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Hu YK, He BW, Su YG, Chen YT, Ru QJ. Meta-analysis of clinical efficacy of percutaneous endoscopic gastrostomy vs percutaneous radiologic gastrostomy. WORLD CHINESE JOURNAL OF DIGESTOLOGY 2025; 33:412-422. [DOI: 10.11569/wcjd.v33.i5.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2025]
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Kleven R, Ikeda I, Cornman-Homonoff J. Percutaneous Radiologic Gastrostomy Tube Placement Techniques. Semin Intervent Radiol 2025; 42:9-16. [PMID: 40342381 PMCID: PMC12058293 DOI: 10.1055/s-0045-1806797] [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: 05/11/2025]
Abstract
Gastrostomy tubes are a common procedure for interventional radiologists. Several techniques are available to obtain gastric access radiologically, including the antegrade, retrograde, and balloon-assisted techniques. The choice of technique can depend on the patient's clinical presentation and the available services at each institution. Indications, preprocedural workup, technique, and postprocedural care help guide the choice of approach. Three common methods will be reviewed in this article: antegrade, retrograde, and balloon assisted. The antegrade technique is comparable to percutaneous endoscopic gastrostomy placement with a decreased incidence of tube dislodgement compared to the retrograde technique, but it requires reliable oral and esophageal access. The retrograde technique reduces the risk of postprocedural infection, has shorter procedure times, and reduces radiation exposure. The balloon-assisted technique reduces procedure time even more than the antegrade or retrograde technique, with comparable outcomes. Understanding the most common techniques available and how they compare is essential to providing patient-centered care.
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Affiliation(s)
- Robert Kleven
- Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, Connecticut
| | - Ian Ikeda
- Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, Connecticut
| | - Joshua Cornman-Homonoff
- Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, New Haven, Connecticut
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Kohli DR, Cosgrove N, Abidi WM, Machicado JD, Desai M, Forbes N, Marya NB, Thiruvengadam NR, Thosani NC, Alipour O, Ngamruengphong S, Elhanafi SE, Sheth SG, Ruan W, Fang JC, McClave SA, Zvavanjanja RC, Radadiya DK, Kamel AY, Qumseya BJ. American Society for Gastrointestinal Endoscopy guideline on gastrostomy feeding tubes: methodology and review of evidence. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2025; 10:1-23. [PMID: 39925405 PMCID: PMC11806427 DOI: 10.1016/j.vgie.2024.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
This article from the American Society for Gastrointestinal Endoscopy (ASGE) provides a full description of the methodology used to inform the final guidance outlined in the accompanying summary and recommendations article for strategies to manage endoscopically placed gastrostomy tubes. This article was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and specifically addresses the utility of PEG versus interventional radiology-guided gastrostomy (IR-G), the need for withholding antiplatelet and anticoagulant medications, appropriate timing to initiate tube feedings, and appropriate selection of the gastrostomy technique in patients with malignant dysphagia. In patients needing enteral access, the ASGE suggests PEG as the preferred technique for initial gastrostomy over IR-G. The ASGE recommends that tube feeding can be safely started within 4 hours of the gastrostomy without the need for an intentional delay. The ASGE suggests that a PEG can be performed without the need to withhold antiplatelet medications. In patients on anticoagulants who need to undergo PEG placement, the ASGE suggests that the periprocedural management of anticoagulants should be based on a multidisciplinary discussion with the patient regarding the risk of bleeding versus cardiovascular adverse events. In patients with malignant dysphagia, either transoral "Pull" PEG or transcutaneous "Direct" PEG can be performed for initial enteral access.
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Affiliation(s)
- Divyanshoo Rai Kohli
- Pancreas and Liver Clinic, Providence Sacred Medical Center, Elson Floyd School of Medicine, Washington State University, Spokane, Washington, USA
| | - Natalie Cosgrove
- Center for Interventional Endoscopy AdventHealth, Orlando, Florida, USA
| | - Wasif M Abidi
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Jorge D Machicado
- Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Madhav Desai
- Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
| | - Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Neil B Marya
- Division of Gastroenterology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Nikhil R Thiruvengadam
- Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA
| | - Nirav C Thosani
- Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
| | - Omeed Alipour
- Division of Gastroenterology, University of Washington Medical Center, Seattle, Washington, USA
| | - Saowanee Ngamruengphong
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sherif E Elhanafi
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Sunil G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Wenly Ruan
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - John C Fang
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah, Salt Lake City, Utah, USA
| | - Stephen A McClave
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Rodrick C Zvavanjanja
- Department of Diagnostic and Interventional Radiology at UTHealth, McGovern Medical School, Houston, Texas, USA
| | - Dhruvil K Radadiya
- Department of Gastroenterology, Hepatology and Motility, University of Kansas, Kansas City, Kansas USA
| | - Amir Y Kamel
- Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
- Department of Pharmacy, UF Health Shands Hospital, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Bashar J Qumseya
- Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
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Kohli DR, Abidi WM, Cosgrove N, Machicado JD, Desai M, Forbes N, Marya NB, Thiruvengadam NR, Thosani NC, Alipour O, Ngamruengphong S, Elhanafi SE, Sheth SG, Ruan W, Fang JC, McClave SA, Zvavanjanja RC, Kamel AY, Qumseya BJ. American Society for Gastrointestinal Endoscopy guideline on gastrostomy feeding tubes: summary and recommendations. Gastrointest Endosc 2025; 101:25-35. [PMID: 39520459 DOI: 10.1016/j.gie.2024.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 08/23/2024] [Indexed: 11/16/2024]
Abstract
This clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for strategies to manage endoscopically placed gastrostomy tubes. This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework. The guideline addresses the utility of PEG versus interventional radiology-guided gastrostomy (IR-G), need for withholding antiplatelet and anticoagulant medications before PEG tube placement, appropriate timing to initiate tube feeding after PEG, and selection of the appropriate technique of gastrostomy in patients with malignant dysphagia. In patients needing enteral access, the ASGE suggests PEG as the preferred technique for initial gastrotomy over IR-G. The ASGE recommends that tube feeding can be safely started within 4 hours of gastrostomy. The ASGE suggests that PEG can be performed without withholding antiplatelet medications. The ASGE suggests that the periprocedural management of anticoagulants should be based on a multidisciplinary discussion regarding the risk of bleeding versus cardiovascular events. In patients with malignant dysphagia, either transoral "pull" PEG or direct PEG can be performed for initial enteral access.
