presentation that lent itself to prescriptive, algorithmic management would likely fall short of the diagnostic criteria for HEG. However, data can inform management on a patient-by-patient basis or at least help patient and provider understand risks and benefits of therapies reserved for refractory cases.
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Maasarani S, Khalid SI, Creighton C, Manatis-Lornell AJ, Wiegmann AL, Terranella SL, Skertich NJ, DeCesare L, Chan EY. Outcomes following percutaneous endoscopic gastrostomy versus fluoroscopic procedures in the Medicare population. Surg Open Sci 2020; 3:2-7. [PMID: 33937737 PMCID: PMC8076911 DOI: 10.1016/j.sopen.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/02/2022] Open
Abstract
Background In the United States, few high-quality manuscripts have directly compared the complication profiles of percutaneous endoscopic versus fluoroscopic gastrostomy. Thus, it is our goal to compare these 2 common procedures to better understand their efficacy and complication profiles. Materials and Methods A retrospective analysis of patient records from Medicare parts A/B from 2007 to 2012 was used to identify percutaneous fluoroscopic gastrostomy and percutaneous endoscopic gastrostomy procedures. Patient demographics were stratified by age, sex, comorbidities, and complications. Results A total of 258,641 patients were found to have either percutaneous fluoroscopic gastrostomy (26,477, 10.2%) or percutaneous endoscopic gastrostomy (232,164, 89.8%). Percutaneous fluoroscopic gastrostomy experienced greater rates for all complications queried. Multivariate analysis revealed that the percutaneous fluoroscopic gastrostomy cohort had statistically significant increased odds for short-term complications, such as ileus (odds ratio 1.4, 95% confidence interval 1.22–1.54), mechanical (odds ratio 2.4, 95% confidence interval 2.28–2.58), wound infection (odds ratio 1.4, 95% confidence interval 1.24–1.52), persistent fistula after tube removal (odds ratio 1.9, 95% confidence interval 1.78–2.12), and other complications (odds ratio 2.2, 95% confidence interval 2.03–2.37), and long-term complications, including abdominal wall pain (odds ratio 1.4, 95% confidence interval 1.33–1.44), wound infection (odds ratio 1.1, 95% confidence interval 1.01–1.15), and persistent fistula after tube removal (odds ratio 1.8, 95% confidence interval 1.72–1.87). Conclusion Gastrostomy tubes are more frequently being placed via percutaneous endoscopic and fluoroscopic methods. This study suggests that those undergoing fluoroscopic placement have higher odds of developing short- and long-term postoperative complications. Fluoroscopic g-tubes have higher odds of developing short- and long-term complications. Fluoroscopy has higher odds for abdominal wall pain and mechanical complications. Hyperlipidemia, smoking, and hypertension are risk factors for abdominal wall pain.
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Affiliation(s)
| | - Syed I Khalid
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
| | | | | | - Aaron L Wiegmann
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Samantha L Terranella
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Nicholas J Skertich
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Laura DeCesare
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Edie Y Chan
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
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Shinozaki N, Morita K, Matsui H, Jo T, Yasunaga H. Semisolid vs Liquid Nutrients and 30-Day Readmission in Gastrostomy Tube-Fed Patients: A Propensity-Matched Analysis. JPEN J Parenter Enteral Nutr 2020; 45:720-728. [PMID: 32458501 DOI: 10.1002/jpen.1928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Semisolid nutrients have been widely used to prevent complications related to enteral nutrition (EN) in Japan. However, there are few data on the effect of feeding semisolid nutrient preparations. We compared 30-day readmission rates of gastrostomy tube-fed patients who had been prescribed semisolid vs liquid nutrients on discharge. METHODS This is a retrospective observational study using a Japanese nationwide inpatient database of data entered between June 2014 and March 2018. We identified patients aged ≥18 years who had received EN through gastrostomy during hospitalization. Patients were classified as having been prescribed semisolid vs liquid EN on discharge. After one-to-one propensity score matching, all-cause 30-day readmission rates were compared between the 2 groups. RESULTS In total, 5331 patients were identified, including a semisolid-nutrients group (n = 2089) and a liquid-nutrients group (n = 3242). Propensity score matching created 1912 pairs. The 30-day readmission rates were 15.6% and 13.9% in the semisolid-nutrients and liquid-nutrients groups, respectively. No significant difference was observed between the groups (risk difference, 1.7%; 95% CI, -0.6 to 4.0%; P = .14). CONCLUSION All-cause 30-day readmission of patients receiving gastrostomy tube feeding did not differ between those prescribed semisolid vs liquid nutrients on discharge. Randomized controlled trials are needed to accurately determine the effect of semisolid nutrients on clinical outcomes.
