|
1
|
Piñar-Gutiérrez A, González-Gracia L, Vázquez Gutiérrez R, García-Rey S, Jiménez-Sánchez A, González-Navarro I, Tatay-Domínguez D, Garrancho-Domínguez P, Remón-Ruiz PJ, Martínez-Ortega AJ, Serrano-Aguayo P, Giménez-Andreu MD, García-Fernández FJ, Bozada-García JM, Nacarino-Mejías V, López-Iglesias Á, Pereira-Cunill JL, García-Luna PP. Percutaneous Gastrostomies: Associated Complications in PUSH vs. PULL Techniques over 12 Years in a Referral Centre. J Clin Med 2024; 13:1836. [PMID: 38610601 PMCID: PMC11012573 DOI: 10.3390/jcm13071836] [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: 02/14/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Objectives: To compare complications associated with percutaneous gastrostomies performed using PUSH and PULL techniques, whether endoscopic (PEG) or radiological (PRG), in a tertiary-level hospital. Methods: This was a prospective observational study. Adult patients who underwent percutaneous PULL or PUSH gastrostomy using PEG or PRG techniques at the Virgen del Rocio University Hospital and subsequently followed up in the Nutrition Unit between 2009-2020 were included. X2 tests or Fisher's test were used for the comparison of proportions when necessary. Univariate analysis was conducted to study risk factors for PRG-associated complications. Results: n = 423 (PULL = 181; PUSH = 242). The PULL technique was associated with a higher percentage of total complications (37.6% vs. 23.8%; p = 0.005), exudate (18.2% vs. 11.2%; p = 0.039), and irritation (3.3% vs. 0%; p = 0.006). In the total sample, there were 5 (1.1%) cases of peritonitis, 3 (0.7%) gastrocolic fistulas, and 1 (0.2%) death due to complications associated with gastrostomy. Gender, age, and different indications were not risk factors for a higher number of complications. The most common indications were neurological diseases (35.9%), head and neck cancer (29%), and amyotrophic lateral sclerosis (17.2%). Conclusions: The PULL technique was associated with more total complications than the PUSH technique, but both were shown to be safe techniques, as the majority of complications were minor.
Collapse
Affiliation(s)
- Ana Piñar-Gutiérrez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Lucía González-Gracia
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Rocío Vázquez Gutiérrez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Silvia García-Rey
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Andrés Jiménez-Sánchez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Irene González-Navarro
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Dolores Tatay-Domínguez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Pilar Garrancho-Domínguez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Pablo J. Remón-Ruiz
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Antonio J. Martínez-Ortega
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Pilar Serrano-Aguayo
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - María Dolores Giménez-Andreu
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | | | | | | | - Álvaro López-Iglesias
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain
| | - José Luis Pereira-Cunill
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| | - Pedro Pablo García-Luna
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
| |
Collapse
|
|
2
|
Stavrou G, Gionga P, Chatziantoniou G, Tzikos G, Menni A, Panidis S, Shrewsbury A, Kotzampassi K. How far is the endoscopist to blame for a percutaneous endoscopic gastrostomy complication? World J Gastrointest Surg 2023; 15:940-952. [PMID: 37342839 PMCID: PMC10277955 DOI: 10.4240/wjgs.v15.i5.940] [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: 12/21/2022] [Revised: 01/28/2023] [Accepted: 04/07/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is a well-established, minimally invasive, and easy to perform procedure for nutrition delivery, applied to individuals unable to swallow for various reasons. PEG has a high technical success rate of insertion between 95% and 100% in experienced hands, but varying complication rates ranging from 0.4% to 22.5% of cases. AIM To discuss the existing evidence of major procedural complications in PEG, mainly focusing on those that could probably have been avoided, had the endoscopist been more experienced, or less self-confident in relation to the basic safety rules for PEG performance. METHODS After a thorough research of the international literature of a period of more than 30 years of published "case reports" concerning such complications, we critically analyzed only those complications which were considered - after assessment by two experts in PEG performance working separately - to be directly related to a form of malpractice by the endoscopist. RESULTS Malpractice by the endoscopist were considered cases of: Gastrostomy tubes passed through the colon or though the left lateral liver lobe, bleeding after puncture injury of large vessels of the stomach or the peritoneum, peritonitis after viscera damage, and injuries of the esophagus, spleen, and pancreas. CONCLUSION For a safe PEG insertion, the overfilling of the stomach and small bowel with air should be avoided, the clinician should check thoroughly for the proper trans-illumination of the light source of the endoscope through the abdominal wall and ensure endoscopically visible imprint of finger palpation on the skin at the center of the site of maximum illumination, and finally, the physician should be more alert with obese patients and those with previous abdominal surgery.
Collapse
Affiliation(s)
- George Stavrou
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
- Department of Surgery, Addenbrooke's Hospital, Cambridge CB22QQ, United Kingdom
| | - Persefoni Gionga
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - George Chatziantoniou
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Georgios Tzikos
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Alexandra Menni
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Stavros Panidis
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Anne Shrewsbury
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Katerina Kotzampassi
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| |
Collapse
|
|
3
|
Okumura T, Kimura T, Yamazaki T, Miyazawa T, Tsukahara Y, Kurozumi M, Iwaya Y, Nagaya T, Umemura T. Management of Rare Hemorrhage From Collateral Vessels During Gastrostomy Replacement Using Percutaneous Transhepatic Occlusion in Patient With Portal Hypertension. GASTRO HEP ADVANCES 2023; 2:652-655. [PMID: 39129867 PMCID: PMC11308812 DOI: 10.1016/j.gastha.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 08/13/2024]
Abstract
A 51-year-old male patient with alcoholic cirrhosis visited our hospital for a scheduled gastrostomy replacement. During the gastrostomy replacement, he suddenly experienced a massive hemorrhage from the fistula site. Based on enhanced computed tomography findings, we concluded that collateral blood vessels from the left gastroepiploic vein had flowed into the varices near the gastrostomy as the main origin of the bleeding. The patient received treatment with percutaneous transhepatic occlusion for the varices, which halted blood flow to the varices. This case suggests the possibility of such a complication in patients with worsening portal hypertension and the effectiveness of percutaneous transhepatic occlusion treatment.
Collapse
Affiliation(s)
- Taiki Okumura
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takefumi Kimura
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
- Consultation Center for Liver Diseases, Shinshu University Hospital, Matsumoto, Japan
| | - Tomoo Yamazaki
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Takayuki Miyazawa
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshinori Tsukahara
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masahiro Kurozumi
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yugo Iwaya
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tadanobu Nagaya
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takeji Umemura
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
- Consultation Center for Liver Diseases, Shinshu University Hospital, Matsumoto, Japan
| |
Collapse
|
|
4
|
Chen BJ, Zeng ZX, Zhao YX, Wu MW, Bao X, Li T, Feng J, Li ZJ, Zhang GL, Feng R. Angioplasty for Supra-Aortic Arterial Lesions from Takayasu Arteritis: Efficacy of Cutting Balloon Angioplasty Versus Conventional Balloon Angioplasty. Ann Vasc Surg 2023:S0890-5096(23)00100-0. [PMID: 36805427 DOI: 10.1016/j.avsg.2023.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND This retrospective study aimed to evaluate the safety and efficacy of cutting balloon angioplasty and conventional balloon angioplasty in supra-aortic arterial lesions caused by Takayasu arteritis. METHODS A total of 46 patients with supra-aortic arterial lesions between January 2011 and December 2018 were included. Cutting balloon angioplasty was applied for 17 patients with 24 supra-aortic arterial lesions (group A), while 29 patients with 36 supra-aortic arterial lesions received conventional balloon angioplasty (group B). The preoperative clinical manifestation, operation result, and postoperative outcomes were recorded and compared in the 2 groups. RESULTS Dizziness, visual disturbance, and unequal/absent pulses were the most common manifestations. The technical success of revascularization was 93.5% (43/46) in patients and 93.3% (56/60) in lesions. The stent implantation rate in group A was significantly lower than that in group B (4.2% vs. 50% in lesions, P < 0.05). Restenosis was the most common complication in both groups. Although the early (≤30 days) and late (>30 days) complications in group A were less than those in group B, there was no significant difference between the 2 groups (P > 0.05). Moreover, the primary-assisted patency of cutting balloon angioplasty and conventional balloon angioplasty at 1, 2, and 5 years were 66.7%, 62.5%, and 62.5% and 61.1%, 58.2%, and 49.8%, there was no significant difference between the 2 groups (P > 0.05), respectively. CONCLUSIONS Compared with conventional balloon angioplasty, cutting balloon angioplasty could be considered a safe and effective alternative for supra-aortic arterial lesions caused by Takayasu arteritis, demonstrating better patency and clinical benefit.
Collapse
Affiliation(s)
- Bing-Ji Chen
- Department of Emergency Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Zhao-Xiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Yu-Xi Zhao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Ming-Wei Wu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Xianhao Bao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Tao Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Zhen-Jiang Li
- Department of Vascular Surgery, The First Affiliated Hospital of the Medical School of Zhejiang University, Hangzhou, Zhejiang, China.
| | - Guang-Lin Zhang
- Department of General Surgery, Jiuquan City People's Hospital, Jiuquan, Gansu, China.
| | - Rui Feng
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai, China.
| |
Collapse
|
|
5
|
Kajihara Y. Gastric Mucosal Laceration due to Percutaneous Endoscopic Gastrostomy. Chonnam Med J 2022; 58:131-132. [PMID: 36245772 PMCID: PMC9535109 DOI: 10.4068/cmj.2022.58.3.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yusaku Kajihara
- Department of Gastroenterology, Fuyoukai Murakami Hospital, Aomori, Japan
| |
Collapse
|
|
6
|
Zhang G, Matthews H, Wong O, Kurda D. Radiologically inserted gastrostomy complications: A case series. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii210021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- George Zhang
- Department of Radiology, The Canberra Hospital, Canberra, Australia
| | - Hayden Matthews
- Australian National University Medical School, Canberra, Australia
| | - Osanna Wong
- Australian National University Medical School, Canberra, Australia
| | - Dylan Kurda
- Department of Radiology, The Canberra Hospital, Canberra, Australia
| |
Collapse
|