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Nishida T, Higaki Y, Nakamatsu D, Matsumoto K, Yamamoto M. Hemorrhagic shock from gastric pseudoaneurysm post-percutaneous endoscopic gastrostomy: a case report. Clin J Gastroenterol 2024:10.1007/s12328-024-02016-8. [PMID: 38997528 DOI: 10.1007/s12328-024-02016-8] [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: 06/15/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024]
Abstract
Percutaneous endoscopic gastrostomy (PEG) is widely used for long-term enteral nutrition in patients unable to maintain adequate oral intake. Despite advancements in PEG techniques, complications remain a concern. We report a case of a 94-year-old bedridden man who developed significant complications after PEG placement using the pull method. Initially, minor bleeding at the puncture site was managed using traction compression. However, the patient later experienced hemorrhagic shock owing to pulsatile bleeding around the gastrostomy site. Despite attempts to control the bleeding through traction and transfusions, a pseudoaneurysm adjacent to the PEG button was identified. The patient underwent successful transcatheter arterial embolization (TAE). Post-TAE, no further bleeding or hematoma was observed, and imaging confirmed the resolution of the pseudoaneurysm and hematoma. Methicillin-resistant Staphylococcus aureus (MRSA) infection was detected at the gastrostomy site, which contributed to complications. Despite successful management of the bleeding, the patient's overall condition deteriorated, and he died on postoperative day 66. This case underscores the importance of vigilant monitoring and management of PEG-related complications, particularly infections that may precipitate severe vascular events.
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Affiliation(s)
- Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan.
| | - Yu Higaki
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Dai Nakamatsu
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Kengo Matsumoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Masashi Yamamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
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2
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Chu HS, Lee H. YouTube as a possible learning platform for patients and their family caregivers for gastrostomy tube feeding: A cross-sectional study. Nutr Clin Pract 2024. [PMID: 38958580 DOI: 10.1002/ncp.11186] [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: 04/26/2024] [Revised: 06/06/2024] [Accepted: 06/15/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Many patients and family caregivers have informational needs, especially regarding gastrostomy care and home gastrostomy tube feeding. YouTube is a potential accessible option for educational resources concerning these topics. METHODS This study aimed to explore the educational quality and content of informational YouTube videos. We used "gastrostomy," "G-tube," "enteral feeding," and "enteral nutrition," as search keywords on YouTube on October 3, 2021. A total of 229 videos were evaluated using the global quality scale (GQS) and modified DISCERN scoring system. Variables extracted from the videos included general features, video parameters, and content themes. RESULTS The GQS and modified DISCERN scores were 3.31 ± 0.90 and 2.63 ± 1.23, respectively. There were educational quality and differences among videos uploaded by various agencies. Frequent video content themes included "cleaning and dressing a gastrostomy tube," "bolus method," and "replacing a balloon-type of gastrostomy tube." CONCLUSION Results showed that YouTube can be a supplemental educational resource for people requiring gastrostomy care and for their caregivers. However, given the open-access nature of YouTube, healthcare professionals' guidance is needed for video selection. Healthcare professionals should know and use specific, reliable resources to effectively guide and educate patients with gastrostomy and their caregivers, enhancing their self-management skills and knowledge.