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Affiliation(s)
- Nana Shinozaki
- Department of Social and Preventive Epidemiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Bunkyo-ku, Japan
| | - Kojiro Morita
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Bunkyo-ku, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Bunkyo-ku, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Bunkyo-ku, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Bunkyo-ku, Japan
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Delf J, Jepson S, Ramachandran S, Elabassy M, Morgan B, Kenningham R, Mullineux JH, Stephenson JA. Predictors for 30-day mortality and complications following radiologically inserted gastrostomies: a single centre, large cohort review. Clin Radiol 2020; 75:375-382. [PMID: 32000984 DOI: 10.1016/j.crad.2019.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 12/23/2019] [Indexed: 11/19/2022]
Abstract
AIM To measure the 30-day mortality and delayed complication rates following radiologically inserted gastrostomy (RIG) placement and determine the predictive risk factors for 30-day mortality and delayed complications to aide pre-procedure informed consent. MATERIALS AND METHODS Retrospective analysis was undertaken of RIG insertions between July 2012 and August 2017 at a single tertiary centre, which included 373 patients (56% male; median age: 65 years, range: 19-92 years). Data were collected from electronic databases on patient demographics, RIG indication, all-cause mortality, complication rates, patient co-morbidities, and biochemical/haematological parameters. Multivariate analysis was performed to identify predictive risk factors for complications and mortality. RESULTS The RIG procedural success rate was 97.9%. The overall 30-day mortality rate was 7.8%; associated with pre-procedural haemoglobin <130 g/l in men (p=0.030, odds ratio [OR] 23.38), white cell count >11×109/l (p=0.001, OR 4.18), C-reactive protein >10 mg/l (p=0.003, OR 10.10) and international normalised ratio (INR) >1.2 (p=0.03, OR 4.63). Inpatient RIG referrals were associated with 10% 30-day mortality; compared to 1.1% for outpatients (p=0.028, OR 9.51). The incidence of immediate and delayed complications was 2.4% and 42.1%, respectively. Neuromuscular disease was associated with gastrostomy dislodgement (p=0.0001, OR 4.99) and fracture (p=0.0009, OR 13.45), cerebrovascular disease with gastrostomy dislodgement (p=0.009, OR 2.51), cardiovascular disease with sepsis 30-days post-RIG (p=0.02, OR 2.94), and diabetes mellitus with gastrostomy dislodgement (p=0.0001, OR 29.45), fracture (p=0.027, OR 5.63) and stoma site infections (p=0.0003, OR 7.16). CONCLUSION RIG 30-day mortality was significantly associated with inpatient procedures compared to outpatient, and a range of biochemical/haematological parameters that suggest infection pre-intervention. It is advised that the markers of infection and catabolism are investigated pre-intervention, which may reduce mortality and complication rates.
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Affiliation(s)
- J Delf
- University Hospitals of Leicester NHS Trust, United Kingdom.
| | - S Jepson
- University Hospitals of Leicester NHS Trust, United Kingdom; Gastrointestinal Imaging Group, Digestive Disease Centre, University Hospitals of Leicester, United Kingdom
| | - S Ramachandran
- University Hospitals of Leicester NHS Trust, United Kingdom
| | - M Elabassy
- University Hospitals of Leicester NHS Trust, United Kingdom; Gastrointestinal Imaging Group, Digestive Disease Centre, University Hospitals of Leicester, United Kingdom
| | - B Morgan
- University Hospitals of Leicester NHS Trust, United Kingdom; Gastrointestinal Imaging Group, Digestive Disease Centre, University Hospitals of Leicester, United Kingdom
| | - R Kenningham
- University Hospitals of Leicester NHS Trust, United Kingdom; Gastrointestinal Imaging Group, Digestive Disease Centre, University Hospitals of Leicester, United Kingdom
| | - J H Mullineux
- University Hospitals of Leicester NHS Trust, United Kingdom; Gastrointestinal Imaging Group, Digestive Disease Centre, University Hospitals of Leicester, United Kingdom
| | - J A Stephenson
- University Hospitals of Leicester NHS Trust, United Kingdom; Gastrointestinal Imaging Group, Digestive Disease Centre, University Hospitals of Leicester, United Kingdom
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Percutaneous endoscopic gastrostomy with jejunal extension for a post-esophagectomy gastric conduit. Clin J Gastroenterol 2020; 13:501-505. [PMID: 31981087 DOI: 10.1007/s12328-020-01096-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Abstract
Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure providing nutritional benefits to malnourished patients. Although a past history of celiotomy is not a contradiction for PEG construction, this procedure is rarely undertaken in post-esophagectomy patients, for two reasons: anatomically limited gastric spaces and high susceptibility to pulmonary aspiration. To overcome these limitations, we developed an original method of introducing PEG with jejunal extension for esophagectomized patients with retrosternal gastric pull-up reconstruction. The procedures were as follows: (1) confirmation of endoscopic transillumination of the antrum; (2) test puncture of the antral wall and subsequent gastropexy using a double-needle device; (3) insertion of a needle jejunostomy catheter into the antrum; (4) direct catheter cannulation to the pylorus and introduction of a feeding tube into the jejunum. We successfully carried out this procedure in three male patients (70-78 years old): two suffering from repetitive aspiration pneumonia and one with extensive recurrence of esophageal carcinoma. The operative times ranged 15-50 min. There were no PEG-associated complications. Of note, none of the patients experienced aspiration pneumonia after PEG construction. Our novel method appears to be a promising approach to managing esophagectomized patients because of its feasibility and the potential to prevent postoperative pulmonary aspiration.
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Strijbos D, Keszthelyi D, Gilissen LPL, Lacko M, Hoeijmakers JGJ, van der Leij C, de Ridder RJJ, de Haan MW, Masclee AAM. Percutaneous endoscopic versus radiologic gastrostomy for enteral feeding: a retrospective analysis on outcomes and complications. Endosc Int Open 2019; 7:E1487-E1495. [PMID: 31673622 PMCID: PMC6811353 DOI: 10.1055/a-0953-1524] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/07/2018] [Indexed: 12/12/2022] Open
Abstract
Background and study aims Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are techniques used for long-term enteral feeding. Our primary aim was to analyze procedure-related and 30-day mortality and complications between PEG and PRG in relation to indications. Patients and methods A single-center retrospective analysis was performed thath included all adult patients receiving initial PEG (January 2008 until April 2016) and PRG (January 2010 until April 2016). Outcomes were mortality (procedure-related, 30-day), complications (early (≤ 30 days) and late) and success rates. Results A total of 760 procedures (469 PRG and 291 PEG) were analyzed. Most common indications were head and neck cancer (HNC), cerebrovascular accident (CVA) and amyotrophic lateral sclerosis (ALS). Success rates for placement were 91.2 % for PEG and 97.1 % for PRG ( P = 0.001). Procedure-related mortality was 1.7 % in PEG and 0.4 % in PRG ( P = 0.113). The 30-day mortality was 10.7 % in PEG and 5.1 % in PRG ( P = 0.481 after multivariate logistic regression) CVA was associated with higher 30-day mortality, whereas ALS, higher body weight, and prophylactic placements in HNC were associated with lower rates. Tube-related complications were less frequent in PEG, both early (2.7 % vs. 26.4 %, P ≤ 0.001) and late (8.6 % vs. 31.5 %, P ≤ 0.001). The percentage of major complications and infections did not differ. Conclusions With respect to procedure-related and 30-day mortality, PEG and PRG compare equally. PRG had a higher procedural success rate. Tube-related complications and pain are less frequent after PEG compared to PRG. The choice for either PEG or PRG therefore should primarily be based on local facilities and expertise.
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Affiliation(s)
- Denise Strijbos
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands,Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, The Netherlands,Corresponding author Denise Strijbos Maastricht University Medical CenterP. Debyelaan 25, 6229 HXMaastrichtthe Netherlands+31(0)402399751
| | - Daniel Keszthelyi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lennard P. L. Gilissen
- Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, The Netherlands
| | - Martin Lacko
- Department of Otorhinolaryngology/Head & Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Rogier J. J. de Ridder
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michiel W. de Haan
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ad A. M. Masclee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
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Toh Yoon EW, Yoneda K, Nishihara K. Percutaneous endoscopic gastrostomy for enteral nutrition: a 5-year clinical experience with 324 patients. MINERVA GASTROENTERO 2019; 65:20-29. [PMID: 30676011 DOI: 10.23736/s1121-421x.18.02535-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is considered the route of choice for long-term enteral nutrition. In this study, we evaluated the short term outcomes of PEG and aimed to identify the risk factors for in-hospital mortality as well as adverse events such as aspiration pneumonia. METHODS Three hundred and twenty-four patients who received PEG for enteral nutrition between January 2007 and December 2011 were included in this study. Data regarding baseline characteristics, preoperative biomarkers and clinical outcomes were collected and analyzed. RESULTS The average patient age was 82.3±10.9 (SD) years old. 149 patients (46%) were men and 199 patients (61%) had stroke as a comorbidity. Postoperatively, feeding-related aspiration pneumonia was observed in 72 patients (22%), diarrhea in 40 patients (12%) and peristomal infection in 34 patients (11%). The average postoperative length of stay was 34.6 days. 51 patients (16%) died before discharge, 22 (6.8%) of them within 30 days after PEG. Two deaths (0.6%) were considered procedure-related (bleeding). Multivariate analysis revealed the male gender, lower serum albumin levels and higher blood urea nitrogen (BUN) levels as significant prognostic factors for in-hospital mortality. Higher C-reactive protein levels and BUN levels were found to be independently associated with the occurrence of postoperative aspiration pneumonia. CONCLUSIONS Our experience reconfirmed PEG as a minimally invasive and safe procedure for long-term enteral nutrition in patients with impaired oral intake. However, significant prognostic factors should be taken into account during the preoperative evaluation of patients. Deferral of procedure or specialized postoperative care may be indicated in high risk patients.
