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Farrugia E, Semciw AI, Bailey S, Cooke Z, Tuck C. Proportion of unplanned tube replacements and complications following gastrostomy: A systematic review and meta-analysis. Nutr Diet 2024; 81:63-78. [PMID: 37614051 DOI: 10.1111/1747-0080.12839] [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: 05/18/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023]
Abstract
AIMS Gastrostomy feeding represents a vital component of supportive care provided to people with swallowing or feeding difficulties; however, the rate of specific long-term complications is currently unknown in the adult population. This study aimed to determine the prevalence of specific long-term gastrostomy-related complications and unplanned replacements in adults. METHODS A prospective systematic review of Medline, CINAHL and Embase databases was performed. Key complications of hypergranulation, infection and displacement among studies relevant to percutaneous endoscopic gastrostomy tubes, radiologically inserted gastrostomy tubes and balloon replacement tubes were critically appraised by two independent reviewers. Results were synthesised quantitatively in a meta-analysis using random effects where the population and condition were sufficiently homogeneous. RESULTS In total, 453 studies were identified, of which 17 met inclusion criteria. 8.5% of adults with a gastrostomy were found to have had an infection ≥42 days after initial tube insertion (p < 0.01), while 13% had hypergranulation (p < 0.01). Displacement occurred in 10.8% of adults (p < 0.01), with age (p < 0.001) and sex (p < 0.001) presenting as a risk factor (R2 = 75%) following meta-regression. CONCLUSIONS Approximately 1 in 10 people with a gastrostomy will experience a complication related to either hypergranulation, infection or dislodgement. Age, in combination with sex, may provide a guide for risk of displacement among adult female cohorts, though further studies reporting prevalence of gastrostomy-related complications along with participant demographics are required.
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Affiliation(s)
- Emily Farrugia
- Allied Health, Northern Health, Bundoora, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Adam Ivan Semciw
- Allied Health, Northern Health, Bundoora, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Shanelle Bailey
- Allied Health, Northern Health, Bundoora, Victoria, Australia
| | - Zoe Cooke
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Caroline Tuck
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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2
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dos Santos ESV, de Oliveira GHP, de Moura DTH, Hirsch BS, Trasolini RP, Bernardo WM, de Moura EGH. Endoscopic vs radiologic gastrostomy for enteral feeding: A systematic review and meta-analysis. World J Meta-Anal 2023; 11:277-289. [DOI: 10.13105/wjma.v11.i6.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/17/2023] [Accepted: 06/16/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are minimally invasive techniques commonly used for prolonged enteral nutrition. Despite safe, both techniques may lead to complications, such as bleeding, infection, pain, peritonitis, and tube-related complications. The literature is unclear on which technique is the safest.
AIM To establish which approach has the lowest complication rate.
METHODS A database search was performed from inception through November 2022, and comparative studies of PEG and PRG were selected following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All included studies compared the two techniques directly and provided absolute values of the number of complications. Studies with pediatric populations were excluded. The primary outcome of this study was infection and bleeding. Pneumonia, peritonitis, pain, and mechanical complications were secondary outcomes. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB2) and we used The Risk of Bias in Nonrandomized Studies (ROBINS-I) to analyze the retrospective studies. We also performed GRADE analysis to assess the quality of evidence. Data on risk differences and 95% confidence intervals were obtained using the Mantel-Haenszel test.
RESULTS Seventeen studies were included, including two randomized controlled trials and fifteen retrospective cohort studies. The total population was 465218 individuals, with 273493 having undergone PEG and 191725 PRG. The only outcome that showed a significant difference was tube related complications in retrospective studies favoring PEG (95%CI: 0.03 to 0.08; P < 0.00001), although this outcome did not show significant difference in randomized studies (95%CI: -0.07 to 0.04; P = 0.13). There was no difference in the analyses of the following outcomes: infection in retrospective (95%CI: -0.01 to 0.00; P < 0.00001) or randomized (95%CI: -0.06 to 0.04; P = 0.44) studies; bleeding in retrospective (95%CI: -0.00 to 0.00; P < 0.00001) or randomized (95%CI: -0.06 to 0.02; P = 0.43) studies; pneumonia in retrospective (95%CI: -0.04 to 0.00; P = 0.28) or randomized (95%CI: -0.09 to 0.11; P = 0.39) studies; pain in retrospective (95%CI: -0.05 to 0.02; P < 0.00001) studies; peritonitis in retrospective (95%CI: -0.02 to 0.01; P < 0.0001) studies.
CONCLUSION PEG has lower levels of tube-related complications (such as dislocation, leak, obstruction, or breakdown) when compared to PRG.
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Affiliation(s)
- Evellin Souza Valentim dos Santos
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | | | - Diogo Turiani Hourneaux de Moura
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Bruno Salomão Hirsch
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Roberto Paolo Trasolini
- Department of Gastroenterology and Hepatology, Hospital Harvard Medical School, Boston, MA 02115, United States
| | - Wanderley Marques Bernardo
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
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Ono S, Furuhashi H, Kisaki S, Horiuchi H, Matsui H, Dobashi A, Ojiri H, Sumiyama K. Sarcopenia Is a Prognostic Factor in Patients Undergoing Percutaneous Endoscopic Gastrostomy. J Clin Med 2023; 12:jcm12103360. [PMID: 37240466 DOI: 10.3390/jcm12103360] [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: 02/14/2023] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Percutaneous endoscopic gastrostomy (PEG) is a widely used long-term enteral nutrition method, but little is known about the associated prognostic factors in patients with PEG. Sarcopenia, a condition characterized by a loss of skeletal muscle mass, increases the risk of developing various gastrointestinal disorders. Yet, the relationship between sarcopenia and the prognosis after PEG remains unclear. (2) Methods: We conducted a retrospective study of patients who underwent PEG consecutively from March 2008 to April 2020. We analyzed preoperative sarcopenia and the prognosis of patients after PEG. We defined sarcopenia as a skeletal muscle index at the level of the third lumbar vertebra of ≤29.6 cm2/m2 for women and ≤36.2 cm2/m2 for men. Cross-sectional computed tomography images of skeletal muscle at the level of the third lumbar vertebra were evaluated using DICOM image analysis software (OsiriX). The primary outcome was the difference in overall survival after PEG based on the status of sarcopenia. We also performed a covariate balancing propensity score matching analysis. (3) Results: Of 127 patients (99 men, 28 women), 71 (56%) were diagnosed with sarcopenia, and 64 patients died during the observation period. The median follow-up period did not differ between patients with and without sarcopenia (p = 0.5). The median survival time after PEG was 273 days in patients with sarcopenia and 1133 days in those without (p < 0.001). Cox proportional hazard model analyses identified three factors that were significantly associated with overall survival: sarcopenia (adjusted hazard ratio [HR]: 2.9, 95% confidence interval [CI]: 1.6-5.4, p < 0.001), serum albumin level (adjusted HR: 0.34, 95% CI: 0.21-0.55, p < 0.001) and male sex (adjusted HR: 2.0, 95% CI: 1.1-3.7, p = 0.03). Propensity score-matched analysis (n = 37 vs. 37) showed that the survival rate was lower in the sarcopenia group than in the non-sarcopenia group (at 90 days: 77% (95% CI, 59-88) vs. 92% (76-97), at 180 days: 56% (38-71) vs. 92% (76-97), and at one year: 35% (19-51) vs. 81% (63-91), p = 0.0014). (4) Conclusions: Sarcopenia was associated with poor prognosis in patients having undergone PEG.
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Affiliation(s)
- Shingo Ono
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroto Furuhashi
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Shunsuke Kisaki
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hideka Horiuchi
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroaki Matsui
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Akira Dobashi
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Kazuki Sumiyama
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
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Ahmed Z, Iqbal U, Aziz M, Arif SF, Badal J, Farooq U, Lee-Smith W, Gangwani MK, Kamal F, Kobeissy A, Mahmood A, Nawras A, Khara HS, Confer BD, Adler DG. Outcomes and Complications of Radiological Gastrostomy vs. Percutaneous Endoscopic Gastrostomy for Enteral Feeding: An Updated Systematic Review and Meta-Analysis. Gastroenterology Res 2023; 16:79-91. [PMID: 37187550 PMCID: PMC10181338 DOI: 10.14740/gr1593] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/09/2023] [Indexed: 05/17/2023] Open
Abstract
Background Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are commonly utilized to establish access to enteral nutrition. However, data comparing the outcomes of PEG vs. PRG are conflicting. Therefore, we aimed to conduct an updated systemic review and meta-analysis comparing PRG and PEG outcomes. Methods Medline, Embase, and Cochrane library databases were searched until February 24, 2023. Primary outcomes included 30-day mortality, tube leakage, tube dislodgement, perforation, and peritonitis. Secondary outcomes included bleeding, infectious complications, and aspiration pneumonia. All analyses were conducted using Comprehensive Meta-Analysis Software. Results The initial search revealed 872 studies. Of these, 43 of these studies met our inclusion criteria and were included in the final meta-analysis. Of 471,208 total patients, 194,399 received PRG and 276,809 received PEG. PRG was associated with higher odds of 30-day mortality when compared to PEG (odds ratio (OR): 1.205, 95% confidence interval (CI): 1.015 - 1.430, I2 = 55%). In addition, tube leakage and tube dislodgement were higher in the PRG group than in PEG (OR: 2.231, 95% CI: 1.184 - 4.2 and OR: 2.602, 95% CI: 1.911 - 3.541, respectively). Perforation, peritonitis, bleeding, and infectious complications were higher with PRG than PEG. Conclusion PEG is associated with lower 30-day mortality, tube leakage, and tube dislodgement rates than PRG.
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Affiliation(s)
- Zohaib Ahmed
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
- Zohaib Ahmed and Umair Iqbal contributed equally and shared the first authorship
- Corresponding Author: Zohaib Ahmed, Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA.
| | - Umair Iqbal
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
- Zohaib Ahmed and Umair Iqbal contributed equally and shared the first authorship
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | | | - Joyce Badal
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Umer Farooq
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH, USA
| | | | - Faisal Kamal
- Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Abdallah Kobeissy
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Asif Mahmood
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Harshit S. Khara
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - Bradley D. Confer
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO, USA
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Attia AC, Childers WK. Percutaneous endoscopic gastrostomy tube replacement after head and neck surgery: A case report. Int J Surg Case Rep 2022; 96:107323. [PMID: 35779317 PMCID: PMC9283987 DOI: 10.1016/j.ijscr.2022.107323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Percutaneous endoscopic gastrostomy (PEG) has been available since the 1980s. Routine replacement is conducted at bedside with relatively few complications. Two replacement methods have come into practice: the percutaneous method and the endoscopic method. The laparoscopic method has recently become favorable in the pediatric population. PRESENTATION OF CASE Herein, we describe a situation in which a gastrostomy tube was replaced at bedside on a patient with previous head and neck surgery for lingual cancer. The percutaneous traction method was used, and gastrostomy tube replacement into the gastric lumen could not be confirmed on subsequent imaging. The patient was ultimately taken to surgery for an open procedure where it was discovered that initial PEG placement had traversed the small bowel mesentery en route to the gastric lumen. DISCUSSION The PEG tube is not a permanent device and routine exchange every 6-12 months is recommended. The percutaneous method and endoscopic method for gastrostomy tube replacement have both been used routinely, each with their set of complications. A third technique, laparoscopic placement, is the preferred modality in the pediatric population. Advantages are twofold: direct visualization of the stomach, thus eliminating inadvertent hollow viscus injury, and applicability in infants too small to undergo endoscopy necessary for PEG tube placement. CONCLUSION Consideration for laparoscopic placement or replacement in the head and neck cancer patient population, in which interval endoscopy is impossible, is thus advocated.
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Affiliation(s)
- Aria C. Attia
- UPMC Harrisburg, 205 S Front St, Harrisburg, PA 17104, United States of America,Corresponding author.
| | - William Kurtis Childers
- UPMC Harrisburg, Department of General Surgery, 205 S Front St, Harrisburg, PA 17104, United States of America
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Tiankanon K, Aniwan S, Karuehardsuwan J, Wiangngoen S, Rerknimitr R. Factors affecting late complications of percutaneous endoscopic gastrostomy tube replacement. Clin Nutr ESPEN 2022; 49:378-384. [PMID: 35623840 DOI: 10.1016/j.clnesp.2022.03.018] [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: 04/22/2021] [Revised: 03/06/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Late complications associated with percutaneous endoscopic gastrostomy (PEG) tube in patients are common occurrences. We aimed to identify risk factors associated with PEG-related late complications. METHODS Patients who underwent PEG exchange were retrospectively collected from electronic medical records between January 2015 and November 2020. Medical records were reviewed longitudinally from the PEG replacement date until the first complication event, death, or the end of the study. The late complication was defined as the PEG-related complications six months after the initial PEG placement. Potential risk factors were tested using Cox proportional hazard. RESULTS A total of 116 patients (mean age 80.5 ± 17.6 years, 52.6% male) were enrolled with a 12 (4-23) months median follow-up. The indications were mostly neurologic disease (89.7%). Non-balloon PEG was used in 93 (80.2%) patients with balloon-type in 23 (19.8%) patients. PEG-related late complications developed in 35 (30.2%) patients with a median time of 9 (4-23) months. In the multivariate analysis, the PEG-related late complication rate was significantly higher in patients with balloon-type PEG tube (HR 5.54; 95%CI, 2.55-12.05; p < 0.001) and also showed a significantly higher cumulative incidence of developing complications (54.9% vs. 12.8% at one year and 76% vs. 22.8% at two years, p < 0.001). The most common complication was PEG dislodgement (n = 14, 40%). CONCLUSION Late-onset of PEG tube-associated complications is a common problem. The significant factor associated with PEG tube complication was balloon-type PEG placement.
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Affiliation(s)
- Kasenee Tiankanon
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Chulalongkorn University, Bangkok, Thailand; Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand.
| | - Satimai Aniwan
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Chulalongkorn University, Bangkok, Thailand; Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand.
| | - Julalak Karuehardsuwan
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand.
| | - Sumitra Wiangngoen
- Department of Nursing, King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand.
| | - Rungsun Rerknimitr
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Chulalongkorn University, Bangkok, Thailand; Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand.
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7
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Li X, Wang JX, Wang YP, Shen JX, Zheng YX, Zhang PH, Wei JJ, Zhuang ZH. Comparison of Pull and Introducer Techniques for Percutaneous Endoscopic Gastrostomy. J Multidiscip Healthc 2022; 15:733-741. [PMID: 35411150 PMCID: PMC8994609 DOI: 10.2147/jmdh.s356865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/15/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To compare indications, success rates and complications of pull [P] and introducer [I] techniques for percutaneous endoscopic gastrostomy (PEG). Methods In this retrospective study, inpatients who underwent primary PEG tube insertion between January 2015 and February 2020 at the Endoscopy Center of the First Affiliated Hospital of Fujian Medical University were included. Results A total of 103 inpatients were included in this study (P group, n = 67; I group, n = 36). The rates of tube replacement within first six months in the P and I groups were 1.5% and 11.1%, respectively (P = 0.049). The most common primary indication of PEG was malignancy. The proportion of patients with esophageal cancer was significantly lower in the P group (24.4% vs 54.2%, P = 0.015). No significant difference was found in the overall, major, or minor complications between the two groups. In patients with esophageal stenosis, the pull method was a risk factor for complications (P = 0.03; odds ratio [OR] = 12, 95% confidence interval [CI]: 1.164–123.684). Logistic regression analysis showed that the risk factors for major and minor complications were the admission-to-gastrostomy interval (OR = 1.078, 95% CI: 1.016–1.145, P = 0.014) and lack of antibiotic use (OR = 4.735, 95% CI: 1.247–17.979, P = 0.022), respectively. Conclusion Both PEG techniques have high clinical success rates. The introducer technique is more suitable for patients with esophageal stricture, which has lower minor complications, but higher rate of tube replacement compared to the pull technique. Use of antibiotics may reduce minor complications following PEG. Early PEG insertion may help to reduce post-PEG major complications.
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Affiliation(s)
- Xia Li
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
- Endoscope Room, Changle District Hospital, Fuzhou, People’s Republic of China
| | - Jun-Xi Wang
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yu-Ping Wang
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jia-Xin Shen
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yi-Xing Zheng
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Pei-Hong Zhang
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jing-Jing Wei
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Ze-Hao Zhuang
- Endoscopy Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
- Correspondence: Ze-Hao Zhuang, Endoscopy Center, First Affiliated Hospital of Fujian Medical University, 20, Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian Province, People’s Republic of China, Tel +860591-87981370, Fax +860591-87981371, Email
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8
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Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, Jonkers-Schuitema C, Lichota M, Nyulasi I, Schneider SM, Stanga Z, Pironi L. ESPEN practical guideline: Home enteral nutrition. Clin Nutr 2021; 41:468-488. [PMID: 35007816 DOI: 10.1016/j.clnu.2021.10.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 01/12/2023]
Abstract
This ESPEN practical guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home enteral nutrition (HEN) providers in a concise way about the indications and contraindications for HEN, as well as its implementation and monitoring. This guideline will also inform interested patients requiring HEN. Home parenteral nutrition is not included but will be addressed in a separate ESPEN guideline. The guideline is based on the ESPEN scientific guideline published before, which consists of 61 recommendations that have been reproduced and renumbered, along with the associated commentaries that have been shorted compared to the scientific guideline. Evidence grades and consensus levels are indicated. The guideline was commissioned and financially supported by ESPEN and the members of the guideline group were selected by ESPEN.
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Affiliation(s)
- Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany.
| | - Peter Austin
- Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK, University College London School of Pharmacy, London, UK
| | - Kurt Boeykens
- AZ Nikolaas Hospital, Nutrition Support Team, Sint-Niklaas, Belgium
| | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Cristina Cuerda
- Hospital General Universitario Gregorio Marañón, Nutrition Unit, Madrid, Spain
| | | | - Marek Lichota
- Intestinal Failure Patients Association "Appetite for Life", Cracow, Poland
| | - Ibolya Nyulasi
- Department of Nutrition, Department of Rehabilitation, Nutrition and Sport, Latrobe University, Department of Medicine, Monash University, Australia
| | - Stéphane M Schneider
- Gastroenterology and Nutrition, Centre Hospitalier Universitaire, Université Côte d'Azur, Nice, France
| | - Zeno Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, Switzerland
| | - Loris Pironi
- Alma Mater Studiorum -University of Bologna, Department of Medical and Surgical Sciences, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for Chronic Intestinal Failure, Clinical Nutrition and Metabolism Unit, Italy
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9
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Dolan RS, Duszak R, Bercu ZL, Martin JG, Newsome J, Kokabi N. Comparing the Safety and Cost of Image-Guided Percutaneous Gastrostomy Tube Placement in the Outpatient Versus Overnight Observation Setting in a Single-Center Retrospective Study. Acad Radiol 2021; 28:1081-1085. [PMID: 32527708 DOI: 10.1016/j.acra.2020.04.044] [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: 02/16/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
RATIONALE AND OBJECTIVES Historically, patients undergoing image-guided percutaneous gastrostomy tube placement have been admitted overnight with feeds commencing 12-24 hours postprocedure. With new expedited feeding protocols starting 3-4 hours postprocedure, same-day discharge is now possible. The purpose of this study was to evaluate the safety and cost of image-guided percutaneous gastrostomy tube placement as an outpatient procedure. MATERIALS AND METHODS In this retrospective study, 131 patients (age 63.9 ± 11.6; 34% female) underwent gastrostomy tube placement as an outpatient procedure with expedited feeding protocol versus 40 patients (age 61.3 ± 12.6; 38% female) who were hospitalized overnight with feeds starting at 12-24 hours, primarily based on operator preference. The two groups were compared regarding complications within 90 days of procedure. Using a subgroup of 33 consecutive patients, procedural costs (total combined insurer and patient payments for professional and hospital services) for outpatients vs. hospitalized patients were compared. RESULTS Complication rates were similar (p = 0.64) for gastrostomy tubes placed on outpatients (0.17 complications/procedure: 4 bleeding, 2 aspiration pneumonia, 1 abdominal abscess, 4 significant pain, 6 cellulitis, 1 surgical consult, 4 malpositioned/fractured tubes) and hospitalized patients (0.20 complications/procedure: 1 aspiration pneumonia, 1 significant pain, 3 cellulitis, 1 surgical consult, 2 fractured tubes). Total combined insurer and patient payments were similar ($2193/outpatient vs $2701/hospitalized patient; p= 0.52). CONCLUSION Outpatient image-guided percutaneous gastrostomy tube placement with an expedited feeding protocol is a safe and cost-comparable alternative to historic overnight hospitalization. Further prospective investigation with a larger sample is warranted.
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10
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Martinez Garcia RJ, Lindquester W, Dhangana R, Warhadpande S, Amesur N. An expanding role for interventional radiology: Medicare trends in fluoroscopic, endoscopic, and surgical enteric tube placement and maintenance from 2010 to 2018. Clin Imaging 2021; 78:201-205. [PMID: 34029970 DOI: 10.1016/j.clinimag.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/21/2021] [Accepted: 05/17/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The purpose of this study is to provide an update on trends in physician volume and payments for enteric tube placement and maintenance procedures by method, provider specialty, and practice setting amongst Medicare beneficiaries from 2010 to 2018. MATERIALS AND METHODS Claims from the Medicare Part B Physician/Supplier Procedure Summary Master File (PSPSMF) for the years 2010 to 2018 were extracted using current procedural terminology (CPT) codes for gastrostomy and jejunostomy placement, as well as conversion of gastrostomy to gastrojejunostomy, fluoroscopy guided and non-image guided replacement. Total volumes and provider reimbursement were analyzed by provider specialty and practice setting. RESULTS Volume of de novo placement of all enteric tubes decreased from 157,123 to 106,549 (-32.2%). While endoscopic placement decreased from 133,658 to 81,171 (-39.3%), the volume of fluoroscopic placement increased from 17,999 to 21,277 (18.2%). Fluoroscopic placement was largely performed by interventional radiology (IR) (91.7% in 2018). Surgical placement decreased from 5466 to 4101 (-25.0%). Volume of fluoroscopic replacement increased from 24,799 to 38,470 (55.1%), while non-image guided replacements decreased from 61,377 to 55,116 (-10.2%). Share of both fluoroscopic and non-image guided replacements by advanced practice providers (APPs) more than doubled over this time period. CONCLUSION De novo placement of enteric tubes decreased from 2010 to 2018, likely related to increased awareness of the complications and limited benefits in scenarios such as end of life care. In contrast to the diminishing volume for gastroenterologists, there was increased participation by IR in both placement and maintenance procedures under fluoroscopic guidance. SUMMARY STATEMENT Decreasing placement of enteric tubes suggests shifting attitudes and recommendations around end-of-life care. Increase in role by IR/APPs highlights the need for comprehensive care in these patients.
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Affiliation(s)
| | - Will Lindquester
- University of Pittsburgh Medical Center (UPMC), Department of Radiology, PUH Suite 200, 200 Lothrop Street, Pittsburgh, PA 15213, United States of America
| | - Rajoo Dhangana
- University of Pittsburgh Medical Center (UPMC), Department of Radiology, PUH Suite 200, 200 Lothrop Street, Pittsburgh, PA 15213, United States of America.
| | - Shantanu Warhadpande
- University of Pittsburgh Medical Center (UPMC), Department of Radiology, PUH Suite 200, 200 Lothrop Street, Pittsburgh, PA 15213, United States of America
| | - Nikhil Amesur
- University of Pittsburgh Medical Center (UPMC), Department of Radiology, PUH Suite 200, 200 Lothrop Street, Pittsburgh, PA 15213, United States of America
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11
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Clements W, Shvarts Y, Koukounaras J, Phan TD, Goh GS, Joseph T, Kuang R, Murnane L. Radiologically Inserted Gastrostomy (RIG) at a Tertiary Center: Periprocedural Safety including Rationalization of Antibiotic Prophylaxis. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1723098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Abstract
Introduction Long-term percutaneous enteral nutrition forms an important part of treatment for patients with an inability to meet nutrient requirements orally. Radiologically inserted gastrostomy (RIG) is an alternative to the traditionally performed percutaneous endoscopic gastrostomy technique. However, there is marked heterogeneity in the way that RIG is performed. In addition, the role for antibiotic prophylaxis during RIG insertion is not clearly established. This study aimed to assess the safety of RIG insertion using our technique including the role of antibiotics in RIG insertion.
Method Retrospective study over 5 years at a tertiary teaching hospital. Periprocedural or early complications within the first 2 weeks of the procedure were collected and correlated with the use of prophylactic antibiotics.
Results A total of 116 patients met the inclusion criteria. 18-French tube was used in 96.6%. Note that 58.6% of procedures were done with intravenous sedation. Prophylactic 1 g cefazolin was used in 70 patients with 1 case of infection. Procedures were performed without antibiotics in 46 patients with 3 infections, p = 0.20.There were two major complications (1.7%) consisting of right gastric artery injury requiring embolization and gastric wall injury requiring laparotomy. There were 12 minor complications (10.3%) including 4 cases of infection, 3 of severe pain, 1 of minor bleeding, 2 of early dislodgement, and 2 of leak/bypass of gastric contents around the tube.
Conclusion The technique used for RIG insertion at our institution results in a low complication rate. In addition, this study shows no significant difference in early peristomal infection rate with the use of antibiotic prophylaxis.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Yasmin Shvarts
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Tuan D. Phan
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Gerard S. Goh
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Ronny Kuang
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Lisa Murnane
- Department of Nutrition and Dietetics, Alfred Hospital, Melbourne, Victoria, Australia
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12
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Mansoor H, Mehmood S, Zafar W, Hassan W, Shah PA, Rajput ZN, Zeb F. Post cricoid tumours; a limiting factor for percutaneous endoscopic gastrostomy insertion in cancer patients: Results from a tertiary care hospital. Arab J Gastroenterol 2020; 21:233-236. [PMID: 32861598 DOI: 10.1016/j.ajg.2020.07.009] [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: 08/07/2018] [Revised: 02/17/2020] [Accepted: 07/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND STUDY AIMS The aim of this study was to review all episodes of PEG insertion in patients with head and neck cancer (HNC) at a cancer specialist centre. PATIENTS AND METHODS Using a structured data extraction form, we abstracted patients' demographic data and clinical information including the primary site of tumour, TNM staging, whether PEG tube was inserted successfully, any complications resulting from PEG tube insertion and duration the tube was in place. RESULTS We identified a total of 339 HNC patients who had received at least one attempted PEG tube insertion. The mean age of patients was 49.5 ± 14.5 years and 66% (n: 233/339) were males. 151/ 339 (44.5%) patients had a tumour in the pharynx and nasopharynx, 103/ 339 (30.4%) in oral cavity, 81/ 339 (23.9%) in post-cricoid region and 4 (1.1%) of the patients had a laryngeal carcinoma. Histopathologically, most tumours (75.8%) were squamous cell carcinoma presenting at a T4 (52.6%), N0 (38.3%) and M0 (91.7%) stage. PEG tube was successfully inserted in 303/339 (89.4%) patients. There were 36 PEG failures; 24 (66.6%) in postcricoid and laryngeal tumours, 8 (22.3%) in pharynx/nasopharynx and 4 (11.1%) in oral cavity tumours. Of the 81 patients with post-cricoid tumour, PEG tube was successfully inserted in 57/ 81 (70.3%) of the patients. Age, gender or T stage of the tumour was not found to be statistically significant predictors of PEG failure. The only significant factor was presence of post-cricoid or laryngeal tumours that increased the risk of PEG failure 12 times (95% confidence interval: 3.4 to 42.3). CONCLUSION PEG tube should be used as a first line feeding option in patients with all type of head and neck cancers, however, the attending clinicians should have this foresight of higher failure rates in patients with post-cricoid tumour.
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Affiliation(s)
- Hala Mansoor
- Department of Internal Medicine, Shaukat Khanum Memorial Hospital and Research Centre, Lahore, Pakistan.
| | - Shafqat Mehmood
- Department of Internal Medicine, Shaukat Khanum Memorial Hospital and Research Centre, Lahore, Pakistan
| | - Waleed Zafar
- Clinical Research Office, Shaukat Khanum Memorial Hospital and Research Centre, Lahore, Pakistan
| | - Waqarul Hassan
- Department of Internal Medicine, Shaukat Khanum Memorial Hospital and Research Centre, Lahore, Pakistan
| | - Peer Ameen Shah
- Department of Internal Medicine, Shaukat Khanum Memorial Hospital and Research Centre, Lahore, Pakistan; Clinical Research Office, Shaukat Khanum Memorial Hospital and Research Centre, Lahore, Pakistan
| | - Zeeshan Naem Rajput
- Department of Internal Medicine, Shaukat Khanum Memorial Hospital and Research Centre, Lahore, Pakistan
| | - Faisal Zeb
- Department of Internal Medicine, Shaukat Khanum Memorial Hospital and Research Centre, Lahore, Pakistan
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13
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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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14
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Partovi S, Li X, Moon E, Thompson D. Image guided percutaneous gastrostomy catheter placement: How we do it safely and efficiently. World J Gastroenterol 2020; 26:383-392. [PMID: 32063687 PMCID: PMC7002903 DOI: 10.3748/wjg.v26.i4.383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 02/06/2023] Open
Abstract
Gastrostomy tube is an effective and safe long-term feeding access that is well-tolerated by patients. The typical placement routes include surgical, endoscopic and interventional radiologic placement. In particular, percutaneous interventional radiologic gastrostomy (PIRG) has increasingly become the preferred method of choice in many practices. Although many PIRG techniques have been developed since the 1980s, there is still a paucity of evidence supporting the choice of a most-optimal PIRG technique. Hence, there is a large variation in institutional approach to PIRG. We are a large, quaternary academic institution with an extensive experience in PIRG. Therefore, we aim to present the “push” PIRG technique utilized in our institution, to review the current literature, to discuss the optimal choice of PIRG technique and to generate further interests in comparison studies.
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Affiliation(s)
- Sasan Partovi
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Xin Li
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Eunice Moon
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Dustin Thompson
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
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15
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Lang K, ElShafie RA, Akbaba S, Koschny R, Bougatf N, Bernhardt D, Welte SE, Adeberg S, Häfner M, Kargus S, Plinkert PK, Debus J, Rieken S. Percutaneous Endoscopic Gastrostomy Tube Placement in Patients with Head and Neck Cancer Treated with Radiotherapy. Cancer Manag Res 2020; 12:127-136. [PMID: 32021429 PMCID: PMC6955619 DOI: 10.2147/cmar.s218432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/02/2019] [Indexed: 12/12/2022] Open
Abstract
Background and aim The primary aim of our study was to evaluate percutaneous endoscopic gastrostomy (PEG) tube placement depending on body weight and body mass index in patients undergoing radiotherapy (RT) for head and neck cancer (HNC). A secondary aim was to evaluate the course of weight change following PEG placement. Methods We retrospectively reviewed the medical records of 186 patients with HNC undergoing radiotherapy (RT) or chemoradiotherapy (CRT) at our institution between January 2010 and August 2017. Initial weight and nutritional intake were analyzed prior to RT initiation and then followed throughout treatment until completion. Based on these data, the indication of PEG placement was determined. Medical records were also reviewed to analyze PEG-related acute toxicities. Results A total of 186 patients met inclusion criteria. Patients were most commonly male (n=123, 66.1%) with squamous cell carcinoma (n=164, 88.2%). Patients who had dysphagia prior to treatment initiation as well as patients with a BMI <18.5 kg/m2 needed PEG placement earlier during the treatment course. Low-grade toxicities related to PEG insertion were observed in 10.7% patients, with peristomal pain and redness adjacent to the PEG tube insertion site being most common. High-grade toxicities, such as peritonitis and organ injury, were found in 4.9% of patients. Conclusion Underweight patients and those with preexisting dysphagia should be closely screened during RT for weight loss and decreased oral intake. For weight loss greater than 4.5% during the treatment of HNC, early PEG-tube placement should be considered. Further prospective studies are needed to confirm these findings, and delineate a scoring system for timing of PEG use (prophylactic vs reactive) as well as assess the quality of life in patients with HNC who receive PEG placement.
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Affiliation(s)
- Kristin Lang
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany
| | - Rami A ElShafie
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany
| | - Sati Akbaba
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany
| | - Ronald Koschny
- Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany
| | - Nina Bougatf
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Stefan E Welte
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Matthias Häfner
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Steffen Kargus
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
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16
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Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, Jonkers-Schuitema C, Lichota M, Nyulasi I, Schneider SM, Stanga Z, Pironi L. ESPEN guideline on home enteral nutrition. Clin Nutr 2020; 39:5-22. [DOI: 10.1016/j.clnu.2019.04.022] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/19/2019] [Indexed: 02/07/2023]
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17
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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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18
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Shangab MOM, Shaikh NA. Prediction of risk of adverse events related to percutaneous endoscopic gastrostomy: a retrospective study. Ann Gastroenterol 2019; 32:469-475. [PMID: 31474793 PMCID: PMC6686100 DOI: 10.20524/aog.2019.0409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Percutaneous endoscopic gastrostomy (PEG) is a popular method for long-term enteral feeding. Our aim was to determine potential risk factors for adverse events related to PEG, as well as consequent prolonged hospitalization. Methods: Data were retrospectively collected from the admission records of a tertiary center between July 2015 and June 2018. Possible predictors of the 3 following outcomes were evaluated: minor PEG-related adverse events, major PEG-related adverse events, and length of hospital stay. Data were tested for correlation using the Spearman coefficient and for association using Kruskal-Wallis tests for significance. Results: A total of 362 admissions involving 146 patients were included in the study. Of the admissions, 221 (61.0%) had only minor adverse events, 100 (27.6%) had only major adverse events, and 41 (11.3%) had both. Eighty (22.1%) had PEG-site infection and 128 (35%) had aspiration pneumonia. Serum albumin levels at presentation were negatively correlated with the length of hospitalization (P<0.001), which also differed between patients presenting with major and minor adverse events (P<0.001 and P=0.026). The Charlson comorbidity index was positively correlated with the duration of hospitalization (P<0.001). Higher index scores were found more among patients presenting with aspiration pneumonia (P=0.004) and lower scores were found among patients presenting with PEG site infection and inadvertent PEG removal compared with those presenting with a major complication (P<0.001). Conclusion: The patient’s general medical condition and nutritional status are the greatest risk predictors for developing adverse events related to their PEG feeding, as well as a consequent extended hospital stay.
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19
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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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20
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To Pull or to Scope: A Prospective Safety and Cost-effectiveness of Percutaneous Endoscopic Gastrostomy Tube Replacement Methods. J Clin Gastroenterol 2019; 53:e37-e40. [PMID: 29369238 DOI: 10.1097/mcg.0000000000000993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tubes are routinely used as an effective method for providing enteral nutrition. The need for their exchange is common. GOALS We aimed to examine the comparative safety and cost-effectiveness of PEG percutaneous counter-traction "pulling" approach or by endoscopically guided retrieval. STUDY A prospective 215 consecutive patients undergoing PEG tube insertion were included. Fifty patients in total were excluded. The patients were examined for demographics, indications for PEG replacement, as well as procedure-related complications and procedural costs. RESULTS Group A included 70 patients (42%) with PEG tubes replaced endoscopically, whereas group B included 95 patients (58%) with PEG tubes replaced percutaneously. Baselines characteristics were similar between the 2 groups (P=NS). Group A and group B had similar immediate complication rates including 4 patients in group B (4.2%), and 2 patients in group A (2.8%) (P=0.24). Complications included a conservatively managed esophageal perforation, and self-limited mild bleeding groups A and group B, respectively. The mean procedure cost was significantly higher in the endoscopic PEG replacement group compared with the percutaneous PEG replacement group ($650 vs. $350, respectively). CONCLUSION Percutaneous PEG replacement appears as safe as endoscopic PEG replacement, however, percutaneous tube exchange is less costly.
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Vincenzi F, De Caro G, Gaiani F, Fornaroli F, Minelli R, Leandro G, Di Mario F, De' Angelis GL. Risk of tumor implantation in percutaneous endoscopic gastrostomy in the upper aerodigestive tumors. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:117-121. [PMID: 30561429 PMCID: PMC6502208 DOI: 10.23750/abm.v89i8-s.7894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Indexed: 01/25/2023]
Abstract
Percutaneous endoscopic gastrostomy (PEG) has become a mainstay in providing enteral access for patients with obstructive head, neck and esophageal tumors. Tumor cell implantation is a rare complication in patients with aerodigestive cancers, who have undergone PEG tube placement. The objective of this review is to determine the incidence and contributing risk factors leading to the implantation of metastases into the abdominal wall following PEG placement. A comprehensive review of the literature in PUBMED (2008-2018) was performed. The literature search revealed reports of more than 50 cases of abdominal wall metastases after PEG placement. As most of these studies were case reports, the exact rate of metastasis remains unknown. Generally pharyngoesophageal location of primary cancer (100%), squamous cell histology (98%), poorly differentiated tumor cells (92%), advanced pathological stage (97%), and large primary cancer size were identified as strong risk factors for the development of stomal metastasis. Abdominal wall metastases following PEG placement are a rare but serious complication in patients with head and neck malignancy. (www.actabiomedica.it)
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Affiliation(s)
- Francesca Vincenzi
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
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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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Hermush V, Berner Y, Katz Y, Kunin Y, Krasniansky I, Schwartz Y, Mimran Nahon D, Elizariev A, Mendelson G. Gastrostomy Tube Placement by Radiological Methods for Older Patients Requiring Enteral Nutrition: Not to be Forgotten. Front Med (Lausanne) 2018; 5:274. [PMID: 30320118 PMCID: PMC6168734 DOI: 10.3389/fmed.2018.00274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 09/05/2018] [Indexed: 01/13/2023] Open
Abstract
Background: The use of gastrostomy tubes for long-term nutritional support in older patients is frequent. Percutaneous gastrostomy tube placement may be performed using various techniques, including endoscopic, surgical, and radiologically-guided methods. While percutaneous endoscopic gastrostomy (PEG) placement is the most widely used and accepted approach, experience with the use of percutaneous radiological gastrostomy (PRG) is more limited. Objective: To evaluate the safety and short-term outcomes of PRG in older patients requiring long-term enteral feeding. Method: We performed a prospective study involving all patients aged 65 years and older who underwent PRG insertion at the Laniado hospital over a period of 2 years. Adverse events related to the gastrostomy tube insertion were recorded over a period of 3 months following the procedure. Results: A total of 58 patients were included with a mean age of 78.1 years, and 48% were women. The most frequent indications for enteral feeding were stroke (47%) and dementia (41%). The technical success rate was 100% with no immediate procedure-related mortality or morbidity. One-month mortality was 3%, and overall mortality at 3-month follow-up was 16%. Complications were reported in 39 (67%) of patients, with 17 (29%) experiencing more than 1 complication. While most complications (88%) were minor, major complications occurred in 19 (33%) of the patients. Peritonitis was the cause of death in 2 patients, and tube dislodgment occurred in 17 subjects. During the follow-up period 17 (29%) of patients were re-admitted to hospital, with the cause for re-hospitalization being unrelated to the PRG in half of the cases. Neither bleeding nor deep wound infection was detected in the study group. Conclusions: PRG is relatively safe and effective for gastrostomy placement in older patients, and this technique may be of value in patients with oral infections and those receiving anti-thrombotic therapy.
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Affiliation(s)
- Vered Hermush
- Department of Geriatrics and Skilled Nursing, Laniado Medical Center, Netanya, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Isreal Istitute of Technology, Haifa, Israel
| | - Yitshal Berner
- Department of Geriatric Medicine, Meir Medical Center, Kfar Saba and Sackler Medical School, Tel Aviv University, Kfar Saba, Israel
| | - Yael Katz
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Isreal Istitute of Technology, Haifa, Israel.,Dorot Geriatric and Rehabilitation Center, Netanya, Israel
| | - Yanina Kunin
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Isreal Istitute of Technology, Haifa, Israel.,Dorot Geriatric and Rehabilitation Center, Netanya, Israel
| | - Irena Krasniansky
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Isreal Istitute of Technology, Haifa, Israel.,Dorot Geriatric and Rehabilitation Center, Netanya, Israel
| | - Yael Schwartz
- Department of Geriatrics and Skilled Nursing, Laniado Medical Center, Netanya, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Isreal Istitute of Technology, Haifa, Israel
| | - Debbie Mimran Nahon
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Isreal Istitute of Technology, Haifa, Israel.,Dorot Geriatric and Rehabilitation Center, Netanya, Israel
| | - Ana Elizariev
- Department of Geriatrics and Skilled Nursing, Laniado Medical Center, Netanya, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Isreal Istitute of Technology, Haifa, Israel
| | - Gad Mendelson
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Isreal Istitute of Technology, Haifa, Israel.,Dorot Geriatric and Rehabilitation Center, Netanya, Israel
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Gasparetto A, Rosenberg M, Hunter D, Golzarian J, D'Souza D. Percutaneous gastric tube placement: Comparison of trans-abdominal and trans-oral approach in patients with chronic ascites. Diagn Interv Imaging 2018; 100:25-29. [PMID: 30220588 DOI: 10.1016/j.diii.2018.08.009] [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: 03/14/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to compare the trans-abdominal (TA) and trans-oral (TO) approaches for fluoroscopic-guided gastrostomy tube placement in patients with chronic ascites. MATERIALS AND METHODS A 10-year review of clinical imaging and medical records at a single institution identified 29 patients with chronic recurrent ascites who underwent gastrostomy (GT) or gastro-jejunostomy tube (GJT) placement. In 22 patients (18 women, 4 men) aged from 22 to 76 years of age (mean age, 57.7±13.1 years), a GT or GJT was placed with the TO approach, and in 7 (7 women) from 31 to 86 years of age (mean age, 63±16.8 years) with the TA approach. RESULTS Technical success was 100% in both groups with one (1/22; 5%) immediate complication in the TO group. Fluoroscopy time was significantly greater in the TO group (P=0.002). Leakage of ascites was significantly more frequent in the TA group (P=0.04). There was no significant difference in bleeding or inflammation (P=0.14 and P=0.43, respectively). The cumulative tract related complication rate was significantly greater in the TA group (P=0.03). CONCLUSION Fluoroscopy times and the overall incidence of tract-related complications, in particular leakage of ascites from the stoma, are more frequent in patients in chronic ascites who underwent TA gastrostomy tube placement compared to those who underwent TO placement.
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Affiliation(s)
- A Gasparetto
- University of Minnesota, Department of Radiology, 420, Delaware St SE, 55455 Minneapolis, MN, United States
| | - M Rosenberg
- University of Minnesota, Department of Radiology, 420, Delaware St SE, 55455 Minneapolis, MN, United States
| | - D Hunter
- University of Minnesota, Department of Radiology, 420, Delaware St SE, 55455 Minneapolis, MN, United States
| | - J Golzarian
- University of Minnesota, Department of Radiology, 420, Delaware St SE, 55455 Minneapolis, MN, United States
| | - D D'Souza
- University of Minnesota, Department of Radiology, 420, Delaware St SE, 55455 Minneapolis, MN, United States.
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25
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Complications of percutaneous endoscopic and radiologic gastrostomy tube insertion: a KASID (Korean Association for the Study of Intestinal Diseases) study. Surg Endosc 2018; 33:750-756. [DOI: 10.1007/s00464-018-6339-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 07/06/2018] [Indexed: 12/13/2022]
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26
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Pih GY, Na HK, Ahn JY, Jung KW, Kim DH, Lee JH, Choi KD, Song HJ, Lee GH, Jung HY. Risk factors for complications and mortality of percutaneous endoscopic gastrostomy insertion. BMC Gastroenterol 2018; 18:101. [PMID: 29954339 PMCID: PMC6025834 DOI: 10.1186/s12876-018-0825-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/15/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is a relatively safe procedure; however, acute and chronic complications of PEG have been reported. We aimed to determine risk factors associated with complications and 30-day mortality after PEG, based on 11 years of experience at a single tertiary hospital. METHODS In total, 401 patients who underwent first PEG insertion at the Asan Medical Center, Seoul, Korea, between January 2005 and December 2015 were eligible. Medical records were retrospectively reviewed to determine clinical characteristics and outcomes of 139 and 262 patients who underwent pull-type and introducer-type PEG, respectively. RESULTS The median age of the overall population was 68 years, and the median body mass index was 19.5 kg/m2. Acute and chronic complications developed in 96 (23.9%) and 105 (26.2%) patients. Acute ileus and chronic tube obstruction were significantly more frequent in the introducer-type PEG group (p = 0.033 and 0.001, respectively). The 30-day mortality rate was 5.0% (median survival: 10.5 days). Multivariate analysis revealed that underlying malignancy was a predictor of acute complications; age ≥ 70 years and diabetes mellitus were predictors of chronic complications. The median follow-up was 354 days. Neurologic disease and malignancy were the most common indications for PEG. Neurologic diseases were classified into two groups: stroke and the other neurologic disease group (including dementia, Parkinson's disease, neuromuscular disease, and hypoxic brain damage). Multivariate analysis showed that 30-day mortality was significantly lower in the other neurologic disease group and higher in patients with platelet count < 100,000/μL, and C-reactive protein (CRP) ≥ 5 mg/dL. CONCLUSIONS PEG is a relatively safe and feasible procedure, but it was associated with significantly higher early mortality rate in patients with platelet count < 100,000/μL or CPR≥5mg/dL, and lower early mortality rate in neurologic disease group including dementia, Parkinson's disase, neuromuscular disease, and hypoxic brain damage. In addition, acute complications in patients with underlying malignancy, and chronic complications in patients aged ≥70 and those with diabetes mellitus should be considered during and after PEG.
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Affiliation(s)
- Gyu Young Pih
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Korea
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27
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Currie BM, Getrajdman GI, Covey AM, Alago W, Erinjeri JP, Maybody M, Boas FE. Push versus pull gastrostomy in cancer patients: A single center retrospective analysis of complications and technical success rates. Diagn Interv Imaging 2018; 99:547-553. [PMID: 29716845 DOI: 10.1016/j.diii.2018.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/12/2018] [Accepted: 04/12/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the technical success and complication rates of push versus pull gastrostomy tubes in cancer patients, and to examine their dependence on operator experience. MATERIALS AND METHODS A retrospective review was performed of 304 cancer patients (170 men, 134 women; mean age 60.3±12.6 [SD], range: 19-102 years) referred for primary gastrostomy tube placement, 88 (29%) of whom had a previously unsuccessful attempt at percutaneous endoscopic gastrostomy (PEG) placement. Analyzed variables included method of insertion (push versus pull), indication for gastrostomy, technical success, operator experience, and procedure-related complications within 30 days of placement. RESULTS Gastrostomy tubes were placed for feeding in 189 patients and palliative decompression in 115 patients. Technical success was 91%: 78% after endoscopy had previously been unsuccessful and 97% when excluding failures associated with prior endoscopy. In the first 30 days, there were 29 minor complications (17.2%) associated with push gastrostomies, and only 8 minor complications (7.5%) with pull gastrostomies (P<0.05). There was no significant difference in major complications (push gastrostomy 5.3%, pull gastrostomy 5.6%). For decompressive gastrostomy tubes, the pull technique resulted in lower rates of both minor and major complications. There was no difference in complications or technical success rates for more versus less experienced operators. CONCLUSION Pull gastrostomy tube placement had a lower rate of complications than push gastrostomy tube placement, especially when the indication was decompression. The technical success rate was high, even after a failed attempt at endoscopic placement. Both the rates of success and complications were independent of operator experience.
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Affiliation(s)
- B M Currie
- Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275, York avenue, New York, NY 10065, United States; Department of Radiology, Hospital of the University of Pennsylvania, 3400, Spruce Street, Philadelphia, PA 19104, United States
| | - G I Getrajdman
- Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275, York avenue, New York, NY 10065, United States
| | - A M Covey
- Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275, York avenue, New York, NY 10065, United States
| | - W Alago
- Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275, York avenue, New York, NY 10065, United States
| | - J P Erinjeri
- Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275, York avenue, New York, NY 10065, United States
| | - M Maybody
- Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275, York avenue, New York, NY 10065, United States
| | - F E Boas
- Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275, York avenue, New York, NY 10065, United States.
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Vidhya C, Phoebe D, Dhina C, Jayne S, Robert F. Percutaneous endoscopic gastrostomy (PEG) versus radiologically inserted gastrostomy (RIG): A comparison of outcomes at an Australian teaching hospital. Clin Nutr ESPEN 2018; 23:136-140. [DOI: 10.1016/j.clnesp.2017.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 10/22/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
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Percutaneous endoscopic gastrostomy under conscious sedation in patients with amyotrophic lateral sclerosis is safe: an observational study. Eur J Gastroenterol Hepatol 2017; 29:1303-1308. [PMID: 28877087 DOI: 10.1097/meg.0000000000000959] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease that causes muscle weakness with respiratory and swallowing dysfunction, eventually leading to death. Permanent enteral feeding is indicated in almost all patients. A percutaneous endoscopic gastrostomy (PEG) tube is considered the first choice, usually performed under conscious sedation (intravenous midazolam). Guidelines are very cautious with respect to sedation in ALS because of the risk for respiratory complications. In our tertiary referral hospital, conscious sedation has been used for many years.Our aim was to review 30-day complications in PEG performed under conscious sedation in ALS patients (without noninvasive positive pressure ventilation during the procedure). PATIENTS AND METHODS A retrospective review, including all ALS patients undergoing PEG under conscious sedation from October 2009 to April 2016, was performed. RESULTS Analysis included 45 (44% men) patients receiving intravenous midazolam sedation (mean dose 5 mg) during PEG placement, age 36-91 years (mean: 68.7 years). Forced vital capacity (FVC) was 24-116% (mean 68%), of which mild to moderate dysfunction (FVC 50-69%) was present in 42.2% of patients and (very) severe dysfunction (FVC <50%) in 8.8%. No respiratory complications (e.g. aspiration pneumonia) were observed. Other complications, for example, infection, bleeding and peritonitis occurred in, respectively, 8.9, 2.2 and 0%. Mean survival after PEG placement was 13.4 months (range: 1-45 months). CONCLUSION Conscious sedation during PEG insertion in ALS patients did not lead to respiratory complications or to an increase in other complications. Our data indicate that conscious sedation can be used safely in ALS patients with mild to moderate pulmonary dysfunction.
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Di Palma LDV, Mello GFDSE, Granados CL, Glória RD, Dalbem CS, Cruz RLD, Ayres ACM, Lisboa RSC, Pelosi AD, Ferreira MA, Mansur GR, Silva SGD, Ribeiro TCD, Dias FL. Pharyngocutaneous fistula as an alternative access route for inserting a percutaneous endoscopic gastrostomy tube in head and neck cancer patients. Endosc Int Open 2017; 5:E630-E634. [PMID: 28691045 PMCID: PMC5500110 DOI: 10.1055/s-0043-106581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 03/02/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Performing a percutaneous endoscopic gastrostomy (PEG) in head and neck cancer (HNC) patients can be challenging because of the presence of trismus, pharyngeal obstruction by tumor, and pharyngoesophageal strictures or fistula. Pharyngocutaneous fistula (PCF) is a major postoperative concern in patients submitted to total laryngectomy (TL). In the medical literature to date, the cervical fistula has been used as an access to PEG in only four reports. The aim of this study was to evaluate the safety of cervical fistula for insertion of a PEG tube. PATIENTS AND METHODS Retrospective study at a single tertiary referral center, regarding the technical feasibility, safety and outcomes of a PEG tube introduced by a cervical fistula in HNC patients with obstructive lesions of the oropharynx. RESULTS The procedure was technically successful in all 21 patients. A PEG tube was used for a minimum of 1 month and a maximum of 120 months. Twelve patients died while using the PEG tube, 8 had it taken out because it was no longer needed, and only 1 had the tube still in use. Adverse events occurred in 8 patients: granuloma (19 %), dermatitis (9.5 %), accidental late removal of the tube (9.5 %), periprocedural gastric wall hematoma (9.5 %), peristomal wound infection (4.7 %), buried bumper syndrome (4.7 %), and traumatic gastric ulcer (4.7 %). CONCLUSION A postoperative cervical fistula can successfully work as a reliable and safe access for a PEG tube procedure in HNC patients, avoiding unnecessary surgery and reducing costs.
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Affiliation(s)
| | - Gustavo Francisco de Souza e Mello
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil,Corresponding author Gustavo Francisco de Souza e Mello, MD, PhD Department of Digestive EndoscopyCancer Hospital IBrazilian National Cancer InstitutePraça Cruz Vermelha 23Rio de Janeiro – RJ, CEP 20230-130
| | - Cindy Lis Granados
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Ricardo Dardengo Glória
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Caroline Sauter Dalbem
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Rolantre Lopes da Cruz
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Ana Carolina Maron Ayres
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Renata Sofia Camara Lisboa
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Alexandre Dias Pelosi
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Maria Aparecida Ferreira
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Gilberto Reynaldo Mansur
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Simone Guaraldi da Silva
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | | | - Fernando Luiz Dias
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
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Tyng CJ, Santos EFV, Guerra LFA, Bitencourt AGV, Barbosa PNVP, Chojniak R. Computed tomography-guided percutaneous gastrostomy: initial experience at a cancer center. Radiol Bras 2017; 50:109-114. [PMID: 28428654 PMCID: PMC5397002 DOI: 10.1590/0100-3984.2015.0219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Gastrostomy is indicated for patients with conditions that do not allow adequate oral nutrition. To reduce the morbidity and costs associated with the procedure, there is a trend toward the use of percutaneous gastrostomy, guided by endoscopy, fluoroscopy, or, most recently, computed tomography. The purpose of this paper was to review the computed tomography-guided gastrostomy procedure, as well as the indications for its use and the potential complications.
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Affiliation(s)
- Chiang Jeng Tyng
- PhD, Attending Physician, Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Erich Frank Vater Santos
- MD, Radiologist, Resident in Interventional Radiology, Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Luiz Felipe Alves Guerra
- MD, Resident in Radiology and Diagnostic Imaging, Hospital Universitário Cassiano Antonio de Morais - Universidade Federal do Espírito Santo (HUCAM-UFES), Vitória, ES, Brazil
| | | | | | - Rubens Chojniak
- PhD, Head of the Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
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Abstract
There are a variety of techniques for gastrostomy tube placement. Endoscopic and radiologic approaches have almost entirely superseded surgical placement. However, an aging population and significant advancements in modern healthcare have resulted in patients with increasingly complex medical issues or postsurgical anatomy. The rising prevalence of obesity has also created technical challenges for proceduralists of many specialties. When patients with these comorbidities develop the need for long-term enteral nutrition and feeding tube placement, standard approaches such as percutaneous endoscopic gastrostomy (PEG) by endoscopists and percutaneous image-guided gastrostomy (PIG) by interventional radiologists may be technically difficult or impossible. For these challenging situations, laparoscopic-assisted PEG (LAPEG) is an alternative option. LAPEG combines the advantages of PEG with direct intraperitoneal visualization, helping ensure a safe tube placement tract free of intervening organs or structures. In this review, we highlight some of the important factors of first-line gastrostomy techniques, with an emphasis on the utility and procedural technique of LAPEG when they are not feasible.
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Affiliation(s)
- Adarsh M Thaker
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, PVUB 2114, MC 694907, Los Angeles, CA, 90095-6949, USA.
| | - Alireza Sedarat
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, PVUB 2114, MC 694907, Los Angeles, CA, 90095-6949, USA
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Fung E, Strosberg DS, Jones EL, Dettorre R, Suzo A, Meara MP, Narula VK, Hazey JW. Incidence of abdominal wall metastases following percutaneous endoscopic gastrostomy placement in patients with head and neck cancer. Surg Endosc 2016; 31:3623-3627. [PMID: 28039644 DOI: 10.1007/s00464-016-5394-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 12/15/2016] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Percutaneous endoscopic gastrostomy (PEG) tubes are an effective modality for enteral nutrition in patients with head and neck cancer; however, there have been documented case reports of "seeding" of the abdominal wall by the theoretic risk of dragging the tube along the tumor during PEG placement. The objective of this study is to determine the incidence and contributing risk factors leading to metastasis to the abdominal wall following PEG placement in patients with head and neck cancer. METHODS A retrospective chart review was performed on patients diagnosed with head and neck malignancy who underwent PEG placement between 1/5/2009 and 12/22/2014. Variables collected included development of abdominal wall metastases, type of malignancy and tumor characteristics, smoking history, PEG placement technique, and survival following recurrence. Data were then analyzed for overall trends. RESULTS Out of 777 patients analyzed, a total of five patients with head and neck malignancy were identified with abdominal wall metastasis following PEG tube placement with an overall incidence of 0.64% over an average follow-up of 27.55 months. All of these patients underwent PEG tube insertion via a Pull technique. One patient was found to have a clinically evident and symptomatic stomal metastasis, while the other four patients had radiologically detected metastases either on CT or PET scan. All of the identified patients were found to have stage IV oral cancer at time of initial diagnosis of their head and neck malignancy, followed by widespread distant metastatic disease at time of presentation with their PEG site stomal metastasis. CONCLUSION Abdominal wall metastases following PEG placement are a rare but serious complication in patients with head and neck malignancy.
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Affiliation(s)
- Eleanor Fung
- Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 654, Columbus, OH, 43210, USA
| | - David S Strosberg
- Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 654, Columbus, OH, 43210, USA.
| | - Edward L Jones
- Department of Surgery, University of Colorado at Denver, Aurora, CO, USA
| | - Rebecca Dettorre
- Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 654, Columbus, OH, 43210, USA
| | - Andrew Suzo
- Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 654, Columbus, OH, 43210, USA
| | - Michael P Meara
- Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 654, Columbus, OH, 43210, USA
| | - Vimal K Narula
- Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 654, Columbus, OH, 43210, USA
| | - Jeffrey W Hazey
- Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 654, Columbus, OH, 43210, USA
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Xu Y, Guo Q, Lin J, Chen B, Wen J, Lu T, Xu Y, Zhang M, Pan J, Lin S. Benefit of percutaneous endoscopic gastrostomy in patients undergoing definitive chemoradiotherapy for locally advanced nasopharyngeal carcinoma. Onco Targets Ther 2016; 9:6835-6841. [PMID: 27853378 PMCID: PMC5104288 DOI: 10.2147/ott.s117676] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIM To evaluate the impact of percutaneous endoscopic gastrostomy (PEG) tube on nutritional status, treatment-related toxicity, and treatment tolerance in patients with locally advanced nasopharyngeal carcinoma (NPC) who underwent chemoradiotherapy. PATIENTS AND METHODS We enrolled 133 consecutive non-metastatic NPC (III/IV stage) patients, who were treated with prophylactic PEG feeding before the initiation of concurrent chemoradiotherapy (CCRT) between June 1, 2010 and June 30, 2014. Meanwhile, another 133 non-PEG patients, who were matched for age, gender, and tumor, node, metastases stage, were selected as historical control cohort. Weight and nutritional status changes from pre-radiotherapy to the end of radiotherapy were evaluated, and treatment tolerance and related acute toxicities were analyzed as well. RESULTS We found that significantly more patients (91.73%) in the PEG group could finish two cycles of CCRT, when compared with those in the non-PEG group (57.89%) (P<0.001). We also indicated that more patients (50.38%) in the non-PEG group experienced weight loss of ≥5%, while the phenomenon was only found in 36.09% patients in the PEG group (P=0.019). In addition, the percentage of patients who lost ≥10% of their weight was similar in these two groups. Changes in albumin and prealbumin levels during radiotherapy in the non-PEG group were higher than those obtained for the PEG group with significant differences (P-values of 0.023 and <0.001, respectively). Furthermore, patients in the PEG group had significantly lower incidence of grade III acute mucositis than those in the non-PEG group (22.56% vs 36.84%, P=0.011). Tube-related complications occurred only in 14 (10.53%) patients in the PEG group, including incision infection of various degrees. CONCLUSION PEG and intensive nutrition support may help to minimize body weight loss, maintain nutritional status, and offer better treatment tolerance for patients with locally advanced NPC who underwent CCRT.
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Affiliation(s)
- Yun Xu
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Qiaojuan Guo
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Jin Lin
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Bijuan Chen
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Jiangmei Wen
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Tianzhu Lu
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Yuanji Xu
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Mingwei Zhang
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Jianji Pan
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Shaojun Lin
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
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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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Ambur V, Taghavi S, Jayarajan S, Gaughan J, Toyoda Y, Dauer E, Sjoholm LO, Pathak A, Santora T, Goldberg AJ. Comparing open gastrostomy tube to percutaneous endoscopic gastrostomy tube in heart transplant patients. Ann Med Surg (Lond) 2016; 7:71-4. [PMID: 27141303 PMCID: PMC4840285 DOI: 10.1016/j.amsu.2016.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 01/11/2023] Open
Abstract
Introduction Impaired wound healing due to immunosuppression has led some surgeons to preferentially use open gastrostomy tube (OGT) over percutaneous gastrostomy tube (PEG) in heart transplant patients when long-term enteral access is deemed necessary. Methods The National Inpatient Sample (NIS) database (2005–2010) was queried for all heart transplant patients. Those receiving OGT were compared to those treated with PEG tube. Results There were 498 patients requiring long-term enteral access treated with a gastrostomy tube, with 424 (85.2%) receiving a PEG and 74 (14.8%) an OGT. The PEG cohort had higher Charlson comorbidity Index (4.1 vs. 2.0, p = 0.002) and a higher incidence of post-operative acute renal failure (31.5 vs. 12.7%, p = 0.001). Post-operative mortality was not different when comparing the two groups (13.8 vs. 6.1%, p = 0.06). On multivariate analysis, while both PEG (OR: 7.87, 95%C.I: 5.88–10.52, p < 0.001) and OGT (OR 5.87, 95%CI: 2.19–15.75, p < 0.001) were independently associated with mortality, PEG conferred a higher mortality risk. Conclusions This is the largest reported study to date comparing outcomes between PEG and OGT in heart transplant patients. PEG does not confer any advantage over OGT in this patient population with respect to morbidity, mortality, and length of stay. OGT may result in less mortality than PEG in heart transplant patients. Complications occur more frequently when heart transplant recipients receive PEG. PEG in heart transplant recipients does not result in decreased LOS or total cost.
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Affiliation(s)
- Vishnu Ambur
- Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA
- Corresponding author. Temple University Hospital, 3401 N. Broad Street, Parkinson Pavilion, Suite 400, Philadelphia, 19140, PA, USA. Tel.: +1 2157073133.Temple University Hospital3401 N. Broad StreetParkinson PavilionSuite 400PhiladelphiaPA19140USA
| | - Sharven Taghavi
- Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA
| | - Senthil Jayarajan
- Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA
| | - John Gaughan
- Temple University School of Medicine, Biostatistics Consulting Center, Philadelphia, PA, USA
| | - Yoshiya Toyoda
- Temple University School of Medicine, Department of Cardiac Surgery, Philadelphia, PA, USA
| | - Elizabeth Dauer
- Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA
| | - Lars Ola Sjoholm
- Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA
| | - Abhijit Pathak
- Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA
| | - Thomas Santora
- Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA
| | - Amy J. Goldberg
- Temple University School of Medicine, Department of Surgery, Philadelphia, PA, USA
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Bravo JGP, Ide E, Kondo A, de Moura DTH, de Moura ETH, Sakai P, Bernardo WM, de Moura EGH. Percutaneous endoscopic versus surgical gastrostomy in patients with benign and malignant diseases: a systematic review and meta-analysis. Clinics (Sao Paulo) 2016; 71:169-78. [PMID: 27074179 PMCID: PMC4797561 DOI: 10.6061/clinics/2016(03)09] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/30/2015] [Indexed: 12/13/2022] Open
Abstract
To compare the complications and mortality related to gastrostomy procedures performed using surgical and percutaneous endoscopic gastrostomy techniques, this review covered seven studies. Five of these were retrospective and two were randomized prospective studies. In total, 406 patients were involved, 232 of whom had undergone percutaneous endoscopic gastrostomy and 174 of whom had undergone surgical gastrostomy. The analysis was performed using Review Manager. Risk differences were computed using a fixed-effects model and forest and funnel plots. Data on risk differences and 95% confidence intervals were obtained using the Mantel-Haenszel test. There was no difference in major complications in retrospective (95% CI (-0.11 to 0.10)) or randomized (95% CI (-0.07 to 0.05)) studies. Regarding minor complications, no difference was found in retrospective studies (95% CI (-00.17 to 0.09)), whereas a difference was observed in randomized studies (95% CI (-0.25 to -0.02)). Separate analyses of retrospective and randomized studies revealed no differences between the methods in relation to mortality and major complications. Moreover, low levels of minor complications were observed among endoscopic procedures in randomized studies, with no difference observed compared with retrospective studies.
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Yuan Y, Zhao Y, Xie T, Hu Y. Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances. Cochrane Database Syst Rev 2016; 2:CD009198. [PMID: 26837233 PMCID: PMC8260094 DOI: 10.1002/14651858.cd009198.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Gastrostomy has been established as the standard procedure for administering long-term enteral nutrition in individuals with swallowing disturbances. Percutaneous gastrostomy is a less-invasive approach than open surgical gastrostomy, and can be accomplished via endoscopy (percutaneous endoscopic gastrostomy or PEG) or sonographic or fluoroscopic guidance (percutaneous radiological gastrostomy or PRG). Both techniques have different limitations, advantages, and contraindications. In order to determine the optimal technique for long-term nutritional supplementation many studies have been conducted to compare the outcomes of these two techniques; however, it remains unclear as to which method is superior to the other with respect to both efficacy and safety. OBJECTIVES To compare the safety and efficacy of PEG and PRG in the treatment of individuals with swallowing disturbances. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, January 2016); MEDLINE (1946 to 22 January 2016); EMBASE (1980 to 22 January 2016); the reference lists of identified articles; databases of ongoing trials, including the Chinese Cochrane Centre Controlled Trials Register; and PubMed. We applied no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing PEG with PRG in individuals with swallowing disturbances, regardless of the underlying disease. DATA COLLECTION AND ANALYSIS Two authors independently evaluated the search results and assessed the quality of the studies. Data analyses could not be performed as no RCTs were identified for inclusion in this review. MAIN RESULTS We identified no RCTs comparing PEG and PRG for percutaneous gastrostomy in individuals with swallowing disturbances. The large body of evidence in this field comes from retrospective and non-randomised controlled studies and case series. Based on this evidence, both PEG and PRG can be safely performed in selected individuals, although both are associated with major and minor complications. A definitive RCT has yet to be conducted to identify the preferred percutaneous gastrostomy technique. AUTHORS' CONCLUSIONS Both PEG and PRG are effective for long-term enteral nutritional support in selected individuals, though current evidence is insufficient to recommend one technique over the other. Choice of technique should be based on indications and contraindications, operator experience and the facilities available. Large-scale RCTs are required to compare the two techniques and to determine the optimal approach for percutaneous gastrostomy.
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Affiliation(s)
- Yong Yuan
- West China Hospital, Sichuan UniversityDepartment of Thoracic SurgeryNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Yongfan Zhao
- West China Hospital, Sichuan UniversityDepartment of Thoracic and Cardiovascular SurgeryNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Tianpeng Xie
- West China Hospital, Sichuan UniversityDepartment of Thoracic and Cardiovascular SurgeryNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Yang Hu
- West China Hospital, Sichuan UniversityDepartment of Thoracic and Cardiovascular SurgeryNo. 37, Guo Xue XiangChengduSichuanChina610041
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Matsutani T, Nomura T, Hagiwara N, Fujita I, Kanazawa Y, Kakinuma D, Kanno H, Matsuda A, Ohta K, Uchida E. Comparison of Postoperative Pain Following Laparoscopic Versus Open Gastrostomy/Jejunostomy in Patients with Complete Obstruction Caused by Advanced Esophageal Cancer. J NIPPON MED SCH 2016; 83:228-234. [DOI: 10.1272/jnms.83.228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Takeshi Matsutani
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
| | - Tsutomu Nomura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
| | - Nobutoshi Hagiwara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
| | - Itsuo Fujita
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
| | - Yoshikazu Kanazawa
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
| | - Daisuke Kakinuma
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
| | - Hitoshi Kanno
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
| | - Keiichiro Ohta
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
| | - Eiji Uchida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine
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Soares da Silva MQ, Lederman A, Coelho da Rocha RF, Lourenção RM. Feeding tube replacement: not always that simple! AUTOPSY AND CASE REPORTS 2015; 5:49-52. [PMID: 26484325 PMCID: PMC4608172 DOI: 10.4322/acr.2014.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/20/2015] [Indexed: 01/12/2023] Open
Abstract
Although surgical gastrostomy is not a technically troublesome surgery, the procedure may be accompanied by unfavorable outcomes. Most complications occur early in the post-operative period and include feeding tube dislodgment, stomal infection, peritonitis, and pneumonia. The authors report the case of an 83-year-old man who underwent a surgical gastrostomy because of a swallowing disorder after an ischemic stroke. Nine months after the procedure, the feeding tube dislodged and a new tube was inserted with a certain delay and with some difficulty, causing a false path and consequently an intrabdominal abscess after diet infusion. The outcome was fatal. The authors call attention for meticulous care with the insertion of feeding tubes and advise the performance of imaging control to assure its precise positioning.
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Affiliation(s)
- Mateus Quitembo Soares da Silva
- Surgery Division - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil . ; Surgery Department - Clínica Girassol, Luanda - Angola
| | - Alex Lederman
- Surgery Division - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
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Kouhen F, Afif M, Benhmidou N, El Majjaoui S, Elkacemi H, Kebdani T, Benjaafar N. [What nutritional management in patients with head and neck cancers undergoing radiotherapy? An overview]. Bull Cancer 2015; 102:874-9. [PMID: 26384695 DOI: 10.1016/j.bulcan.2015.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/04/2015] [Accepted: 07/22/2015] [Indexed: 11/24/2022]
Abstract
Radiotherapy is an effective treatment for head and neck cancers but patients often experience side effects, which lead to malnutrition. Morbidity related to weight loss during treatment may include dehydration, hospitalization, compromised treatment efficacy, and reduced quality of life and may impact survival hence the importance of early nutritional management prior to radiotherapy. Multiple interventions have been implemented to help ameliorate the impact of treatment on weight loss and nutritional status, including the use of percutaneous endoscopic gastrostomy tubes. The goal of this overview is to search the predictive factors of malnutrition and an overview of the different types of nutritional interventions and their impact on the local control of the disease, mortality and quality of life of patients treated with radiotherapy or concomitant chemoradiotherapy.
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Affiliation(s)
- Fadila Kouhen
- Université Mohammed 5 Souissi, Institut national d'oncologie, service de radiothérapie, Rabat, Maroc.
| | - Mohammed Afif
- Université Mohammed 5 Souissi, Institut national d'oncologie, service de radiothérapie, Rabat, Maroc
| | - Naoual Benhmidou
- Université Mohammed 5 Souissi, Institut national d'oncologie, service de radiothérapie, Rabat, Maroc
| | - Sanaa El Majjaoui
- Université Mohammed 5 Souissi, Institut national d'oncologie, service de radiothérapie, Rabat, Maroc
| | - Hanan Elkacemi
- Université Mohammed 5 Souissi, Institut national d'oncologie, service de radiothérapie, Rabat, Maroc
| | - Tayeb Kebdani
- Université Mohammed 5 Souissi, Institut national d'oncologie, service de radiothérapie, Rabat, Maroc
| | - Noureddine Benjaafar
- Université Mohammed 5 Souissi, Institut national d'oncologie, service de radiothérapie, Rabat, Maroc
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Mobily M, Patel JA. Palliative percutaneous endoscopic gastrostomy placement for gastrointestinal cancer: Roles, goals, and complications. World J Gastrointest Endosc 2015; 7:364-369. [PMID: 25901215 PMCID: PMC4400625 DOI: 10.4253/wjge.v7.i4.364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/11/2014] [Accepted: 01/12/2015] [Indexed: 02/05/2023] Open
Abstract
Percutaneous endoscopic gastrostomy tube placement is an invaluable tool in clinical practice that has an important role in the palliative care of patients with gastrointestinal cancer. While there is no extensive data regarding the use of this procedure in patients with gastrointestinal malignancy, inferences can be made from the available information derived from studies of similar or mixed populations. Percutaneous endoscopic gastrostomy tubes can be used to provide enteral nutrition for terminal malignancies of the upper gastrointestinal tract as well as for decompression of malignant obstructions. The rates of successful placement for cancer patients with either of these indications are high, similar to those in mixed populations. There is no conclusive evidence that the procedure will help patients reach nutritional goals for those needing alimental supplementation. However, it is effective at relieving symptoms caused by malignant obstruction. A high American Society of Anesthesiologist physical status score and an advanced tumor stage have been shown to be independent predictors of poor outcomes following placement in cancer patients. This suggests the potential for similar outcomes in the palliative care of patients with advanced stage gastrointestinal cancer who may be in relatively poor physiologic condition. However, this potential should not preclude its use in patients with terminal gastrointestinal cancer considering the high rate of successful tube placement, the possible benefits and the ultimate goal of comfort in palliative care.
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Ahmed O, Jilani D, Sheth S, Giger M, Funaki B. Radiologically Guided Placement of Mushroom-retained Gastrostomy Catheters: Long-term Outcomes of Use in 300 Patients at a Single Center. Radiology 2015; 276:588-96. [PMID: 25775194 DOI: 10.1148/radiol.15141327] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess long-term outcomes including risk of complications and nutritional benefits of mushroom-retained (pull-type) gastrostomy catheters placed in patients by interventional radiologists. MATERIALS AND METHODS All patients who received pull-type gastrostomy tubes between 2010 and 2013 were retrospectively reviewed, including 142 men (average weight, 169.6 lb [76.32 kg]; mean age, 65.2 years; range, 22-92 years) and 158 women (average weight, 150.4 lb [67.68 kg]; mean age, 65.2 years; range, 18-98 years). Indications for placement were cerebrovascular accident (n = 80), failure to thrive (n = 71), other central nervous system disorder (n = 51), head and neck cancer (n = 47), and other malignancy (n = 51). Complications were recorded per Society of Interventional Radiology practice guidelines. Patient weight was documented at specific follow-up intervals. Statistical analysis was performed by using the Student t test and one-way analysis of variance for the effects of sex and indication for placement, respectively, on average weight change. RESULTS The technical success rate was 98.4% (300 of 305 patients). Major and minor complications occurred at a rate of 3.7% (n = 11) and 13% (n = 39), respectively. Follow-up weight during the early (≤45 days), intermediate (≤180 days), and long-term (>180 days) periods was available for 71% (n = 214), 36% (n = 108), and 15% (n = 44) of the 300 patients, respectively. Weight gain occurred in 77% (160 of 214), 60% (65 of 108), and 73% (32 of 44) of the patients, respectively. Patients who gained weight gained 6.7, 10.6, and 16.3 lb (3.02, 4.77, and 7.34 kg) during each follow-up period, respectively. Average weight gain at follow-up in all patients was 4.2, 0.6, and 5.4 lb (1.89, 0.27, and 2.43 kg), respectively. No significant differences in average weight change were seen among groups when they were classified according to sex or indication for placement. CONCLUSION Placement of mushroom-retained gastrostomy catheters is a viable long-term treatment option for enteral nutrition, with complication rates similar to those reported for other gastrostomy techniques. Improvement in nutrition status measured as weight gain was seen in most patients in both early and long-term periods.
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Affiliation(s)
- Osman Ahmed
- From the Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (O.A., S.S., M.G., B.F.); and Wright State University Boonshoft School of Medicine, Dayton, Ohio (D.J.)
| | - Danial Jilani
- From the Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (O.A., S.S., M.G., B.F.); and Wright State University Boonshoft School of Medicine, Dayton, Ohio (D.J.)
| | - Sujay Sheth
- From the Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (O.A., S.S., M.G., B.F.); and Wright State University Boonshoft School of Medicine, Dayton, Ohio (D.J.)
| | - Maryellen Giger
- From the Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (O.A., S.S., M.G., B.F.); and Wright State University Boonshoft School of Medicine, Dayton, Ohio (D.J.)
| | - Brian Funaki
- From the Department of Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (O.A., S.S., M.G., B.F.); and Wright State University Boonshoft School of Medicine, Dayton, Ohio (D.J.)
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44
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Shaw SM, Flowers H, O'Sullivan B, Hope A, Liu LWC, Martino R. The effect of prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement on swallowing and swallow-related outcomes in patients undergoing radiotherapy for head and neck cancer: a systematic review. Dysphagia 2015; 30:152-75. [PMID: 25737196 DOI: 10.1007/s00455-014-9592-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/11/2014] [Indexed: 11/29/2022]
Abstract
Patients undergoing radiotherapy for head and neck cancer (HNC) often experience malnutrition and dehydration during treatment. As a result, some centres place PEG tubes prophylactically (pPEG) to prevent these negative consequences. However, recent research has suggested that pPEG use may negatively affect swallowing physiology, function and/or quality of life, especially in the long term. The purpose of this study was to systematically review the literature on pPEG use in HNC patients undergoing radiotherapy and to determine its impact on swallowing-related outcomes. The following electronic databases were searched for all relevant primary research published through February 24, 2014: AMED, CINAHL, the Cochrane Library, Embase, Healthstar, Medline, and PsycINFO. Main search terms included HNC, radiotherapy, deglutition disorders, feeding tube(s), and prophylactic or elective. References for all accepted papers were hand searched to identify additional relevant research. Methodological quality was assessed using Cochrane's Risk of Bias. At all levels, two blinded raters provided judgments. Discrepancies were resolved by consensus. The search retrieved 181 unique citations. Twenty studies met our inclusion criteria. Quality assessment revealed that all studies were at risk for bias due to non-randomized sampling and unreported or inadequate blinding. Ten studies demonstrated selection bias with significant baseline differences between pPEG patients and controls. Results regarding the frequency and severity of dysphagia and swallowing-related outcomes were varied and inconclusive. The impact of pPEG use on swallowing and swallowing-related outcomes remains unclear. Well-controlled, randomized trials are needed to determine if pPEG places patients at greater risk for developing long-term dysphagia.
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Affiliation(s)
- Stephanie M Shaw
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, 160-500 University Ave., Toronto, ON, M5G 1V7, Canada,
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45
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Khaja SF, Schularick NM, Hoffman HT. Can technique used for gastrostomy tube placement reduce the risk of gastrostomy-site metastasis in head and neck cancer patients? Laryngoscope 2015; 125:2016-7. [DOI: 10.1002/lary.25188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/13/2014] [Accepted: 01/09/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Sobia F. Khaja
- Department of Otolaryngology-Head and Neck Surgery; University of Iowa Hospitals and Clinic; 200 Hawkins Drive Iowa City Iowa U.S.A
| | - Nathan M. Schularick
- Department of Otolaryngology-Head and Neck Surgery; University of Iowa Hospitals and Clinic; 200 Hawkins Drive Iowa City Iowa U.S.A
| | - Henry T. Hoffman
- Department of Otolaryngology-Head and Neck Surgery; University of Iowa Hospitals and Clinic; 200 Hawkins Drive Iowa City Iowa U.S.A
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46
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Shariff AH, Waqas M, Akhtar S. Transcervical approach to percutaneous endoscopic gastrostomy tube insertion in a patient with head and neck cancer. Asian J Endosc Surg 2014; 7:256-9. [PMID: 25131323 DOI: 10.1111/ases.12104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/24/2014] [Accepted: 03/16/2014] [Indexed: 01/01/2023]
Abstract
This is the case of a 48-year-old woman with recurrent head and neck cancer. Six years before presenting at our institution, she was diagnosed with a moderately differentiated squamous cell carcinoma involving the right maxilla and underwent surgical resection followed by chemoradiation. More recently, she presented at our institution with oral bleeding and pain. Examination revealed severe trismus, and biopsy demonstrated recurrent squamous cell carcinoma. She underwent surgical resection with a plan for simultaneous placement of a feeding gastrostomy tube. Owing to the near non-existent mouth opening, traditional per-oral placement of a percutaneous endoscopic gastrostomy (PEG) tube was impossible. Intraoperatively, following tumor resection, endoscopy was performed via direct pharyngeal access through a right cervical incision. The PEG tube was then placed uneventfully. Numerous studies have shown the superiority of PEG tubes over either radiologically or surgically placed gastrostomy tubes. This report describes an approach to PEG placement in a patient in whom per-oral placement was not feasible.
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Affiliation(s)
- Amir Hafeez Shariff
- Section of General Surgery, Department of Surgery, The Aga Khan University, Karachi, Pakistan
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47
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Mansoor H, Masood MA, Yusuf MA. Complications of Percutaneous Endoscopic Gastrostomy Tube Insertion in Cancer Patients: A Retrospective Study. J Gastrointest Cancer 2014; 45:452-9. [DOI: 10.1007/s12029-014-9630-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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48
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Habib SF, Ahmed S, Skelly R, Bhatt K, Patel B, Lowe D, Tuson J, Rogers SN. Developing a protocol for gastrostomy tube insertion in patients diagnosed with head and neck cancer. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:551-559. [DOI: 10.1016/j.oooo.2013.12.412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 12/01/2013] [Accepted: 12/30/2013] [Indexed: 01/05/2023]
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Artul S, Nseir W, Assaf V, Abboud N. Abdominal wall necrotising fasciitis due to dislodged percutaneous endoscopic gastrostomy tube. BMJ Case Rep 2014; 2014:bcr-2013-201346. [PMID: 24591380 DOI: 10.1136/bcr-2013-201346] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Accessing the stomach via a percutaneous endoscopic gastrostomy (PEG) tube is the preferred (and sometimes the only) method for providing enteral nutritional support in disabled patients. However, it is associated with serious and potentially lethal complications which must be completely recognised by physicians, by nurses and especially by radiologists. Abdominal wall necrotising fasciitis of a dislodged or leaking PEG tube could be a lethal complication. We present a case of a 74-year-old bed bound woman who was admitted to our hospital with fever and abdominal pain. On presentation, the patient's temperature was 36°C and laboratory tests showed leucocytosis. Physical examination revealed extensive redness of the abdominal wall, diffuse tenderness of the abdomen and yellowish discharge around the gastrostomy.
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Affiliation(s)
- Suheil Artul
- Department of Radiology, EMMS Hospital, Bar Ilan University, Faculty of Medicine, Nazareth, Israel
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50
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Anselmo CB, Tercioti Junior V, Lopes LR, Coelho Neto JDS, Andreollo NA. Surgical gastrostomy: current indications and complications in a university hospital. Rev Col Bras Cir 2014; 40:458-62. [PMID: 24573623 DOI: 10.1590/s0100-69912013000600007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 11/18/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the surgical gastrostomies performed at a public University Hospital, their indications and complications. METHODS We conducted a retrospective, nonrandomized review of medical records of patients who underwent surgical gastrostomy from 2007 to 2011; RESULTS , In the period of studied, 86 patients underwent surgical gastrostomies for enteral nutrition. The Stamm technique was employed in all cases. Men constituted 76 (88%) of the cases and the mean age was 58.4 years, the maximum age being 87 years and the minimum 19. We observed 16 (18.60%) minor complications, 17 (19.76%) serious complications and 8 (9.3%) perioperative deaths. CONCLUSION Surgical gastrostomy, while considered a smaller procedure, is not without complications and mortality. The Stamm technique, despite the complications reported, is easy to perform and to handle, as well as safe.
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