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Affiliation(s)
- Hyeon Sik Chu
- College of Nursing, Dankook University, Cheonan-si, Republic of Korea
| | - Hanyi Lee
- College of Nursing, Hanyang University, Seoul, Republic of Korea
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3
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Grund KE, Zipfel A, Jost WH. [Intrajejunal levodopa in Parkinson's disease: Optimization of PEG application]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024. [PMID: 38959947 DOI: 10.1055/a-2337-3433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
The various forms of Percutaneous Endoscopic Gastrostomy (PEG) are highly relevant in neurology, as pump-administered intrajejunal levodopa application is one of the indispensable forms of therapy in advanced Parkinson's disease. Optimal PEG placement and follow-up are therefore significant for the success of the therapy. However, the standard intrajejunal administration of levodopa gel via a JET-PEG, i. e. a PEG with an internal catheter inserted into the jejunum, is not without problems for various reasons. In particular, the considerable cumulative complication rates demand a reconsideration of the situation. The very limited absorption area of the drug in the region of the flexura duodenojejunalis must also be taken into account. Causes of complications are predominantly a non-optimal application technique of PEG and internal catheter as well as the frequent lack of an adequate follow-up. In this paper, the details of a modified and optimized application technique compared to the conventional techniques are presented. These new methods have proved their usefulness in clinical applications for years, and additionally a new application form, the Hybrid-PEG, is presented. However, many of the details derived from anatomical/physiological, surgical and endoscopic aspects must be strictly observed during the application in order to reduce or avoid minor and major complications. In particular, problems are caused by local infections in the area of the insertion point of the PEG including peritonitis, leaks and buried bumper syndrome (BBS). The relatively frequent dislocations of the internal catheter also prove to be particularly troublesome. These can ultimately be avoided by clip fixation of the catheter tip down in the jejunum. In particular, the use of the newly developed Hybrid-PEG, a combination of endoscopically controlled gastropexy with three sutures and subsequent central thread-pull-through of the PEG tube, can significantly reduce the complication rate and thus achieve a decisive improvement for patients. The aspects discussed here are highly relevant for all those involved in the therapy of advanced Parkinson's disease. Trustful interdisciplinary collaboration between neurology and endoscopy/surgery/gastroenterology is a prerequisite for good clinical outcomes.
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Affiliation(s)
- Karl-Ernst Grund
- Experimentelle chirurgische Endoskopie, Universitätsklinikum Tübingen, Universitätsklinik für Allgemeine Viszeral- und Transplantationschirurgie, Tübingen, Germany
| | - Annette Zipfel
- Experimentelle chirurgische Endoskopie, Universitätsklinikum Tübingen, Universitätsklinik für Allgemeine Viszeral- und Transplantationschirurgie, Tübingen, Germany
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Tae CH, Lee JY, Joo MK, Park CH, Gong EJ, Shin CM, Lim H, Choi HS, Choi M, Kim SH, Lim CH, Byeon JS, Shim KN, Song GA, Lee MS, Park JJ, Lee OY. Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy. Gut Liver 2024; 18:10-26. [PMID: 37850251 PMCID: PMC10791499 DOI: 10.5009/gnl230146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/06/2023] [Accepted: 06/20/2023] [Indexed: 10/19/2023] Open
Abstract
With an aging population, the number of patients with difficulty swallowing due to medical conditions is gradually increasing. In such cases, enteral nutrition is administered through a temporary nasogastric tube. Long-term use of a nasogastric tube leads to various complications and a decreased quality of life. Percutaneous endoscopic gastrostomy (PEG) is the percutaneous placement of a tube into the stomach, aided endoscopically, which may be an alternative to a nasogastric tube when enteral nutritional is required for 4 weeks or more. This paper is the first Korean clinical guideline for PEG. It was developed jointly by the Korean College of Helicobacter and Upper Gastrointestinal Research and led by the Korean Society of Gastrointestinal Endoscopy. These guidelines aimed to provide physicians, including endoscopists, with the indications, use of prophylactic antibiotics, timing of enteric nutrition, tube placement methods, complications, replacement, and tubes removal for PEG based on the currently available clinical evidence.
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Affiliation(s)
- Chung Hyun Tae
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ju Yup Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Moon Kyung Joo
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Eun Jeong Gong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Lim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Sang Hoon Kim
- Department of Gastroenterology, Dongguk University Ilsan Hospital, Goyang, Korea
- Korean College of Helicobacter and Upper Gastrointestinal Research–Metabolism, Obesity & Nutrition Research Group, Seoul, Korea
| | - Chul-Hyun Lim
- Division of Gastroenterology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Korean Society of Gastrointestinal Endoscopy–The Research Group for Endoscopes and Devices, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University College of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon Sung Lee
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jong-Jae Park
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
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Park JW, Kim TG, Cho KB, Kim JS, Cho JW, Jeon JW, Lim SG, Kim CG, Park HJ, Kim TJ, Kim ES, Jeong SJ, Kwon YH. A Multicenter Survey of Percutaneous Endoscopic Gastrostomy in 2019 at Korean Medical Institutions. Gut Liver 2024; 18:77-84. [PMID: 38013476 PMCID: PMC10791510 DOI: 10.5009/gnl230174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/29/2023] Open
Abstract
Background/Aims : This study aimed to review the indications, methods, cooperation, complications, and outcomes of percutaneous endoscopic gastrostomy (PEG). Methods : Questionnaires were sent to 200 hospitals, of which 62 returned their questionnaires, with a response rate of approximately 30%. Descriptive statistics were calculated to analyze the responses to the questionnaires. Results : In 2019, a total of 1,052 PEGs were performed in 1,017 patients at 62 hospitals. The main group who underwent PEG was older adult patients with brain disease, particularly stroke. Nutritional supply was an important purpose of the PEG procedure. "The pull method" was the most commonly used for initial PEG insertion. The complications related to PEG were mostly mild, with leakage being the most common. Patients who underwent PEG procedures were primarily educated regarding the post-procedure management and complications related to PEG. Preoperative meetings were skipped at >50% of the institutions. Regarding the cooperation between the nutrition support team (NST) and the physician performing PEG, few endoscopists answered that they cooperated with NST before and after PEG. Moreover, the rate of NST certification obtained by physicians performing PEG and the frequency of attendance at NST-related conferences were relatively low. Conclusions : This study shows a similar trend to that found in the previous PEG guidelines. However, it covers new aspects, including team-based work for PEG procedure, nutrition support, and education for patients and guardians. Therefore, each medical institution needs to select an appropriate method considering the medical environment and doctor's abilities.
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Affiliation(s)
- Jun Woo Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Tae Gyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Kwang Bum Cho
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jeong Seok Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jin Woong Cho
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jung Won Jeon
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Sun Gyo Lim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Chan Gyoo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Hong Jun Park
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Tae Jun Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sun Kim
- Department of Gastroenterology, Korea University College of Medicine, Seoul, Korea
| | - Su Jin Jeong
- Department of Pediatric Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Yong Hwan Kwon
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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6
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Grund KE, Zipfel A, Duckworth-Mothes B, Jost WH. Optimised endoscopic access for intrajejunal levodopa application in idiopathic Parkinson's syndrome. J Neural Transm (Vienna) 2023; 130:1383-1394. [PMID: 36809488 PMCID: PMC10645636 DOI: 10.1007/s00702-023-02601-0] [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: 01/06/2023] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
Pump-guided intrajejunal levodopa administration is one of the indispensable forms of therapy in advanced Parkinson's syndrome, along with deep brain stimulation and subcutaneous apomorphine injection. The standard application of levodopa gel via a JET-PEG, i.e. a percutaneous endoscopic gastrostomy (PEG) with an inserted internal catheter into the jejunum, has not been unproblematic due to the restricted absorption area of the drug in the region of the flexura duodenojejunalis and especially due to the sometimes considerable accumulated complication rates of a JET-PEG. Causes of complications are mainly a non-optimal application technique of PEG and internal catheter as well as the often missing adequate follow-up care. This article presents the details of a-compared to the conventional technique-modified and optimised application technique, which has been clinically proven successfully for years. However, many details derived from anatomical, physiological, surgical and endoscopic aspects must be strictly observed during the application to reduce or avoid minor and major complications. Local infections and buried bumper syndrome cause particular problems. The relatively frequent dislocations of the internal catheter (which can ultimately be avoided by clip-fixing the catheter tip) also prove to be particularly troublesome. Finally, using the Hybrid technique, a new combination of an endoscopically controlled gastropexy with 3 sutures and subsequent central thread pull-through (TPT) of the PEG tube, the complication rate can be dramatically reduced and thus a decisive improvement achieved for patients. The aspects discussed here are highly relevant for all those involved in the therapy of advanced Parkinson's syndrome.
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Affiliation(s)
- K E Grund
- Surgical and Experimental Endoscopy, University Hospital of Tübingen, Tübingen, Germany.
- , Gottwollshaeuser Steige 25, 74523, Schwaebisch Hall, Germany.
| | - A Zipfel
- Surgical and Experimental Endoscopy, University Hospital of Tübingen, Tübingen, Germany
| | - B Duckworth-Mothes
- Working Group for Experimental Endoscopy, Education and Training, Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Tübingen, Germany
| | - W H Jost
- Parkinson-Klinik Ortenau, Wolfach, Germany
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7
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Ahmad MB, Ansar F, Shakoor K, Adnan M, Naqi SA, Tahir Z, Rauf MS, Bin Shafaat Chaudhary U, Alamgir A, Aslam N. Compliance With Percutaneous Endoscopic Gastrostomy Tube Insertion Guidelines and Associated Complications in a Tertiary Care Setting: A Clinical Audit. Cureus 2023; 15:e43566. [PMID: 37719490 PMCID: PMC10503224 DOI: 10.7759/cureus.43566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION Percutaneous endoscopic gastrostomy (PEG) tube insertion is a widely utilized enteral access technique offering long-term nutritional support for patients unable to tolerate oral intake. While the PEG tube provides numerous advantages, adherence to evidence-based guidelines is crucial to minimize complications. This study aims to evaluate adherence to PEG tube insertion guidelines and analyze associated complication rates in a tertiary care setting. METHODS A retrospective clinical audit was conducted at Quaid-e-Azam International Hospital, Islamabad. Data were collected over three years from patients undergoing PEG tube insertion by a single consultant gastrointestinal surgeon. Adherence to guidelines was evaluated using a 10-item checklist developed based on European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Complication rates and patient characteristics were analyzed. RESULTS The study included 70 participants (mean age = 72.21 ± 13.17). The PEG tube insertion rate was 100%. The mean checklist score was 8.34 ± 1.2. Laboratory investigations were performed for 98.6% of patients. 91.4% of patients had a life expectancy exceeding 30 days. 60% of patients received an anticoagulation hold. Prophylactic antibiotics were administered to 90% of patients. Psychological counseling and dietician consultation were offered to 38.6% and 64.2% of patients, respectively. Caregivers received specialized training in 98.5% of cases. 12.8% of patients experienced early complications post-procedure, and 14.2% experienced late complications. PEG tube removal occurred in 27% of patients, with only one patient experiencing complications after removal. CONCLUSION Adherence to PEG tube insertion guidelines was observed in various aspects of patient care, resulting in a low incidence of complications. Comprehensive auditing and guideline adherence are essential to ensure optimal patient safety and procedural outcomes.
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Affiliation(s)
| | - Farrukh Ansar
- Medicine, Quaid-e-Azam International Hospital, Islamabad, PAK
| | - Kainaat Shakoor
- Medicine, Quaid-e-Azam International Hospital, Islamabad, PAK
| | - Muhammad Adnan
- Medicine, Quaid-e-Azam International Hospital, Islamabad, PAK
| | - Syed Ali Naqi
- Surgery, Quaid-e-Azam International Hospital, Islamabad, PAK
| | - Zainab Tahir
- Surgery, Quaid-e-Azam International Hospital, Islamabad, PAK
| | - Mohammad S Rauf
- Medicine and Surgery, Northwest General Hospital, Peshawar, PAK
| | | | - Asad Alamgir
- Internal Medicine, Fauji Foundation Hospital Rawalpindi, Islamabad, PAK
| | - Nabiha Aslam
- Surgery, Quaid-e-Azam International Hospital, Islamabad, PAK
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8
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Thomas N, Thomas CP, Pai CG. An unusual complication of percutaneous endoscopic gastrostomy and its endoscopic treatment. Indian J Gastroenterol 2023; 42:580-581. [PMID: 37133644 DOI: 10.1007/s12664-022-01279-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
| | | | - C Ganesh Pai
- Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576 104, India.
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Leifeld L, Denzer U, Frieling T, Jakobs R, Faiss S, Lenzen H, Lynen P, Mayerle J, Ockenga J, Tappe U, Terjung B, Wedemeyer H, Albert J. [Structural, procedural, and personnel requirements for cross-sectoral provision of endoscopic gastroenterological procedures]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:799-809. [PMID: 37494075 DOI: 10.1055/a-2105-4995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Gastroenterology has made crucial advances in diagnostic and interventional endoscopic procedures, opening up improvements in the treatment of many patients. Thus, organ-preserving treatments are increasingly being made possible, replacing more invasive organ resecting surgical procedures. At the same time, the degree of complexity and risks varies widely between different endoscopic procedures. In many cases, simpler endoscopic procedures are now offered on an outpatient basis. Further potential for cross-sectoral performance of endoscopic procedures exists in the case of complex endoscopic procedures, which, however, require special structural, procedural and personnel requirements in order to provide quality-assured treatment, enable post-interventional monitoring and, if necessary, take measures to ensure the success of the treatment. We summarize the essential prerequisites and limitations for cross-sector performance of endoscopic procedures in gastroenterology.
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Affiliation(s)
- Ludger Leifeld
- Medizinische Klinik 3 - Allgemeine Innere Medizin und Gastroenterologie, St Bernward Krankenhaus, Hildesheim, Deutschland
| | - Ulrike Denzer
- Klinik und Poliklinik für Gastroenterologie, Endokrinologie, Stoffwechsel und klinische Infektiologie, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Deutschland
| | - Thomas Frieling
- Medizinische Klinik II, Helios Klinikum Krefeld, Krefeld, Deutschland
| | - Ralf Jakobs
- Medizinische Klinik C mit Schwerpunkt Gastroenterologie, Klinikum Ludwigshafen, Deutschland
| | - Siegbert Faiss
- Gastroenterologie, Sana Klinikum Lichtenberg, Berlin, Deutschland
| | - Henrike Lenzen
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Deutschland
| | - Petra Lynen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Julia Mayerle
- Klinik für Innere Medizin II, LMU München, Deutschland
| | - Johann Ockenga
- Medizinische Klinik II, Gesundheit Nord, Klinikverbund Bremen, Deutschland
| | - Ulrich Tappe
- Gastropraxis an der St. Barbara Klinik, Hamm, Deutschland
| | - Birgit Terjung
- Klinik für Innere Medizin und Gastroenterologie, GFO Kliniken Bonn, Deutschland
| | - Heiner Wedemeyer
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Deutschland
| | - Jörg Albert
- Klinik für Gastroenterologie, gastroenterologische Onkologie, Hepatologie, Infektiologie und Pneumologie, Klinikum der Landeshauptstadt Stuttgart gemeinnützige Kommunalanstalt öffentlichen Rechts (gKAöR), Stuttgart, Deutschland
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10
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Bourgeois A, Gkolfakis P, Fry L, Arvanitakis M. Jejunal access for enteral nutrition: A practical guide for percutaneous endoscopic gastrostomy with jejunal extension and direct percutaneous endoscopic jejunostomy. Best Pract Res Clin Gastroenterol 2023; 64-65:101849. [PMID: 37652649 DOI: 10.1016/j.bpg.2023.101849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/02/2023] [Indexed: 09/02/2023]
Abstract
For patients requiring long-term (>4 weeks) jejunal nutrition, jejunal medication delivery, or decompression, a percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) or a direct percutaneous endoscopic jejunostomy (DPEJ) may be indicated. PEG-J is the preferred option if a PEG tube is already in place or if simultaneous gastric decompression and jejunal nutrition are needed. DPEJ is recommended for patients with altered anatomy due to foregut surgery, high risk of jejunal extension migration, and whenever PEG-J fails. Successful placement rates are lower for DPEJ but recent publications have reported improvements, partly due to the use of balloon-assisted enteroscopy. Both techniques are contraindicated in cases of active peritonitis, uncorrectable coagulopathy, and ongoing bowel ischaemia, and relative contraindications include, among other, peptic ulcer disease and haemodynamic or respiratory instability. In this narrative review, we present the most recent evidence on indications, contraindications, technical considerations, adverse events, and outcomes of PEG-J and DPEJ.
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Affiliation(s)
- Amélie Bourgeois
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lucia Fry
- Internal Medicine, Gastroenterology and Geriatrics, Frankenwaldklinikum Kronach, Germany
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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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.
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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
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12
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Bassotti G, Castellani D. Possible Role of Carbocysteine Syrup in the Deflation of Percutaneous Endoscopic Gastrostomy Balloons. Clin Pract 2023; 13:483-486. [PMID: 37530722 PMCID: PMC10136862 DOI: 10.3390/clinpract13020043] [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: 02/04/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 08/03/2023] Open
Abstract
Percutaneous endoscopic gastrostomy is the method of choice to allow enteral access in patients requiring long-term enteral nutrition. However, although generally safe, percutaneous tube positioning may be plagued by several complications. Among these, the deterioration and/or deflation of balloons serving as internal bolster is particularly worrisome in that it may lead to gastrostomy cannulas dislocation. Of interest, such balloon deflation may occur in up to 30% of cases for apparently unexplained causes. Here, we provide a hypothesis that could explain some of these causes.
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Affiliation(s)
- Gabrio Bassotti
- Gastroenterology, Hepatology, and Digestive Endoscopy Section, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Danilo Castellani
- Gastroenterology Unit, Perugia General Hospital, 06129 Perugia, Italy
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13
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Zimmer V. Transpyloric misplacement and intramural dislocation: two novel complications related to balloon-type G-tubes. Porto Biomed J 2023; 8:e210. [PMID: 37152630 PMCID: PMC10158886 DOI: 10.1097/j.pbj.0000000000000210] [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: 11/22/2022] [Accepted: 02/25/2023] [Indexed: 05/09/2023] Open
Affiliation(s)
- Vincent Zimmer
- Marienhausklinik St Josef Kohlhof, Department of Medicine, Neunkirchen, Germany
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
- Corresponding author: Department of Medicine, Marienhausklinik St Josef Kohlhof, Klinikweg 1-5, 66539 Neunkirchen, Germany. E-mail address: (Vincent Zimmer)
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14
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Gurtsiev MK, Teterin YS, Yartsev PA, Zharikov YO, Petrikov SS. [Complications of percutaneous endoscopic gastrostomy in intensive care patients with dysphagia associated with neurological disorders]. Khirurgiia (Mosk) 2023:22-30. [PMID: 37186647 DOI: 10.17116/hirurgia202305122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To develop an effective method for percutaneous endoscopic gastrostomy using gastropexy technology. MATERIAL AND METHODS We retrospectively analyzed 260 ICU patients with dysphagia associated with neurological disorders between 2010 and 2020. All patients were divided into two groups: the main group (n=50) - percutaneous endoscopic gastrostomy with gastropexy, control group (n=210) - surgery without fixing the anterior wall of the stomach to the abdominal wall. RESULTS. G Astropexy significantly reduced the incidence of postoperative complications (p=0.045) and severe complications (grade IIIa and higher) (χ2=3.701, p=0.055). Early postoperative complications occurred in 20 (7.7%) patients. Surgery and subsequent treatment were associated with normalization of leukocyte count (p=0.041), C-reactive protein (p=0.024) and serum albumin (p=0.0012). Mortality was similar in both groups. Overall 30-day mortality rate in both groups was 20.8% that was associated with clinical severity of patients. Percutaneous endoscopic gastrostomy was not the direct cause of death in any case. However, complications of endoscopic gastrostomy aggravated the underlying disease in 2.9% of cases. CONCLUSION Percutaneous endoscopic gastrostomy with gastropexy reduces the incidence of postoperative complications.
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Affiliation(s)
- M Kh Gurtsiev
- Sklifosovskiy Research Institute for Emergency Care, Moscow, Russia
| | - Yu S Teterin
- Sklifosovskiy Research Institute for Emergency Care, Moscow, Russia
| | - P A Yartsev
- Sklifosovskiy Research Institute for Emergency Care, Moscow, Russia
| | - Yu O Zharikov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S S Petrikov
- Sklifosovskiy Research Institute for Emergency Care, Moscow, Russia
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15
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Piñar-Gutiérrez A, Serrano-Aguayo P, García-Rey S, Vázquez-Gutiérrez R, González-Navarro I, Tatay-Domínguez D, Garrancho-Domínguez P, Remón-Ruiz PJ, Martínez-Ortega AJ, Nacarino-Mejías V, Iglesias-López Á, Pereira-Cunill JL, García-Luna PP. Percutaneous Radiology Gastrostomy (PRG)-Associated Complications at a Tertiary Hospital over the Last 25 Years. Nutrients 2022; 14:nu14224838. [PMID: 36432521 PMCID: PMC9694556 DOI: 10.3390/nu14224838] [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: 10/04/2022] [Revised: 11/05/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We aimed to describe and compare the complications associated with different percutaneous radiologic gastrostomy (PRG) techniques. METHODS A retrospective and prospective observational study was conducted. Patients who underwent a PRG between 1995-2020 were included. TECHNIQUES A pigtail catheter was used until 2003, a balloon catheter without pexy was used between 2003-2009 and a balloon catheter with gastropexy was used between 2015-2021. For the comparison of proportions, X2 tests or Fisher's test were used when necessary. Univariate analysis was performed to study the risk factors for PRG-associated complications. RESULTS n = 330 (pigtail = 114, balloon-type without pexy = 28, balloon-type with pexy = 188). The most frequent indication was head and neck cancer. The number of patients with complications was 44 (38.5%), 11 (39.2%) and 54 (28,7%), respectively. There were seven (25%) cases of peritonitis in the balloon-type without-pexy group and 1 (0.5%) in the balloon-type with-pexy group, the latter being the only patient who died in the total number of patients (0.3%). Two (1%) patients of the balloon-type with-pexy group presented with gastrocolic fistula. The rest of the complications were minor. CONCLUSIONS The most frequent complications associated with the administration of enteral nutrition through PRG were minor and the implementation of the balloon-type technique with pexy has led to a decrease in them.
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Affiliation(s)
- Ana Piñar-Gutiérrez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Pilar Serrano-Aguayo
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Silvia García-Rey
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Rocío Vázquez-Gutiérrez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Irene González-Navarro
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Dolores Tatay-Domínguez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | | | - Pablo J. Remón-Ruiz
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | | | - Verónica Nacarino-Mejías
- Servicio de Radiología, Unidad de Radiología Intervencionista, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Álvaro Iglesias-López
- Servicio de Radiología, Unidad de Radiología Intervencionista, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - José Luis Pereira-Cunill
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
- Correspondence:
| | - Pedro Pablo García-Luna
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
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16
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Kozyk M, Strubchevska K, Batke M. Transcolonic misplacement as a rare complication associated with
PEG
tube. Clin Case Rep 2022; 10:e6650. [PMCID: PMC9702337 DOI: 10.1002/ccr3.6650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Marko Kozyk
- Beaumont Hospital Royal Oak Royal Oak Michigan USA
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17
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Mohajir WA, O'keefe SJ, Seres DS. Disease-Related Malnutrition and Enteral Nutrition. Med Clin North Am 2022; 106:e1-e16. [PMID: 36697116 DOI: 10.1016/j.mcna.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
There are many misconceptions surrounding the diagnosing and treatment of malnutrition and around feeding people with enteral nutrition (EN). Often the decisions made by clinicians are made from anecdote or guidelines that may be out of date or supported by low-quality evidence. In this article, we will discuss different aspects of diagnosing malnutrition and delve deeper into the science and evidence behind certain recommendations. Our goal is to better equip the reader with the most current data-supported recommendation, such as indications, contraindications, complications of EN, tube and ostomy complications, types and use of specialized enteral formulas, and home management.
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Affiliation(s)
- Wasay A Mohajir
- Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Stephen J O'keefe
- Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop Street, 853 Scaife Hall, Pittsburgh, PA 15213, USA
| | - David S Seres
- Department of Medicine, Division of Preventive Medicine and Nutrition, Columbia University Irving Medical Center, P&S 9-501, 630 West 168th Street, New York, NY 10032, USA.
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18
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Abdelfattah T, Kaspar M. Gastroenterologist's Guide to Gastrostomies. Dig Dis Sci 2022; 67:3488-3496. [PMID: 35579798 DOI: 10.1007/s10620-022-07538-0] [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: 01/29/2022] [Accepted: 04/22/2022] [Indexed: 12/09/2022]
Abstract
Gastroenterologists are frequently consulted for evaluation feeding tube placement, or for management of complications in an existing feeding tube. Though a frequent topic of consultation for GI Fellows, there are few comprehensive resources for feeding tube placement and troubleshooting available. In this review, we discuss different types of feeding tubes, when each should be considered, and various methods and techniques for placement. Considerations for when one type, method, technique, or specialty may be preferred over the other will be discussed. Additionally, we discuss management of the many complications of indwelling feeding tubes. Our goal is to create a comprehensive review for gastroenterologists to cover clinically relevant questions related to feeding tube placement and management.
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Affiliation(s)
- Thaer Abdelfattah
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, 1200 E Broad Street, West Hospital, 14th Floor, Box 980341, Richmond, VA, USA.
| | - Matthew Kaspar
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, 1200 E Broad Street, West Hospital, 14th Floor, Box 980341, Richmond, VA, USA
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19
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Boeykens K, Duysburgh I, Verlinden W. Prevention and management of minor complications in percutaneous endoscopic gastrostomy. BMJ Open Gastroenterol 2022; 9:bmjgast-2022-000975. [PMID: 35851280 PMCID: PMC9297220 DOI: 10.1136/bmjgast-2022-000975] [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: 06/18/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022] Open
Abstract
Background Percutaneous endoscopic gastrostomy (PEG) was developed by Ponsky-Gauderer in the early 1980s. These tubes are placed through the abdominal wall mainly to administer fluids, drugs and/or enteral nutrition but can also be used for drainage or decompression. The tubes consist of an internal and external retention device. It is a generally safe technique but major or minor complications may arise during and after tube placement. Method A narrative review of the literature investigating minor complications after PEG placement. Results This review was written from a clinical viewpoint focusing on prevention and management of minor complications and documented with real cases from more than 21 years of clinical practice. Conclusions Depending on the literature the incidence of minor complications after gastrostomy placement can be high. To decrease associated morbidity, prevention, early recognition and popper management of these complications are important.
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20
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Rajan A, Wangrattanapranee P, Kessler J, Kidambi TD, Tabibian JH. Gastrostomy tubes: Fundamentals, periprocedural considerations, and best practices. World J Gastrointest Surg 2022; 14:286-303. [PMID: 35664365 PMCID: PMC9131834 DOI: 10.4240/wjgs.v14.i4.286] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/09/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
Gastrostomy tube placement is a procedure that achieves enteral access for nutrition, decompression, and medication administration. Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events (AEs). Appropriate indications, contraindications, ethical considerations, and comorbidities of patients referred for gastrostomy placement should be weighed and balanced. Additionally, endoscopist should consider either a transoral or transabdominal approach is appropriate, and radiologic or surgical gastrostomy tube placement is needed. However, medical history, physical examination, and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.
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Affiliation(s)
- Anand Rajan
- Department ofGastroenterology, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
- Department ofGastroenterology, City of Hope Medical Center, Duarte, CA 91010, United States
| | | | - Jonathan Kessler
- Department ofInterventional Radiology, City of Hope Medical Center, Duarte, CA 91010, United States
| | - Trilokesh Dey Kidambi
- Department ofGastroenterology, City of Hope Medical Center, Duarte, CA 91010, United States
| | - James H Tabibian
- Department ofGastroenterology, UCLA-Olive View Medical Center, Sylmar, CA 91342, United States
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21
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Choi IH, Cho YK. Percutaneous Endoscopic Gastrostomy: Procedure, Complications and Management. BRAIN & NEUROREHABILITATION 2022; 15:e2. [PMID: 36743844 PMCID: PMC9833457 DOI: 10.12786/bn.2022.15.e2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 11/08/2022] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is considered in patients with insufficient oral intake who need enteral feeding or therapeutic gastric decompression. PEG tube feeding is generally superior to nasogastric tube feeding in terms of patients' comfort, long-term use, and feeding efficiency. Patient selection for PEG, the proper endoscopic insertion technique, early recognition of complications, and appropriate management are important for patient care. During preparation, adequate management of anticoagulation and antithrombotic agents are important to prevent bleeding, and prophylactic antibiotics prevent wound infection. Most complications are minor; however, major complications that require surgical correction or are life-threatening may occur, such as wound infection, bleeding, buried bumper syndrome, colocutaneous fistula, perforation, volvulus, and injuries to other organs. This review presents practical guidelines for the selection and preparation of patients, endoscopic insertion methods, and complication management strategies.
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Affiliation(s)
- In Hyoung Choi
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Yu Kyung Cho
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
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22
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„Eingewachsene“ Perkutane-endoskopische-Gastrostomie-Sonde. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01429-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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