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Affiliation(s)
- Ezekiel W Toh Yoon
- Department of Gastroenterology and Hepatology, Hiroshima Kyoritsu Hospital, Hiroshima, Japan -
| | - Kaori Yoneda
- Endoscopy Center, Hiroshima Kyoritsu Hospital, Hiroshima, Japan
| | - Kazuki Nishihara
- Department of Gastroenterology and Hepatology, Hiroshima Kyoritsu Hospital, Hiroshima, Japan
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Montes de Oca MK, Nye A, Porter C, Collins J, Satterfield C, Schammel CMG, Trocha SD. Head and neck cancer PEG site metastases: Association with PEG placement method. Head Neck 2019; 41:1508-1516. [DOI: 10.1002/hed.25564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 08/16/2018] [Accepted: 11/21/2018] [Indexed: 02/01/2023] Open
Affiliation(s)
- Mary K. Montes de Oca
- University of South Carolina School of Medicine Greenville Greenville South Carolina
| | - Anthony Nye
- University of South Carolina School of Medicine Greenville Greenville South Carolina
| | - Caroline Porter
- University of South Carolina School of Medicine Greenville Greenville South Carolina
| | - Justin Collins
- Institute for Translational Oncologic ResearchGreenville Health System Greenville South Carolina
| | | | | | - Steven D. Trocha
- Department of SurgeryGreenville Health System Greenville South Carolina
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Differences in the incidence of postoperative pneumonia after percutaneous endoscopic gastrostomy between liquid and semi-solid nutrient administration. Eur J Clin Nutr 2019; 73:250-257. [PMID: 30610212 PMCID: PMC6368559 DOI: 10.1038/s41430-018-0380-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/05/2018] [Accepted: 12/03/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES This historical control study examined the differences in the incidence of postoperative pneumonia between patients administered liquid and semi-solid nutrients after percutaneous endoscopic gastrostomy (PEG). SUBJECTS/METHODS The medical records of adult patients who underwent PEG between March 1999 and March 2014 were investigated. The patients were administered either liquid or semi-solid nutrient and examined for gastroesophageal reflux via radiography after PEG. The study period was divided into periods I (liquid nutrient to all patients), II (semi-solid nutrient to patients with reflux and liquid nutrient to those without), and III (semi-solid nutrient to all patients). The patient characteristics and incidence of postoperative pneumonia were stratified by the periods. To assess the relationship between postoperative pneumonia and the periods, a logistic regression analysis was performed. RESULTS Of 370 patients enrolled, 149 were in period I, 64 in period II, and 157 in period III. Postoperative pneumonia was more frequently observed in period I (20.8%) than in periods II (7.8%) and III (10.2%). The odds ratios were higher in period I (period I vs. II: 3.10 [95% confidence intervals: 1.15-8.38]; period I vs. III: 2.32 [1.21-4.44]). The incidence of gastroesophageal reflux did not greatly differ between periods II (25.0%) and III (35.0%). CONCLUSIONS The incidence of postoperative pneumonia after PEG was lower in the patients administered semi-solid nutrient than in those administered liquid nutrient, suggesting that semi-solid nutrient administration to patients with PEG tubes is preferable to prevent postoperative pneumonia. Furthermore, it may be favored especially in those with gastroesophageal reflux.
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Molina Villalba C, Vázquez Rodríguez JA, Gallardo Sánchez F. Percutaneous endoscopic gastrostomy. Indications, care and complications. Med Clin (Barc) 2018; 152:229-236. [PMID: 30424936 DOI: 10.1016/j.medcli.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 02/08/2023]
Abstract
Percutaneous endoscopic gastrostomy (PEG) is an effective and safe method for nutritional support in patients with malnutrition and impossibility of oral intake with an estimated survival higher than the months that require enteral nutrition beyond four weeks. The main indications include neoplasms of the upper air-digestive tract and neurological diseases, with dementia currently considered a controversial indication. Anatomical alterations and infectious diseases are the most frequent contraindications. There are different endoscopic techniques; the most widely used being the "pull" method, with a low mortality. Complications are more frequent in patients with multiple pathologies and the elderly. Wound infection, extraction of the tube, tube blockage and bronchoaspiratory pneumonia are the most prevalent complications. Adequate prior preparation of the patient and exhaustive maintenance of the tube can reduce the appearance of these.