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Affiliation(s)
- Divyanshoo Rai Kohli
- Pancreas and Liver Clinic, Providence Sacred Medical Center, Elson Floyd School of Medicine, Washington State University, Spokane, Washington, USA
| | - Wasif M Abidi
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Natalie Cosgrove
- Center for Interventional Endoscopy AdventHealth, Orlando, Florida, USA
| | - Jorge D Machicado
- Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Madhav Desai
- Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
| | - Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Neil B Marya
- Division of Gastroenterology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Nikhil R Thiruvengadam
- Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA
| | - Nirav C Thosani
- Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
| | - Omeed Alipour
- Division of Gastroenterology, University of Washington Medical Center, Seattle, Washington, USA
| | - Saowanee Ngamruengphong
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sherif E Elhanafi
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Sunil G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Wenly Ruan
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - John C Fang
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah, Salt Lake City, Utah, USA
| | - Stephen A McClave
- Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Rodrick C Zvavanjanja
- Department of Diagnostic and Interventional Radiology at UTHealth, McGovern Medical School, Houston, Texas, USA
| | - Amir Y Kamel
- Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA; Department of Pharmacy, UF Health Shands Hospital, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Bashar J Qumseya
- Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
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Neitzel E, Stearns J, Guido J, Porter K, Whetten J, Lammers L, vanSonnenberg E. Iatrogenic vascular complications of non-vascular percutaneous abdominal procedures. Abdom Radiol (NY) 2024; 49:4074-4091. [PMID: 38849536 DOI: 10.1007/s00261-024-04381-x] [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: 03/05/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well as take steps to minimize risks. METHODS A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J. Biopsy and tumor ablation were deferred from this article. RESULTS 214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG. CONCLUSION Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still can arise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA.
| | - Jack Stearns
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jessica Guido
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Kaiden Porter
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jed Whetten
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Luke Lammers
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Eric vanSonnenberg
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
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Orlandoni P, Jukic Peladic N. Safety and Effectiveness of Percutaneous Endoscopic Gastrostomy May Be Improved by Proper Pre- and Post-Positioning Management of Elderly Patients with Multimorbidity. Nutrients 2024; 16:2893. [PMID: 39275209 PMCID: PMC11397536 DOI: 10.3390/nu16172893] [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: 07/17/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 09/16/2024] Open
Abstract
INTRODUCTION The main risk factors for major complications and early mortality after the positioning of percutaneous endoscopic gastrostomy (PEG) reported in the literature are old age, multimorbidity, and the use of inappropriate methods for PEG positioning. A proper PEG positioning technique and adequate post-positioning patient management and surveillance are the main protective factors, but the information on protective factors in the literature is much poorer. The aim of this study was to provide more information on PEG-related complications and mortality in geriatric patients treated with long-term enteral nutrition administered by PEG according to a specific home enteral nutrition (HEN) protocol. METHODS This was a retrospective study based on data from 136 elderly patients in whom PEG was positioned from 2017 to 2023 at the geriatric hospital IRCCS INRCA, Ancona (Italy), 88 of whom were treated with HEN. Data on PEG-related complications, duration of HEN, hospitalizations, and mortality were analyzed. RESULTS No complications were registered during or immediately after the PEG positioning. The prevalence of a major complication-buried bumper-was in the lower limit of the range reported in the literature (4.32%). The prevalence of minor complications such as peristomal leakage, inadvertent tube removal, and granulation tissue was higher than that reported in the literature (14.71%, 23.53%, 29.41%), while tube blockage and peristomal site infection were less frequent (8.82%, 38.23%). Three hospitalizations for PEG-related complications occurred. Both the all-cause 30-day mortality and within-two-months mortality were lower than those in the literature (1.92% and 3.84%). CONCLUSIONS The impact of the risk factors recognized by the literature on complications and mortality could be probably mitigated by improving the PEG placement techniques and pre- and post-PEG placement patient management practices. Data on the prevalence of complications and mortality must be interpreted in correlation to this information.
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Affiliation(s)
- Paolo Orlandoni
- Clinical Nutrition Unit, National Institute of Health and Science on Aging, IRCCS INRCA Ancona, Via della Montagnola 81, 60127 Ancona, Italy
| | - Nikolina Jukic Peladic
- Vivisol Srl. at Clinical Nutrition Unit, National Institute of Health and Science on Aging, IRCCS INRCA Ancona, Via della Montagnola 81, 60127 Ancona, Italy
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Campbell WA, Chick JFB, Shin DS, Makary MS. Value of interventional radiology and their contributions to modern medical systems. FRONTIERS IN RADIOLOGY 2024; 4:1403761. [PMID: 39086502 PMCID: PMC11288872 DOI: 10.3389/fradi.2024.1403761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/25/2024] [Indexed: 08/02/2024]
Abstract
Interventional radiology (IR) is a unique specialty that incorporates a diverse set of skills ranging from imaging, procedures, consultation, and patient management. Understanding how IR generates value to the healthcare system is important to review from various perspectives. IR specialists need to understand how to meet demands from various stakeholders to expand their practice improving patient care. Thus, this review discusses the domains of value contributed to medical systems and outlines the parameters of success. IR benefits five distinct parties: patients, practitioners, payers, employers, and innovators. Value to patients and providers is delivered through a wide set of diagnostic and therapeutic interventions. Payers and hospital systems financially benefit from the reduced cost in medical management secondary to fast patient recovery, outpatient procedures, fewer complications, and the prestige of offering diverse expertise for complex patients. Lastly, IR is a field of rapid innovation implementing new procedural technology and techniques. Overall, IR must actively advocate for further growth and influence in the medical field as their value continues to expand in multiple domains. Despite being a nascent specialty, IR has become indispensable to modern medical practice.
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Affiliation(s)
- Warren A. Campbell
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, VA, United States
| | - Jeffrey F. B. Chick
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, United States
| | - David S. Shin
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Southern California, Los Angeles, CA, United States
| | - Mina S. Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Chau LC, Soheim R, Dix M, Chung S, Obeid N, Hodari-Gupta A, Stanton C. Risk factors and natural history of bedside percutaneous endoscopic versus fluoroscopy-guided gastrostomy tubes in intensive care unit patients. Surg Endosc 2023; 37:8742-8747. [PMID: 37563346 DOI: 10.1007/s00464-023-10320-6] [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: 03/31/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION There is a paucity of literature comparing patients receiving bedside placed percutaneous endoscopic gastrostomy (PEG) versus fluoroscopic-guided percutaneous gastrostomy tubes (G-tube) in an intensive care unit (ICU) setting. This study aims to investigate and compare the natural history and complications associated with PEG versus fluoroscopic G-tube placement in ICU patients. METHODS All adult patients admitted in the ICU requiring feeding tube placement at our center from 1/1/2017 to 1/1/2022 with at least 12-month follow up were identified through retrospective chart review. Adjusting for patient comorbidities, hospital factors, and indications for enteral access, a 1-to-2 propensity score matched Cox proportional-hazards model was fitted to evaluate the treatment effect of bedside PEG tube placement versus G-tube placement on patient 1-year complication, readmission, and death rates. Major complications were defined as those requiring operative or procedural intervention. RESULTS This study included 740 patients, with 178 bedside PEG and 562 fluoroscopic G-tube placements. The overall rate of complication was 22.3% (13% PEG, 25.2% G-tube, P = 0.003). The major complication rate was 11.2% (8.5% PEG, 12.1% G-tube, P = 0.09). Most common complications were tube dysfunction (16.7% PEG; 39.4% G-tube; P = 0.04) and dislodgement (58.3% PEG; 40.8% G-tube). After propensity score matching, G-tube recipients had significantly increased risk for all-cause (HR 2.7, 95% CI 1.56-4.87, P < 0.001) and major complications (HR 2.11, 95% CI 1.05-4.23, P = 0.035). There were no significant differences in 1-year rates of readmission (HR 0.90, 95% CI 0.58-1.38, P = 0.62) or death (HR 1.00, 95% CI 0.70-1.44, P = 0.7). CONCLUSIONS The overall rate of complications for ICU patients requiring feeding tube in our cohort was 22.3%. ICU patients receiving fluoroscopic-guided percutaneous gastrostomy tube placement had significantly elevated risk of 1-year all-cause and major complications compared to those undergoing bedside PEG.
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Affiliation(s)
- Lucy Ching Chau
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.
| | - Ryan Soheim
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Michael Dix
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Sarah Chung
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Nadia Obeid
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | | | - Cletus Stanton
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
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Piñar-Gutiérrez A, Serrano-Aguayo P, Gutiérrez RV, Rey SG, González-Navarro I, Tatay-Domínguez D, Garrancho-Domínguez P, Remón-Ruiz PJ, Martínez-Ortega AJ, Mejías VN, Iglesias-López Á, Socas M, Morales-Conde S, García-Fernández FJ, Bozada-García JM, Pereira-Cunill JL, García-Luna PP. Gastrostomies: experience and complications with three modalities in a tertiary centre over a 26-year period. Front Med (Lausanne) 2023; 10:1191204. [PMID: 37915325 PMCID: PMC10616244 DOI: 10.3389/fmed.2023.1191204] [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: 03/21/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023] Open
Abstract
Objectives To describe the complications associated with the different gastrostomy techniques [endoscopic (PEG), radiologic (PRG), and surgical (SG)] performed in the last 26 years in a terciary hospital. Methods Retrospective observational study. Patients who underwent gastrostomy at the Virgen del Rocío University Hospital between 1995 and 2021 were included. For PEG, the PULL technique was performed until 2018 and subsequently the PUSH technique predominantly. For PRG, a pigtail catheter was used until 2003, a balloon catheter between 2003 and 2009, and a balloon catheter with gastropexy between 2015 and 2021. For SG, the conventional technique (CSG) was performed until 2009 and since then the laparoscopic assisted percutaneous gastrostomy (PLAG) technique. Descriptive analysis was performed obtaining the median and quartiles of the quantitative variables [P50 (P25-P75)] and the frequency for the qualitative variables [n (%)].The comparison of complications between patients who underwent different techniques was performed with Fisher's test. Results n = 1,070 (PEG = 608, PRG = 344, SG = 118). The three most frequent indications were head and neck tumors, neurological diseases and gastroesophageal tumors. The percentage of patients who had any complication was 48.9% (PEG-PULL), 23.7% (PEG-PUSH), 38.5% (pigtail PRG), 39.2% (balloon PRG), 29.7% (balloon with gastropexy PRG), 87.3% (CSG), and 41.26% (PLAG). 2 (0.18%) patients died from gastrostomy-related complications. 18(1.68%) presented with peritonitis and 5 (0.4%) presented with gastrocolic fistula. The rest of the complications were minor. Conclusion Gastrostomy in any of its modalities is currently a safe procedure with a low rate of complications, most of which are minor.
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Affiliation(s)
- Ana Piñar-Gutiérrez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Pilar Serrano-Aguayo
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Silvia García Rey
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | - Pablo J. Remón-Ruiz
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | - María Socas
- Servicio de Cirugía General, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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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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Dams G, Knapen RRMM, Korenblik R, van Dam RM, de Haan MW, van der Leij C. 12Fr-Pigtail Versus 14Fr-Balloon Percutaneous Radiologic Gastrostomy (PRG), Retrospective Evaluation of Outcomes and Complications; A Maastricht University Medical Centre Study. Cardiovasc Intervent Radiol 2023; 46:1231-1237. [PMID: 37592019 PMCID: PMC10471621 DOI: 10.1007/s00270-023-03527-6] [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: 03/20/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE To retrospectively compare tube and placement related results of a 12Fr-pigtail and a 14Fr-balloon gastrostomy tube. MATERIALS AND METHODS All consecutive patients who underwent percutaneous radiologic gastrostomy (PRG) between January 2016 and June 2020 were enrolled in this retrospective single-center analysis. Follow-up for all patients was 180 days. Mortality after 30 days, technical success, days to first complication within 180 days, reason of unexpected visit (tube, anchor or pain related), and tube specific complications (obstruction, pain, luxation, leakage) were taken as outcome measures. Data were obtained from both PACS software and electronic health records. RESULTS A total of 247 patients were enrolled (12Fr-pigtail: n = 139 patients and 14Fr-balloon: n = 108 patients). 30-day mortality was very low in both groups and never procedure related. Technical success was 99% in both groups. The average number of complications within 180 days after initial PRG placement was significantly higher in the 12Fr-pigtail group (12Fr-pigtail: 0.93 vs. 14Fr-balloon: 0.64, p = 0.028). Time to first complication within 180 days was significantly longer in the 14Fr-balloon group (12Fr-pigtail: 29 days vs. 14Fr-balloon: 53 days, p = 0.005). In the 14Fr-balloon group, the rate of tube-related complications (luxation and obstruction) was significantly lower compared to 12Fr-pigtail (29% vs. 45%, p = 0.011). CONCLUSION 14Fr-balloon gastrostomy tubes have significantly lower (tube-related) complications rates and longer time to first complication compared to 12Fr-pigtail tubes. No procedure-related mortality was observed in either group. Technical success was very high in both groups. Level of Evidence Level 3, non-controlled retrospective cohort study.
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Affiliation(s)
- Glenn Dams
- Department of Radiology and Nuclear Medicine, Zuyderland MC, Sittard-Geleen, Netherlands
| | - Robrecht R M M Knapen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, Netherlands.
- CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands.
| | - Remon Korenblik
- Department of Surgery, Zuyderland MC, Sittard-Geleen, Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Ronald M van Dam
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - Michiel W de Haan
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Christiaan van der Leij
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
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12
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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: 1.5] [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
| | - 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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13
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Liang J, Jiang Y, Abboud Y, Gaddam S. Role of Endoscopy in Management of Upper Gastrointestinal Cancers. Diseases 2022; 11:diseases11010003. [PMID: 36648868 PMCID: PMC9844461 DOI: 10.3390/diseases11010003] [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] [Received: 09/21/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Upper gastrointestinal (GI) malignancy is a leading cause of cancer-related morbidity and mortality. Upper endoscopy has an established role in diagnosing and staging upper GI cancers, screening for pre-malignant lesions, and providing palliation in cases of advanced malignancy. New advances in endoscopic techniques and technology have improved diagnostic accuracy and increased the therapeutic potential of upper endoscopy. We aim to describe the different types of endoscopic technology used in cancer diagnosis, summarize the current guidelines for endoscopic diagnosis and treatment of malignant and pre-malignant lesions, and explore new potential roles for endoscopy in cancer therapy.
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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: 5] [Impact Index Per Article: 1.7] [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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15
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Kohli DR, Radadiya DK, Patel H, Sharma P, Desai M. Comparative outcomes of endoscopic and radiological gastrostomy tube placement: a systematic review and meta-analysis with GRADE analysis. Ann Gastroenterol 2022; 35:592-602. [PMID: 36406969 PMCID: PMC9648526 DOI: 10.20524/aog.2022.0752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/23/2022] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are invasive interventions used for enteral access. We performed a systematic review and meta-analysis with assessment of certainty of evidence to compare the risk of adverse outcomes and technical failure between PEG and PRG. METHODS We queried PubMed, EMBASE, and Cochrane from inception through January 2022 to identify studies comparing outcomes of PEG and PRG. The primary outcome was 30-day all-cause mortality; secondary outcomes included the risk of colon perforation, peritonitis, bleeding, technical failure, peristomal infections, and tube-related complications. We performed GRADE assessment to assess the certainty of evidence and leave-one-out analysis for sensitivity analysis. RESULTS In the final analysis, 33 studies, including 26 high-quality studies, provided data on 275,117 patients undergoing PEG and 192,691 patients undergoing PRG. Data from high quality studies demonstrated that, compared to PRG, PEG had significantly lower odds of selected outcomes, including 30-day all-cause mortality (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.60-0.95; P=0.02), colon perforation (OR 0.61, 95%CI 0.49-0.75; P<0.001), and peritonitis (OR 0.71, 95%CI 0.63-0.81; P<0.001). There was no significant difference between PEG and PRG in terms of technical failure, bleeding, peristomal infections or mechanical complications. The certainty of the evidence was rated moderate for colon perforation and low for all other outcomes. CONCLUSIONS PEG is associated with a significantly lower risk of 30-day all-cause mortality, colon perforation, and peritonitis compared to PRG, while having a comparable technical failure rate. PEG should be considered as the first-line technique for enteral access.
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Affiliation(s)
- Divyanshoo R. Kohli
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, MO (Divyanshoo R. Kohli, Dhruvil K Radadiya, Prateek Sharma, Madhav Desai)
- Pancreas and Liver Clinic, Sacred Heart Medical Center, Spokane WA (Divyanshoo R. Kohli)
| | - Dhruvil K Radadiya
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, MO (Divyanshoo R. Kohli, Dhruvil K Radadiya, Prateek Sharma, Madhav Desai)
| | - Harsh Patel
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA, (Harsh Patel), USA
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, MO (Divyanshoo R. Kohli, Dhruvil K Radadiya, Prateek Sharma, Madhav Desai)
| | - Madhav Desai
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, MO (Divyanshoo R. Kohli, Dhruvil K Radadiya, Prateek Sharma, Madhav Desai)
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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: 14] [Impact Index Per Article: 4.7] [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: 04/03/2022] [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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17
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Comparative Safety of Endoscopic vs Radiological Gastrostomy Tube Placement: Outcomes From a Large, Nationwide Veterans Affairs Database. Am J Gastroenterol 2021; 116:2367-2373. [PMID: 34506328 DOI: 10.14309/ajg.0000000000001504] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/04/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION A gastrostomy is generally performed in patients who are unable to maintain volitional intake of food. We compared outcomes of percutaneous endoscopic gastrostomy (PEG) and interventional radiologist-guided gastrostomy (IRG) using an integrated nationwide database. METHODS Using the VA Informatics and Computing Infrastructure database, patients who underwent PEG or IRG from 2011 through 2021 were selected using Current Procedural Terminology and International Classification of Diseases codes. The primary outcome was the comparative incidence of adverse events between PEG and IRG. Secondary outcomes included all-cause mortality. Comorbidities were identified using International Classification of Diseases codes, and adjusted odds ratio (OR) for adverse events were calculated using multivariate logistic regression analysis. RESULTS A total of 23,566 (70.7 ± 10.2 years) patients underwent PEG and 9,715 (69.6 ± 9.7 years) underwent IRG. Selected frequent indications for PEG vs IRG were as follows: stroke, 6.8% vs 5.3%, P < 0.01; aspiration pneumonia, 10.9% vs 6.8%, P < 0.001; feeding difficulties, 9.8% vs 6.3%, P < 0.01; and upper aerodigestive tract malignancies 58.8% vs 79.8%, P < 0.01. Across all subtypes of malignancies of the head and neck and foregut, the proportion of patients undergoing IRG was greater than those undergoing PEG (P < 0.001). The all-cause 30-day mortality and overall incidence of adverse events were significantly lower for PEG compared with those for IRG (PEG vs IRG): all-cause 30-day mortality, 9.35% vs 10.3% (OR 0.80; 95% confidence interval [CI] 0.74-0.87; P < 0.01); perforation of the colon, 0.12% vs 0.24% (OR 0.50; 95% CI 0.29-0.86; P = 0.04); peritonitis, 1.9% vs 2.7% (OR 0.68; 95% CI 0.58-0.79; P < 0.01); and hemorrhage 1.6% vs 1% (OR 1.47; 95% CI 1.18-1.83; P < 0.01). DISCUSSION In a large nationwide database of more than 33,000 gastrostomy procedures, PEG was associated with a lower incidence of adverse outcomes and the 30-day mortality than IRG.
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18
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Alhasani F, Bazarah S, Ahmed M, Alraddadi B, Alotaibi A. Gastrostomy Tube Insertion Complications and Patient Care Outcomes in a Tertiary Care Hospital. Cureus 2021; 13:e18458. [PMID: 34745782 PMCID: PMC8562559 DOI: 10.7759/cureus.18458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/15/2022] Open
Abstract
Background Percutaneous endoscopic gastrostomy (PEG) is a widely known procedure where an endoscopist inserts a tube through the stomach to provide enteral nutrition. The existing literature shows inconsistent results regarding complication rates, and very few studies have examined the relationship between patient characteristics and PEG outcomes. Therefore, we aimed to investigate PEG tube insertion outcomes and determine different variables associated with these outcomes. Methods This retrospective record review included 207 patients who underwent PEG tube insertion at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between 2010 and 2021. We obtained variables such as demographics, complications, and length of hospitalization. The Student t-test, chi-square test, and Mann-Whitney test were used in the data analysis. Results Of 207 patients, 106 were male (51.2%). The patient's median age was 10 years, and the median length of hospital stay was two days. The PEG-related complication rate was 32.4%, while the 1-year adverse outcome rate was 44.9%. The most common complications were unspecified fever (21.3%) and vomiting (14%). We found a significant relationship between dysphagia and length of hospitalization (P=0.015) and between age and the occurrence of tube leakage (P=0.021). Another significant relationship was found between the number of PEG insertions and gastrostomy-site infection (P=0.046). Conclusions This study's results indicate the importance of a thorough review of patients' medical records; some patient characteristics can be valuable predictors of PEG outcomes. Thus, we urge physicians to study each patient to anticipate PEG tube insertion outcomes carefully. Moreover, we recommend that researchers with access to larger patient registries study more variables to reach unified guidelines that ensure the best possible outcomes.
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Affiliation(s)
- Faisal Alhasani
- Gastroenterology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Salem Bazarah
- Gastroenterology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Mohammad Ahmed
- Gastroenterology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Basim Alraddadi
- Gastroenterology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Amjad Alotaibi
- Gastroenterology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Wei M, Ho E, Hegde P. An overview of percutaneous endoscopic gastrostomy tube placement in the intensive care unit. J Thorac Dis 2021; 13:5277-5296. [PMID: 34527366 PMCID: PMC8411178 DOI: 10.21037/jtd-19-3728] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 05/06/2020] [Indexed: 01/03/2023]
Abstract
Critically ill patients are at increased risk for malnutrition as they often have underlying acute and chronic illness, stress related catabolism, decreased appetite, trauma and ongoing inflammation. Malnutrition is recognized as a leading cause of adverse outcomes, higher mortality, and increased hospital costs. Percutaneous endoscopic gastrostomy (PEG) tubes provide a safe and effective route to provide supplemental enteral nutrition to these patients. PEG placement has essentially replaced surgical gastrostomy as the modality of choice for longer term feeding in patients. This is a highly prevalent procedure with 160,000 to 200,000 PEG procedures performed each year in the United States. The purpose of this review is to provide an overview of current knowledge and practice standards with regards to placement of PEG tube in the Intensive Care Unit (ICU). When a patient is considered for a PEG tube, it is important to evaluate the treatment alternatives and identify the best option for each patient. In this review, we provide the advantages and disadvantages of various feeding modalities and devices. We review the indications and contraindications for PEG tube placement as well as the risks of this procedure. We then describe in detail the per-oral pull, per-oral push, and direct percutaneous techniques for PEG tube placement. Additionally, we review the feasibility of having interventional pulmonologists place PEG tubes in the ICU.
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Affiliation(s)
- Margaret Wei
- Department of Internal Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Elliot Ho
- Division of Advanced Interventional Thoracic Endoscopy/Interventional Pulmonology, University of California San Francisco - Fresno, Fresno, CA, USA
| | - Pravachan Hegde
- Division of Advanced Interventional Thoracic Endoscopy/Interventional Pulmonology, University of California San Francisco - Fresno, Fresno, CA, USA
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Safety of endoscopic gastrostomy tube placement compared with radiologic or surgical gastrostomy: nationwide inpatient assessment. Gastrointest Endosc 2021; 93:1077-1085.e1. [PMID: 32931781 DOI: 10.1016/j.gie.2020.09.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS A gastrostomy tube is often required for inpatients requiring long-term nutritional access. We compared the safety and outcomes of 3 techniques for performing a gastrostomy: percutaneous endoscopic gastrostomy (PEG), fluoroscopy-guided gastrostomy by an interventional radiologist (IR-gastrostomy), and open gastrostomy performed by a surgeon (surgical gastrostomy). METHODS Using the Nationwide Readmissions Database, we identified hospitalized patients who underwent a gastrostomy from 2016 to 2017. They were identified using the International Classification of Diseases, 10th Revision, Procedure Coding System. The selected patients were divided into 3 cohorts: PEG (0DH64UZ), IR-gastrostomy (0DH63UZ), and open surgical gastrostomy (0DH60UZ). Adjusted odds ratios for adverse events associated with each technique were calculated using multivariable logistic regression analysis. RESULTS Of the 184,068 patients meeting the selection criteria, the route of gastrostomy tube placement was as follows: PEG, 16,384 (53.7 ± 29.0 years); IR-gastrostomy, 154,007 (67.2 ± 17.5 years); and surgical gastrostomy, 13,677 (57.9 ± 24.3 years). Compared with PEG, the odds for colon perforation using IR-gastrostomy and surgical gastrostomy, respectively, were 1.90 (95% confidence interval [CI], 1.26-2.86; P = .002) and 6.65 (95% CI, 4.38-10.12; P < .001), for infection of the gastrostomy 1.28 (95% CI, 1.07-1.53; P = .006) and 1.61 (95% CI, 1.29-2.01; P < .001), for hemorrhage requiring blood transfusion 1.84 (95% CI, 1.26-2.68; P = .002) and 1.09 (95% CI, .64-1.86; P = .746), for nonelective 30-day readmission 1.07 (95% CI, 1.03-1.12; P = .0023) and 1.13 (95% CI, 1.06-1.2; P = .0002), and for inpatient mortality 1.09 (95% CI, 1.02-1.17; P = .0114) and 1.55 (95% CI, 1.42-1.69; P < .0001). CONCLUSIONS Placement of a gastrostomy tube (PEG) endoscopically is associated with a significantly lower risk of inpatient adverse events, mortality, and readmission rates compared with IR-gastrostomy and open surgical gastrostomy.
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Jang BS, Park JY, Lee JH, Sim YJ, Jeong HJ, Kim GC. Clinical Factors Associated With Successful Gastrostomy Tube Weaning in Patients With Prolonged Dysphagia After Stroke. Ann Rehabil Med 2021; 45:33-41. [PMID: 33557480 PMCID: PMC7960957 DOI: 10.5535/arm.20149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023] Open
Abstract
Objective To investigate the clinical factors associated with successful gastrostomy tube weaning in patients with prolonged dysphagia after stroke. Methods This study involved a retrospective medical chart review of patients diagnosed with prolonged dysphagia after stroke who underwent gastrostomy tube insertion between May 2013 and January 2020. Forty-seven patients were enrolled and consequently divided into gastrostomy tube sustaining and weaning groups. The numbers of patients in the sustaining and weaning groups were 31 and 16, respectively. The patients’ demographic data, Korean version of Mini-Mental State Examination (K-MMSE) score, Korean version of the Modified Barthel Index (K-MBI), Functional Dysphagia Scale (FDS) score, and Penetration-Aspiration Scale (PAS) score were compared between the two groups. A videofluoroscopic swallowing study was performed before making the decision of gastrostomy tube weaning. The clinical factors associated with gastrostomy tube weaning were then investigated. Results There were significant differences in age; history of aspiration pneumonia; K-MMSE, FDS, and PAS scores; and K-MBI between the groups. In the multiple logistic regression analysis, the FDS (odds ratio [OR]=0.791; 95% confidence interval [CI], 0.634–0.987) and PAS scores (OR=0.205; 95% CI, 0.059–0.718) were associated with successful gastrostomy tube weaning. In the receiver operating characteristic curve analysis, the FDS and PAS were useful screening tools for successful weaning, with areas under the curve of 0.911 and 0.918, respectively. Conclusion In patients with prolonged dysphagia, the FDS and PAS scores are the only factors associated with successful gastrostomy tube weaning. An evaluation of the swallowing function is necessary before deciding to initiate gastrostomy tube weaning.
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Affiliation(s)
- Bo Seong Jang
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Jun Young Park
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Jae Hyun Lee
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Young Joo Sim
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Ho Joong Jeong
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Ghi Chan Kim
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
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22
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Sethupathi S, Walter K, Lim M, Fang A. Retrospective Analysis of the Safety and Outcomes of Percutaneous Radiologic Gastrostomy in Obese vs Nonobese Patients. JPEN J Parenter Enteral Nutr 2021; 45:1714-1719. [PMID: 33433937 DOI: 10.1002/jpen.2075] [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: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study is to compare the safety and outcomes of percutaneous radiologic gastrostomy (PRG) in obese vs nonobese patients. METHODS This is an institutional review board-approved retrospective study of 109 patients (male:female, 68:41; mean age, 64.7 years; range, 21-94 years) who underwent PRG with or without gastropexy at a single academic medical center between 2015 and 2018. Body mass index (BMI) of ≥30 kg/m2 was defined as obese. Patient demographics, indications, technical success, intraoperative variables, and major/minor complications were analyzed. Major and minor complications occurring within 30 days of the procedure were recorded and categorized based on the Society of Interventional Radiology Quality Improvement guidelines. RESULTS Of 109 patients included in the study, 22.9% (n = 25) of patients were obese (average BMI, 34.6 kg/m2 ; range, 30-50). Overall technical success in the obese and nonobese groups was 100% each. In the obese vs nonobese group, major and minor complications were not significantly different. There were also no significant differences in procedure time, fluoroscopy time, or contrast volume. However, mean peak skin dose was significantly increased in the obese group vs nonobese group (190.3 ± 224.2 vs 59.1 ± 71.1 mGy; P < .0001). CONCLUSION PRG is a safe procedure in obese patients with similar technical success, major and minor complication rates, procedure time, fluoroscopy time, and contrast volume. However, PRG is associated with increased radiation dose with obese patients; therefore, optimal methods of radiation protection should be utilized.
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Affiliation(s)
| | - Kate Walter
- Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Maria Lim
- Saint Louis College of Pharmacy, St Louis, Missouri, USA
| | - Adam Fang
- the Department of Diagnostic Radiology and Nuclear Medicine, Division of Vascular and Interventional Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Maasarani S, Khalid SI, Creighton C, Manatis-Lornell AJ, Wiegmann AL, Terranella SL, Skertich NJ, DeCesare L, Chan EY. Outcomes following percutaneous endoscopic gastrostomy versus fluoroscopic procedures in the Medicare population. Surg Open Sci 2020; 3:2-7. [PMID: 33937737 PMCID: PMC8076911 DOI: 10.1016/j.sopen.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/02/2022] Open
Abstract
Background In the United States, few high-quality manuscripts have directly compared the complication profiles of percutaneous endoscopic versus fluoroscopic gastrostomy. Thus, it is our goal to compare these 2 common procedures to better understand their efficacy and complication profiles. Materials and Methods A retrospective analysis of patient records from Medicare parts A/B from 2007 to 2012 was used to identify percutaneous fluoroscopic gastrostomy and percutaneous endoscopic gastrostomy procedures. Patient demographics were stratified by age, sex, comorbidities, and complications. Results A total of 258,641 patients were found to have either percutaneous fluoroscopic gastrostomy (26,477, 10.2%) or percutaneous endoscopic gastrostomy (232,164, 89.8%). Percutaneous fluoroscopic gastrostomy experienced greater rates for all complications queried. Multivariate analysis revealed that the percutaneous fluoroscopic gastrostomy cohort had statistically significant increased odds for short-term complications, such as ileus (odds ratio 1.4, 95% confidence interval 1.22–1.54), mechanical (odds ratio 2.4, 95% confidence interval 2.28–2.58), wound infection (odds ratio 1.4, 95% confidence interval 1.24–1.52), persistent fistula after tube removal (odds ratio 1.9, 95% confidence interval 1.78–2.12), and other complications (odds ratio 2.2, 95% confidence interval 2.03–2.37), and long-term complications, including abdominal wall pain (odds ratio 1.4, 95% confidence interval 1.33–1.44), wound infection (odds ratio 1.1, 95% confidence interval 1.01–1.15), and persistent fistula after tube removal (odds ratio 1.8, 95% confidence interval 1.72–1.87). Conclusion Gastrostomy tubes are more frequently being placed via percutaneous endoscopic and fluoroscopic methods. This study suggests that those undergoing fluoroscopic placement have higher odds of developing short- and long-term postoperative complications.
Fluoroscopic g-tubes have higher odds of developing short- and long-term complications. Fluoroscopy has higher odds for abdominal wall pain and mechanical complications. Hyperlipidemia, smoking, and hypertension are risk factors for abdominal wall pain.
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Affiliation(s)
| | - Syed I Khalid
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
| | | | | | - Aaron L Wiegmann
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Samantha L Terranella
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Nicholas J Skertich
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Laura DeCesare
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Edie Y Chan
- Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL
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Abstract
Nutrition support involves the use of oral supplements, enteral tube feeding or parenteral nutrition. These interventions are considered when oral intake alone fails to meet nutritional requirements. Special diets and oral supplements are usually the first approach to managing malnutrition; however, their role becomes limited when oral intake is restricted or if swallowing is unsafe. Enteral tube feeding or parenteral nutrition are alternative means of providing nutrition support for this select group of patients. Percutaneous endoscopic gastrostomy (PEG) feeding was introduced into clinical practice in 1980. It describes a feeding tube placed directly into the stomach under endoscopic guidance. It is an established means of providing enteral nutrition to those who have functionally normal gastrointestinal tracts, but who cannot meet their nutritional requirements due to inadequate oral intake. The intervention is usually reserved when nutritional intake is likely to be inadequate for more than 4-6 weeks. Although the benefits of PEG have been shown for a select group of patients, there currently exists concerns about the increasing frequency of this intervention, and also uncertainty about the long-term benefits for certain patients. The 2004 UK National Confidential Enquiry into Patient Outcome and Death report emphasised this concern, with almost a fifth of PEG being undertaken for futile indications that negatively influenced morbidity and mortality. The present review paper discusses the indications for, controversies surrounding and complications of gastrostomy feeding and provides practical advice on optimising patient selection for this intervention.
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25
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Nunes G, Fonseca J, Barata AT, Dinis-Ribeiro M, Pimentel-Nunes P. Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique? GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020; 27:172-184. [PMID: 32509923 PMCID: PMC7250336 DOI: 10.1159/000502981] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/27/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Digestive tumours are among the leading causes of morbidity and mortality. Many cancer patients cannot maintain oral feeding and develop malnutrition. The authors aim to: review the endoscopic, radiologic and surgical techniques for nutritional support in cancer patients; address the strategies for nutritional intervention according to the selected technique; and establish a decision-making algorithm to define the best approach in a specific tumour setting. SUMMARY This is a narrative non-systematic review based on an electronic search through the medical literature using PubMed and UpToDate. The impossibility of maintaining oral feeding is a major cause of malnutrition in head and neck (H&N) cancer, oesophageal tumours and malignant gastric outlet obstruction. Tube feeding, endoscopic stents and gastrojejunostomy are the three main nutritional options. Nasal tubes are indicated for short-term enteral feeding. Percutaneous endoscopic gastrostomy (PEG) is the gold standard when enteral nutrition is expected for more than 3-4 weeks, especially in H&N tumour and oesophageal cancer patients undergoing definite chemoradiotherapy. A gastropexy push system may be considered to avoid cancer seeding. Radiologic and surgical gastrostomy are alternatives when an endoscopic approach is not feasible. Postpyloric nutrition is indicated for patients intolerant to gastric feeding and may be achieved through nasoenteric tubes, PEG with jejunal extension, percutaneous endoscopic jejunostomy and surgical jejunostomy. Oesophageal and enteric stents are palliative techniques that allow oral feeding and improve quality of life. Surgical or EUS-guided gastrojejunostomy is recommended when enteric stents fail or prolonged survival is expected. Nutritional intervention is dependent on the technique chosen. Institutional protocols and decision algorithms should be developed on a multidisciplinary basis to optimize nutritional care. CONCLUSIONS Gastroenterologists play a central role in the nutritional support of cancer patients performing endoscopic techniques that maintain oral or enteral feeding. The selection of the most effective technique must consider the cancer type, the oncologic therapeutic program, nutritional aims and expected patient survival.
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Affiliation(s)
- Gonçalo Nunes
- Gastroenterology Department, GENE − Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal
| | - Jorge Fonseca
- Gastroenterology Department, GENE − Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal
- CiiEM − Center for Interdisciplinary Research Egas Moniz, Monte da Caparica, Portugal
| | - Ana Teresa Barata
- Gastroenterology Department, GENE − Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
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Percutaneous Closure of Gastrostomy Using a Suture-Mediated Vascular Closure Device in a Swine Model. Cardiovasc Intervent Radiol 2020; 43:781-786. [DOI: 10.1007/s00270-020-02450-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/29/2020] [Indexed: 12/19/2022]
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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: 7] [Impact Index Per Article: 1.4] [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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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: 3.0] [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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Clayton S, DeClue C, Lewis T, Rodriguez A, Kolkhorst K, Syed R, Kumar A, Davis C, Brady P. Radiologic versus Endoscopic Placement of Gastrostomy Tube: Comparison of Indications and Outcomes at a Tertiary Referral Center. South Med J 2019; 112:39-44. [PMID: 30608631 DOI: 10.14423/smj.0000000000000916] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Percutaneous gastrostomy tube placement is performed in patients requiring long-term enteral nutrition. Although both endoscopic and fluoroscopic techniques may be used, there are inherent risks and potential complications associated with both procedures that are not generally known to referring physicians. The purpose of this study was to compare and contrast indications for placement and procedurally related complications between fluoroscopic and endoscopic gastrostomy tubes techniques at a tertiary care facility. METHODS A retrospective cohort study was performed. All consecutive patients with either percutaneous endoscopic (PEG) or percutaneous radiologic (PRG) gastrostomy tube placement between October 2011 and January 2013 were eligible for inclusion. Basic demographic information, American Society of Anesthesiologists score, procedure indication, laboratory data, and use of anticoagulation were recorded. Both direct and indirect procedural complications were documented if they occurred 30 days after gastrostomy tube placement, and were classified and scored based on severity and need for further intervention. RESULTS A total of 297 patients met the inclusion criteria, 150 of whom had gastrostomy tubes placed fluoroscopically and 147 of whom had them placed endoscopically. There was no statistically significant difference in direct complications within the first 30 days (PEG 6.8% vs PRG 8%); however, the type of complication observed varied between the two groups. Although superficial wound infections and buried bumpers were more common in the PEG group, bleeding was more common in the PRG group. CONCLUSIONS Placement of gastrostomy tubes either endoscopically or fluoroscopically is relatively safe with similar indications. Although the complication rate between the two groups was not significant, the types of procedural complications observed did vary.
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Affiliation(s)
- Steven Clayton
- From the University of South Carolina School of Medicine, Greenville, the Departments of Radiology and Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and the Department of Internal Medicine, Ochsner Medical Center Jefferson, Louisiana
| | - Christopher DeClue
- From the University of South Carolina School of Medicine, Greenville, the Departments of Radiology and Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and the Department of Internal Medicine, Ochsner Medical Center Jefferson, Louisiana
| | - Trevor Lewis
- From the University of South Carolina School of Medicine, Greenville, the Departments of Radiology and Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and the Department of Internal Medicine, Ochsner Medical Center Jefferson, Louisiana
| | - Andrea Rodriguez
- From the University of South Carolina School of Medicine, Greenville, the Departments of Radiology and Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and the Department of Internal Medicine, Ochsner Medical Center Jefferson, Louisiana
| | - Kimberly Kolkhorst
- From the University of South Carolina School of Medicine, Greenville, the Departments of Radiology and Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and the Department of Internal Medicine, Ochsner Medical Center Jefferson, Louisiana
| | - Rashid Syed
- From the University of South Carolina School of Medicine, Greenville, the Departments of Radiology and Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and the Department of Internal Medicine, Ochsner Medical Center Jefferson, Louisiana
| | - Ambuj Kumar
- From the University of South Carolina School of Medicine, Greenville, the Departments of Radiology and Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and the Department of Internal Medicine, Ochsner Medical Center Jefferson, Louisiana
| | - Clifford Davis
- From the University of South Carolina School of Medicine, Greenville, the Departments of Radiology and Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and the Department of Internal Medicine, Ochsner Medical Center Jefferson, Louisiana
| | - Patrick Brady
- From the University of South Carolina School of Medicine, Greenville, the Departments of Radiology and Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and the Department of Internal Medicine, Ochsner Medical Center Jefferson, Louisiana
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30
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MDCT evaluation of complications of percutaneous gastrostomy tube placement. Emerg Radiol 2019; 26:663-674. [PMID: 31444681 DOI: 10.1007/s10140-019-01716-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/06/2019] [Indexed: 01/12/2023]
Abstract
Percutaneous gastrostomy tube placement is a commonly performed procedure to provide enteral alimentation to patients unable to tolerate oral feeds. Percutaneous gastrostomy is a relatively safe procedure, and serious complications like gastrointestinal bleeding, perforated viscus, and adjacent organ injury are rare. The most common complications after gastrostomy tube placement occur early and are usually minor. The purpose of this review article is to describe the techniques of percutaneous gastrostomy tube insertion and imaging protocol for gastrostomy tube evaluation, and describe the early, late, and anytime complications. The article will also illustrate very rare late complications of gastrostomy tube placement like gastro-hepatic fistula, gastro-colic fistula, buried bumper syndrome, and gastrostomy site hernia.
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Cherian P, Blake C, Appleyard M, Clouston J, Mott N. Outcomes of radiologically inserted gastrostomy versus percutaneous endoscopic gastrostomy. J Med Imaging Radiat Oncol 2019; 63:610-616. [PMID: 31402568 DOI: 10.1111/1754-9485.12932] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/04/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Gastrostomy insertion either via radiological (radiologically inserted gastrostomy, RIG) or endoscopic (percutaneous endoscopic gastrostomy, PEG) approaches are widely practiced throughout Australia. The purpose of this study was to compare outcomes of inserted tubes and cost evaluation by both methods. METHODS A retrospective cohort study conducted on all-cause gastrostomy insertions at a quaternary Australian Hospital, Royal Brisbane and Womens' Hospital (RBWH) between January 2012 and August 2015. Current referral pattern is first-line gastrostomy and second-line radiological insertion. RESULTS A total of 402 gastrostomy tubes were inserted with a total of 307 PEG tubes and 95 RIG tubes, with follow-up to one calendar year. Mean patient age was 61 years ± 14.2 years with 76% male patients. A total of 84% of patients were head and neck cancer patients; major indications for insertion include prophylaxis (58%), dysphagia (32%) and NBM (2.5%). Patient groups were heterogeneous with varied indications for insertion including prophylaxis, dysphagia, decompression, NBM and treatment side effects. Outcomes measured included the following: complications, premature tube failure prior to expected removal and, overall tube outcome/ disposition. A lower incidence of minor complications was observed with the RIG group than the PEG group without differences in major complications over time. Tube failure due to either blockage or dislodgement was assessed. Multivariate analysis of all-cause dislodgement found 'method of insertion' a predictor of dislodgement with RIG 5.4(OR) times more likely to be dislodged than PEG. Competing risk analysis demonstrates equipment as a significant cause of dislodgement occurring more commonly with RIG than PEG tubes. Tubes were removed more often in the PEG group because a large volume were prophylactic. Tubes were replaced more often in the RIG group, with tube blockage and equipment as causes for tube replacement in this group. Replacements occur either in suite or bedside. Costing data were limited with only 94 patients' costing data qualifying for a limited unit cost evaluation, with radiologically inserted tubes marginally more expensive than tubes inserted endoscopically. CONCLUSIONS Both are safe procedures, with improved techniques; radiologically inserted gastrostomies have an improved profile with respect to dislodgement rates than previously reported in the literature. Radiological tubes remain limited by equipment factors with balloon failure an ongoing issue. Cost analysis was hindered by poor documentation; however, the opportunity cost remains an important advantage of radiological insertion at peripheral sites, increasingly relevant for health service delivery in our geographically vast state.
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Affiliation(s)
- Priya Cherian
- Royal Brisbane and Women's Hospital (RBWH), Brisbane, Queensland, Australia.,Department of Radiology, RBWH, Brisbane, Queensland, Australia
| | - Claire Blake
- Royal Brisbane and Women's Hospital (RBWH), Brisbane, Queensland, Australia.,Department of Nutrition and Dietetics, RBWH, Brisbane, Queensland, Australia
| | - Mark Appleyard
- Royal Brisbane and Women's Hospital (RBWH), Brisbane, Queensland, Australia.,Department of Gastroenterology, RBWH, Brisbane, Queensland, Australia
| | - John Clouston
- Royal Brisbane and Women's Hospital (RBWH), Brisbane, Queensland, Australia.,Department of Radiology, RBWH, Brisbane, Queensland, Australia
| | - Nigel Mott
- Royal Brisbane and Women's Hospital (RBWH), Brisbane, Queensland, Australia.,Department of Radiology, RBWH, Brisbane, Queensland, Australia
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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: 0.7] [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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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: 4.6] [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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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: 2.3] [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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Kulvatunyou N, Zimmerman SA, Sadoun M, Joseph BA, Friese RS, Gries LM, O'Keeffe T, Tang AL. Comparing Outcomes Between "Pull" Versus "Push" Percutaneous Endoscopic Gastrostomy in Acute Care Surgery: Under-Reported Pull Percutaneous Endoscopic Gastrostomy Incidence of Tube Dislodgement. J Surg Res 2018; 232:56-62. [PMID: 30463774 DOI: 10.1016/j.jss.2018.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 03/24/2018] [Accepted: 06/01/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) complications are often under-reported in the literature, especially regarding the incidence of tube dislodgement (TD). TD can cause significant morbidity depending on its timing. We compared outcomes between "push" and "pull" PEGs. We hypothesized that push PEGs, because of its T-fasteners and balloon tip, would have a lower incidence of TD and complications compared with pull PEGs. METHODS We performed a chart review of our prospectively maintained acute care surgery database for patients who underwent PEG tube placement from July 1, 2009 through June 30, 2013. Data regarding age, gender, body mass index, indications (trauma versus nontrauma), and complications (including TD) were extracted. Procedure-related complications were classified as either major if patients required an operative intervention or minor if they did not. We compared outcomes between pull PEG and push PEG. Multiple regression analysis was performed to identify risk factors associated with major complications. RESULTS During the 4-y study period, 264 patients underwent pull PEGs and 59 underwent push PEGs. Age, gender, body mass index, and indications were similar between the two groups. The overall complications (major and minor) were similar (20% pull versus 22% push, P = 0.61). The incidence of TD was also similar (12% pull versus 9% push, P = 0.49). However, TD associated with major complications was higher in pull PEGs but was not statistically significant (6% pull versus 2% push, P = 0.21). Multiple regression analysis showed that dislodged pull PEG was associated with major complications (odds ratio 29.5; 95% confidence interval, 11.3-76.9; P < 0.001). CONCLUSIONS The incidence of pull PEG TD associated with major complications is under-recognized. Specific measures should be undertaken to help prevent pull PEG TD. LEVEL OF EVIDENCE IV, therapeutic.
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Affiliation(s)
- Narong Kulvatunyou
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Steven A Zimmerman
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona.
| | - Moutamn Sadoun
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Bellal A Joseph
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Randall S Friese
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Lynn M Gries
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Terence O'Keeffe
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Andrew L Tang
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
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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: 1.1] [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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Lee TF, Cho YJ, Shin AJH, Ko HK, Park J, Kim SH, Kim JH, Song HY. Percutaneous radiologic gastrostomy in patients with failed percutaneous endoscopic gastrostomy. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2017. [DOI: 10.18528/gii160031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Tang-fei Lee
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chaiwan, Hong Kong
| | - Young Jong Cho
- Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam, Korea
| | - a Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heung Kyu Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihong Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo Hwan Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Young Song
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kato K, Iwasaki Y, Onodera K, Matsuda M, Higuchi M, Kato K, Kato Y, Taniguchi M, Furukawa H. Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy Combined with CT-GC. J INVEST SURG 2017; 30:193-200. [PMID: 27700181 DOI: 10.1080/08941939.2016.1232451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/31/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. MATERIALS AND METHODS In total, seven high-risk individuals diagnosed using computed tomography (CT)-gastrocolonography (GC) underwent laparoscopic-assisted PEG (LAPEG) placement. Study endpoints included the success of LAPEG under local anesthetic and intravenous sedation, inability to thread the PEG tube, the eventual tube location, the number of tube adjustments needed, adverse events, the operating time, and PEG tube-related infection. RESULTS In total, 135 PEG procedures were performed during this study. Successful CT-GC was achieved in all 135 patients, and we successfully used a standard PEG technique to place the gastrostomy tube in 128 patients (95%). In seven patients (5%), the LAPEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. LAPEG procedure-related minor complications were observed in two patients. CONCLUSIONS LAPEG combined with CT-GC can be used for patients with difficult anatomical orientations and may minimize the risk of complications in PEG placement.
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Affiliation(s)
- Kazuya Kato
- a Department of Surgery , Pippu Clinic , Hokkaido , Japan
| | - Yoshiaki Iwasaki
- b Department of Gastroenterology and Hepatology , Okayama University , Okayama , Japan
| | | | - Minoru Matsuda
- d Department of Surgery , Nihon University , Tokyo , Japan
| | - Mineko Higuchi
- a Department of Surgery , Pippu Clinic , Hokkaido , Japan
| | - Kimitaka Kato
- a Department of Surgery , Pippu Clinic , Hokkaido , Japan
| | - Yurina Kato
- e Department of Oral Surgery , Jikei University , