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Barq RM, Gassie HE, Sulkowski JP. Necrotizing soft tissue infection following use of Punch Excision of Epithelialized Tract (PEET) procedure for gastrocutaneous fistula closure. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Boeykens K, Duysburgh I. Prevention and management of major complications in percutaneous endoscopic gastrostomy. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000628. [PMID: 33947711 PMCID: PMC8098978 DOI: 10.1136/bmjgast-2021-000628] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 12/17/2022] Open
Abstract
Background Percutaneous endoscopic gastrostomy is a commonly used endoscopic technique where a tube is placed through the abdominal wall mainly to administer fluids, drugs and/or enteral nutrition. Several placement techniques are described in the literature with the ‘pull’ technique (Ponsky-Gardener) as the most popular one. Independent of the method used, placement includes a ‘blind’ perforation of the stomach through a small acute surgical abdominal wound. It is a generally safe technique with only few major complications. Nevertheless these complications can be sometimes life-threatening or generate serious morbidity. Method A narrative review of the literature of major complications in percutaneous endoscopic gastrostomy. Results This review was written from a clinical viewpoint focusing on prevention and management of major complications and documented scientific evidence with real cases from more than 20 years of clinical practice. Conclusions Major complications are rare but prevention, early recognition and popper management are important.
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Affiliation(s)
- Kurt Boeykens
- AZ Nikolaas, Nutrition Support Team, Sint-Niklaas, Oost-Vlaanderen, Belgium
| | - Ivo Duysburgh
- AZ Nikolaas, Nutrition Support Team, Sint-Niklaas, Oost-Vlaanderen, Belgium
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Gkolfakis P, Arvanitakis M, Despott EJ, Ballarin A, Beyna T, Boeykens K, Elbe P, Gisbertz I, Hoyois A, Mosteanu O, Sanders DS, Schmidt PT, Schneider SM, van Hooft JE. Endoscopic management of enteral tubes in adult patients - Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53:178-195. [PMID: 33348410 DOI: 10.1055/a-1331-8080] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
ESGE recommends the "pull" technique as the standard method for percutaneous endoscopic gastrostomy (PEG) placement.Strong recommendation, low quality evidence.ESGE recommends the direct percutaneous introducer ("push") technique for PEG placement in cases where the "pull" method is contraindicated, for example in severe esophageal stenosis or in patients with head and neck cancer (HNC) or esophageal cancer.Strong recommendation, low quality evidence.ESGE recommends the intravenous administration of a prophylactic single dose of a beta-lactam antibiotic (or appropriate alternative antibiotic, in the case of allergy) to decrease the risk of post-procedural wound infection.Strong recommendation, moderate quality evidence.ESGE recommends that inadvertent insertion of a nasogastric tube (NGT) into the respiratory tract should be considered a serious but avoidable adverse event (AE).Strong recommendation, low quality evidence.ESGE recommends that each institution should have a dedicated protocol to confirm correct positioning of NGTs placed "blindly" at the patient's bedside; this should include: radiography, pH testing of the aspirate, and end-tidal carbon dioxide monitoring, but not auscultation alone.Strong recommendation, low quality evidence.ESGE recommends confirmation of correct NGT placement by radiography in high-risk patients (intensive care unit [ICU] patients or those with altered consciousness or absent gag/cough reflex).Strong recommendation, low quality evidence.ESGE recommends that EN may be started within 3 - 4 hours after uncomplicated placement of a PEG or PEG-J.Strong recommendation, high quality evidence.ESGE recommends that daily tube mobilization (pushing inward) along with a loose position of the external PEG bumper (1 - 2 cm from the abdominal wall) could mitigate the risk of development of buried bumper syndrome.Strong recommendation, low quality evidence.
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Affiliation(s)
- Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Edward J Despott
- Royal Free Unit for Endoscopy and Centre for Gastroenterology, UCL Institute for Liver and Digestive Health, The Royal Free Hospital, London, United Kingdom
| | - Asuncion Ballarin
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Torsten Beyna
- Department of Gastroenterology and Therapeutic Endoscopy, Evangelisches Krankenhaus Düsseldorf, Germany
| | - Kurt Boeykens
- Nutrition Support Team, AZ Nikolaas Hospital, Moerlandstraat 1, 9100, Sint-Niklaas, Belgium
| | - Peter Elbe
- Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.,Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Gisbertz
- Department of Gastroenterology, Bernhoven Hospital, Uden, the Netherlands
| | - Alice Hoyois
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Ofelia Mosteanu
- Department of Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - David S Sanders
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital & University of Sheffield, United Kingdom
| | - Peter T Schmidt
- Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Ersta Hospital, Stockholm, Sweden
| | - Stéphane M Schneider
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Gastroentérologie et Nutrition, Nice, France
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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Gravina AG, Tessitore A, Ormando VM, Nagar F, Romeo M, Amato MR, Dallio M, Loguercio C, Federico A, Romano M, Ferraro F. May chronic cough in chronic obstructive pulmonary disease be a contraindication of Percutaneous Endoscopic Gastrostomy placement: a case report. BMC Gastroenterol 2021; 21:31. [PMID: 33478385 PMCID: PMC7819233 DOI: 10.1186/s12876-021-01603-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 01/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background Percutaneous Endoscopic Gastrostomy (PEG) can involve some complications, despite the good safety of its track record. The Buried Bumper Syndrome (BBS) is a rare, late and dangerous complication that consists in the erosion of the internal bumper through the gastric wall. Case presentation We report the development of BBS in a man with chronic obstructive pulmonary disease (COPD) who had a persistent chronic cough which was prevalently but not solely in the morning and required placement of a PEG tube for continuous infusion of Levodopa/carbidopa intestinal gel for advanced Parkinson's disease. Conclusion We believe that COPD with chronic cough while not representing an absolute contraindication to PEG placement, may potentially cause BBS and therefore an appropriate regimen of tube care by expert personnel is mandatory in this setting.
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Affiliation(s)
- A G Gravina
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy.
| | - A Tessitore
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - V M Ormando
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy
| | - F Nagar
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M Romeo
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy
| | - M R Amato
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy
| | - M Dallio
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy
| | - C Loguercio
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy
| | - A Federico
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy
| | - M Romano
- Hepatogastropenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Pansini, 5, 80131, Naples, Italy
| | - F Ferraro
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Complications of percutaneous gastrostomy and gastrojejunostomy tubes in children. Pediatr Radiol 2020; 50:404-414. [PMID: 31848639 DOI: 10.1007/s00247-019-04576-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/21/2019] [Accepted: 11/12/2019] [Indexed: 12/31/2022]
Abstract
Percutaneous feeding tubes are generally considered a safe option for enteral feeding and are widely used in children who require long-term nutritional support. However, complications are not infrequent and can range from bothersome to life-threatening. Radiologists should be familiar with the imaging appearances of potential complications for optimal patient care. In this review, we discuss radiologic appearances of common complications and less frequent but serious complications related to percutaneous feeding tubes. Additionally, as fluoroscopic feeding tube evaluation is often requested as the initial imaging study, we also discuss the fluoroscopic appearances of some uncommon complications.
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Hoang PT, Menias CO, Niemeyer MM. Percutaneous Gastrostomy Tube Placement: Recognizing When Things Go Wrong. Semin Intervent Radiol 2019; 36:264-274. [PMID: 31435135 PMCID: PMC6699954 DOI: 10.1055/s-0039-1693983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Percutaneous radiologic gastrostomy is a commonly performed, minimally invasive procedure for long-term enteral access in patients with a variety of conditions. Compared with other methods, it is less invasive, less costly, and safe, with a high technical success rate. The risk of complications is low, and most require only conservative management. Early, accurate diagnosis of more severe complication is crucial, as these may require prompt intervention. Therefore, radiologists should understand the imaging features, clinical presentation, and management of gastrostomy-related complications. This article will review the indications for long-term enteral access, discuss the available methods, summarize the percutaneous radiologic technique, and highlight the associated complications from gastrostomy placement.
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Affiliation(s)
- Peter T. Hoang
- Diagnostic Radiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Christine O. Menias
- Division of Abdominal Radiology, Mayo Clinic in Arizona, Scottsdale, Arizona
| | - Matthew M. Niemeyer
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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Abstract
Percutaneous endoscopic gastrostomy (PEG) was developed in 1980. Since that time this method has become preferable for long-term enteral nutrition. PEG is an effective and relatively safe procedure for enteral nutrition of patients with impaired enteral feeding. However, complications and mortality are also observed. Indications, contraindications and potential complications of PEG are reviewed in the article.
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Affiliation(s)
- A N Petrovskiy
- Ochapovsky Research Institute - Regional Clinical Hospital #1, Krasnodar, Russia
| | - A Yu Popov
- Ochapovsky Research Institute - Regional Clinical Hospital #1, Krasnodar, Russia
| | - A G Baryshev
- Ochapovsky Research Institute - Regional Clinical Hospital #1, Krasnodar, Russia
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Gjeorgjievski M, Reddy N, Stecevic V, Cappell MS. Abdominal Abscess Related to Endoscopically Placed AspireAssist® Device. ACG Case Rep J 2018; 5:e12. [PMID: 29484305 PMCID: PMC5814570 DOI: 10.14309/crj.2018.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/12/2017] [Indexed: 01/21/2023] Open
Abstract
We report a 55-year-old diabetic woman with abdominal pain, pyrexia, and leukocytosis 3 months after aspiration tube placement. Abdominal computed tomography revealed a hypodense mass (10.8 × 7.2 cm) extending into the right anterior abdominal wall. Aspiration of the abscess revealed purulent fluid that grew Streptococcus intermedius. The aspiration tube was removed and 4 endoclips were deployed to close the intragastric stoma. The patient recovered well with 21 days of antibiotics, with resolution of the abscess and full wound healing.
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Affiliation(s)
- Mihajlo Gjeorgjievski
- Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Naveen Reddy
- Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Veslav Stecevic
- Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Mitchell S. Cappell
- Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, Royal Oak, MI
- Division of Gastroenterology & Hepatology, Department of Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
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Rafiq A, Abbas N, Tariq H, Nayudu SK. Gastro-Hepatic Fistula with Liver Abscess: A Rare Complication of a Common Procedure. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:652-7. [PMID: 26402902 PMCID: PMC4588675 DOI: 10.12659/ajcr.895098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patient: Female, 76 Final Diagnosis: Septic shock secondary to liver abscesses and gastro-hepatic fistula from PEG displacement Symptoms: Acute delirium Medication: — Clinical Procedure: None Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Arsalan Rafiq
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Naeem Abbas
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Hassan Tariq
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
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