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A Systematic Review and Meta-Analysis on Outcomes and Complications of Percutaneous Endoscopic Versus Radiologic Gastrostomy for Enteral Feeding. J Clin Gastroenterol 2018; 52:753-764. [PMID: 29924079 DOI: 10.1097/mcg.0000000000001082] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal technique for long-term enteral feeding has not yet been established. Both percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are widely used. Aim was to extensively review outcomes of PEG and PRG. MATERIALS AND METHODS A systematic review using Medline, Embase, and Cochrane was performed, using standardized tools for assessing bias. Main outcomes were infectious and tube-related complications, procedure related and 30-day mortality. Pooled risk differences (RDs) with corresponding 95% confidence intervals (95% CIs) were calculated using random effects. Arcsine transformations were applied. RESULTS In total, 344 studies were identified, of which 16 were included, reporting on 934 PEGs and 1093 PRGs. No differences were found for infectious complications [RD, 0.03 (-0.05 to 0.11)], procedure-related mortality [RD, 0.01 (-0.04 to 0.06)], or 30-day mortality [RD, 0.06 (-0.01 to 0.13)]. Tube-related complications were higher in PRG [RD, 0.16 (0.06-0.26)]. Subgroup analysis was performed for head and neck cancer (HNC) and motor neuron disease. In HNC, this revealed significantly lower tube-related complications and procedure-related mortality after PEG. In motor neuron disease, no differences were seen. The level of evidence appears sufficient considering the low degree of heterogeneity. CONCLUSIONS No differences were found with regard to mortality or infectious complications. PEG showed lower risk of tube-related complications. Subgroup analysis revealed PEG to be favorable in HNC based on lower rates of procedure-related mortality and tube-related complications. Local experience and availability should be taken into account in the decision process.
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17
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Agudo Tabuenca A, Altemir Trallero J, Gimeno Orna JA, Ocón Bretón MJ. Mortality risk factors after percutaneous gastrostomy: Who is a good candidate? Clin Nutr 2018. [PMID: 29525511 DOI: 10.1016/j.clnu.2018.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The percutaneous gastrostomy tube (PG) is an effective and safe way for the delivery of enteral nutrition. The aim of this study was to identify predictive factors for mortality after PG placement. MATERIAL AND METHODS An observational and analytical cohort study was conducted. All endoscopic or radiological percutaneous gastrostomy tubes placed between January 2009 and July 2016 were evaluated. Mortality was the dependent variable. Initial clinical and analytical patient features and the development of complications during follow-up were recorded. Cox regression models were used to evaluate the risk of mortality associated to the studied variables. Hazard ratios with the corresponding 95% confidence intervals were retrieved from these models. RESULTS A total of 289 patients underwent PG placement (57% male). The mean age was 70.1 (SD 13.6) years. The median follow-up period was 8.7 (IQR 18) months. One hundred and seventy-four patients died during the follow-up period. The overall mortality rate was 4.8 per 100 patients-month. The highest mortality rate was during the first month after PG placement (13.2 per 100 patients-month), subsequently decreasing. Multivariate regression analysis showed that age (HR1year = 1.01; p = 0.015), Charlson comorbidity index ≥4 (HR = 1.69; p = 0.011), the presence of degenerative neurological disease (HR = 1.69; p = 0.012) or malignancy (HR = 2.02; p = 0.012) and the development of aspiration pneumonia during the follow-up period (HR = 3.29; p = 0.001) were statistically significant independent predictive risk factors associated with mortality. A model to predict survival probability prior to placing the PG was developed from the variables of the multivariate analysis. CONCLUSION Mortality after PG placement is high. Older age, higher comorbidity and the development of aspiration pneumonia are predictive factors for mortality. A more careful selection of candidates for PG placement should be done to improve the patient prognosis after the procedure.
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Affiliation(s)
- Ana Agudo Tabuenca
- Clinical University Hospital Lozano Blesa, Avenida San Juan Bosco, 15, 50009, Zaragoza, Spain.
| | | | | | - María Julia Ocón Bretón
- Clinical University Hospital Lozano Blesa, Avenida San Juan Bosco, 15, 50009, Zaragoza, Spain
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Karasahin O, Tasar PT, Timur O, Binici DN, Yilmaz TK, Aslan A, Sahin S. High C-Reactive Protein and Low Albumin Levels Predict High 30-Day Mortality in Patients Undergoing Percutaneous Endoscopic Gastrotomy. Gastroenterology Res 2017; 10:172-176. [PMID: 28725304 PMCID: PMC5505282 DOI: 10.14740/gr862w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 05/31/2017] [Indexed: 01/16/2023] Open
Abstract
Background Percutaneous endoscopic gastrotomy (PEG) enables long-term enteral feeding. The aim of this study was to identify biomarkers that may guide the decision of whether to perform the elective procedure of PEG. Methods The medical records of all patients who underwent PEG in our hospital from 2010 to 2016 were screened retrospectively. Patients with mortality within a 30-day follow-up period and those without were compared using the Chi-square test, and continuous variables were compared with the Kruskal-Wallis and Mann-Whitney U tests. Receiver operating characteristic (ROC) curve analysis was used to demonstrate the ability of biomarkers to predict mortality; a cut-off point was determined and its sensitivity, specificity, and positive and negative predictive values were calculated. The Youden index was used to determine the cut-off point. Kaplan-Meier analysis was used to identify PEG-related mortality risk factors and a Cox regression model was applied for risk characterization. Results A total of 120 patients who underwent PEG were evaluated in the study. The mean age was 67.00 ± 18.00 years. The most common indication for PEG was cerebrovascular disease, in 69 (57.5%) of the patients. Infection of the PEG site was most common within 14 days after PEG tube placement, occurring in 13 patients (10.3%). The mortality rate among patients with post-PEG infection was 68.2%, significantly higher than in patients without infection (P = 0.012). Thirty-four patients (28.3%) died within 30 days of undergoing PEG. CRP values ≥ 78.31 mg/L increased mortality by 8.756-fold, and albumin levels < 2.71 g/dL increased mortality by 2.255-fold. Conclusion Our results indicate that the presence of both high CRP level and low albumin level were associated with significantly higher rate of mortality (73.1%) in patients who underwent PEG.
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Affiliation(s)
- Omer Karasahin
- Infectious Diseases Clinic, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Pinar Tosun Tasar
- Geriatrics Clinic, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Ozge Timur
- Internal Medicine Clinic, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Dogan Nasir Binici
- Internal Medicine Clinic, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Tugba Kiper Yilmaz
- Internal Medicine Clinic, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Adem Aslan
- General Surgery Clinic, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Sevnaz Sahin
- Department of Internal Medicine, Department of Geriatrics, Ege University School of Medicine, Izmir, Turkey
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Toh Yoon EW, Yoneda K, Nishihara K. Semi-solid feeds may reduce the risk of aspiration pneumonia and shorten postoperative length of stay after percutaneous endoscopic gastrostomy (PEG). Endosc Int Open 2016; 4:E1247-E1251. [PMID: 27995184 PMCID: PMC5161128 DOI: 10.1055/s-0042-117218] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/20/2016] [Indexed: 10/27/2022] Open
Abstract
Background and study aims: Feeding-related adverse events after percutaneous endoscopic gastrostomy (PEG) such as aspiration pneumonia may result in prolonged hospitalization and postoperative mortality. This study evaluated the efficacy of using semi-solid feeds to reduce feeding-related adverse events and improve clinical outcomes. Patients and methods: Patients who received PEG for enteral nutrition at our hospital between January 2014 and December 2015 were allocated to a postoperative feeding protocol that used either liquid feed or semi-solid feed. Baseline characteristics, postoperative feeding-related adverse events and clinical outcomes in the 2 groups were prospectively analysed and compared. Results: One hundred and seventeen PEG patients (age range: 59 - 97 years, male: 53) were enrolled with 72 patients given liquid feed and 45 patients receiving semi-solid feed. Baseline characteristics were similar in both groups. The semi-solid feed group experienced fewer incidence of feeding-related aspiration pneumonia (2.2 % vs. 22.2 %, P < 0.005) and shorter postoperative hospital length of stay (12.7 days vs. 18.8 days, P < 0.01). Significant differences were not observed in the frequency of peristomal infection (11.1 % vs. 12.5 %, P = 0.82), feeding-related diarrhea (2.2 % vs. 12.5 %, P = 0.09) and 30-day mortality rates (2.2 % vs. 8.3 %, P = 0.25). Conclusions: Semi-solid feeding may reduce the risk of aspiration pneumonia and shorten postoperative hospital length of stay after PEG. Semi-solid feeds are safe to use and can be employed either as a first line feeding protocol or an alternative when liquid feeding is unsuccessful.
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Affiliation(s)
- Ezekiel Wong Toh Yoon
- Department of Internal Medicine
(Gastroenterology), Hiroshima Kyoritsu Hospital, Hiroshima City,
Japan,Corresponding author Ezekiel Wong Toh
Yoon, MD Department of Internal
MedicineHiroshima Kyoritsu
Hospital2-20-20 Nakasu Asaminami-ku Hiroshima
CityJapan+81-82-879-1111
| | - Kaori Yoneda
- Endoscopy Center, Hiroshima Kyoritsu
Hospital, Hiroshima City, Japan
| | - Kazuki Nishihara
- Department of Internal Medicine
(Gastroenterology), Hiroshima Kyoritsu Hospital, Hiroshima City,
Japan
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20
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Lim JH, Choi SH, Lee C, Seo JY, Kang HY, Yang JI, Chung SJ, Kim JS. Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis. Intest Res 2016; 14:333-342. [PMID: 27799884 PMCID: PMC5083262 DOI: 10.5217/ir.2016.14.4.333] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/10/2016] [Accepted: 02/22/2016] [Indexed: 02/07/2023] Open
Abstract
Background/Aims A percutaneous gastrostomy can be placed either endoscopically (percutaneous endoscopic gastrostomy, PEG) or radiologically (radiologically-inserted gastrostomy, RIG). However, there is no consistent evidence of the safety and efficacy of PEG compared to RIG. Recently, 30-day mortality has become considered as the most important surrogate index for evaluating the safety and efficacy of percutaneous gastrostomy. The aim of this meta-analysis was to compare the 30-day mortality rates between PEG and RIG. Methods Major electronic databases (MEDLINE, Embase, Scopus, and Cochrane library) were queried for comparative studies on the two insertion techniques of gastrostomy among adults with swallowing disturbance. The primary outcome was the 30-day mortality rate after gastrostomy insertion. Forest and funnel plots were generated for outcomes using STATA version 14.0. Results Fifteen studies (n=2,183) met the inclusion criteria. PEG was associated with a lower risk of 30-day mortality after tube placement compared with RIG (odds ratio, 0.60; 95% confidence interval [CI], 0.38–0.94; P=0.026). The pooled prevalence of 30-day mortality of PEG was 5.5% (95% CI, 4.0%–6.9%) and that of RIG was 10.5% (95% CI, 6.8%–14.3%). No publication bias was noted. Conclusions The present meta-analysis demonstrated that PEG is associated with a lower probability of 30-day mortality compared to RIG, suggesting that PEG should be considered as the first choice for long-term enteral tube feeding. Further prospective randomized studies are needed to evaluate and compare the safety of these two different methods of gastrostomy.
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Affiliation(s)
- Joo Hyun Lim
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Seung Ho Choi
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Changhyun Lee
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Ji Yeon Seo
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Hae Yeon Kang
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Jong In Yang
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Su Jin Chung
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
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Enteral tube feeding for individuals with cystic fibrosis: Cystic Fibrosis Foundation evidence-informed guidelines. J Cyst Fibros 2016; 15:724-735. [PMID: 27599607 DOI: 10.1016/j.jcf.2016.08.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/02/2016] [Accepted: 08/15/2016] [Indexed: 01/12/2023]
Abstract
Nutrition is integral to the care of individuals with cystic fibrosis (CF). Better nutritional status is associated with improved pulmonary function. In some individuals with CF, enteral tube feeding can be useful in achieving optimal nutritional status. Current nutrition guidelines do not include detailed recommendations for enteral tube feeding. The Cystic Fibrosis Foundation convened an expert panel to develop enteral tube feeding recommendations based on a systematic review of the evidence and expert opinion. These guidelines address when to consider enteral tube feeding, assessment of confounding causes of poor nutrition in CF, preparation of the patient for placement of the enteral feeding tube, management of the tube after placement and education about enteral feeding. These recommendations are intended to guide the CF care team, individuals with CF, and their families through the enteral tube feeding process.
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Antibacterial gauzes are effective in preventing infections after percutaneous endoscopic gastrostomy placement: a retrospective analysis. Eur J Gastroenterol Hepatol 2016; 28:297-304. [PMID: 26735159 DOI: 10.1097/meg.0000000000000561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The most common complication after percutaneous endoscopic gastrostomy (PEG) placement is peristomal wound infection (up to 40% without antibiotic prophylaxis). Single-dose parenteral prophylactic antibiotics as advised by current guidelines decrease the infection rate to 9-15%. We assume a prolonged effect of local antibiotic treatment with antibacterial gauzes. This study is the first to describe the effect of antibacterial gauzes in preventing infections in PEG without the use of antibiotics. METHODS A retrospective data analysis was carried out of all patients with PEG insertion between January 2009 and October 2014 in the Catharina Hospital Eindhoven. Data include placement and the period of the first 2 weeks after PEG placement, and long-term follow-up. All patients received a locally applied antibacterial gauze polyhexamethylene biguanide immediately following PEG insertion for 3 days. No other antibiotics were administered. The main outcomes were wound infection, peritonitis, and necrotizing fasciitis; secondary outcomes included other complications. RESULTS A total of 331 patients with only antibacterial gauzes were analyzed. The total number of infections 2 weeks after PEG insertion was 9.4%, including 8.2% minor and 1.2% major infections (peritonitis). No wound infection-related mortality or bacterial resistance was found. Costs are five times lower than antibiotics, and gauzes are more practical and patient friendly for use. CONCLUSION Retrospectively, antibacterial gauzes are at least comparable with literature data on parenteral antibiotics in preventing peristomal wound infection after PEG placement, with an infection rate of 9.4%. Rates of other complications found in this study were comparable with current literature data.
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Gastrostomy in head and neck cancer: current literature, controversies and research. Curr Opin Otolaryngol Head Neck Surg 2015; 23:162-70. [PMID: 25692626 DOI: 10.1097/moo.0000000000000135] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW This article explores the literature on the role of gastrostomy tube feeding use in the management of head and neck cancer, with special attention to its indications, timing of insertion, advantages, complications and quality of life issues. RECENT FINDINGS The current guidelines in place across different countries and two ongoing randomized controlled trials are discussed in detail, and placed in the context of current evidence. SUMMARY There remains a lack of consensus about when and which enteral feeding routes (gastrostomy or nasogastric tube) should be used and controversy about the long-term effects on swallowing function as well as quality of life for patients. Local guidelines should be used or generated to guide practice or patients enrolled into existing trials until higher level evidence is generated.
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Banfi PI, Volpato E, Nicolini A, Lunetta C, Pagnini F, Esquinas A. Gastrostomy in amyotrophic lateral sclerosis: effects of non-invasive ventilation. Lancet Neurol 2015; 14:1152-3. [PMID: 26581964 DOI: 10.1016/s1474-4422(15)00293-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 10/05/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Paolo Innocente Banfi
- Unità di Riabilitazione Respiratoria, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
| | - Eleonora Volpato
- Unità di Riabilitazione Respiratoria, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy; Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Christian Lunetta
- Fondazione Serena, Centro Clinico Nemo, Ospedale Niguarda, Milan, Italy
| | - Francesco Pagnini
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy; Niguarda Ca' Granda Hospital, Milan, Italy
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Udd M, Lindström O, Mustonen H, Bäck L, Halttunen J, Kylänpää L. Assessment of indications for percutaneous endoscopic gastrostomy--development of a predictive model. Scand J Gastroenterol 2015; 50:245-52. [PMID: 25540954 DOI: 10.3109/00365521.2014.927914] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Percutaneous endoscopic gastrostomy (PEG) is used for long-term enteral nutrition in neurological patients with dysphagia (NEUR), in head and neck cancer patients prior to chemoradiation therapy (head and neck malignancy group [HNM]), or in cases of oropharyngeal or esophageal tumor obstruction or stricture (OBSTR). Considerable morbidity and overall mortality is reported. Aim was to analyze the complication rates and mortality with PEG and to identify subgroups with poor outcomes. MATERIAL AND METHODS Patients underwent PEG (n = 401) in a single tertiary care center. Indications, characteristics, and causes of death were recorded. RESULTS Number of patients in groups: HNM 135 (34%), OBSTR 74 (18%), and NEUR 192 (48%); follow-up time median (interquartile range): 17 (39) months; the time PEG used for feeding: 4 (7) months. A total of 91 patients (23%) had 110 complications, 31 patients (8%) had early (≤30 days) complications, and 49 patients (12%) major complications. Two deaths (0.5%, 2 peritonitis) were related to PEG. The 30-day mortality was 11% (n = 47). According to multivariate analysis, an increased 30-day mortality was associated with ≥75 years of age, American Society of Anesthesiologists (ASA) class IV, a Charlson comorbidity index (CCI) ≥4, body mass index (BMI) <18.5, and ongoing antibiotic therapy. With this model, 95% specificity was obtained in the 30-day survival figures. CONCLUSION The presented predictive model derived from our analysis may recognize patients with poor outcome when referred for PEG. The parameters in the present model (age, ASA class, CCI score, BMI, and data of ongoing antibiotic treatment) are easily measurable, and it is possible to integrate them into everyday work.
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Affiliation(s)
- Marianne Udd
- Department of Gastroenterological and General Surgery, Unit of Therapeutic Endoscopy, Helsinki University Central Hospital and Helsinki University , Helsinki , Finland
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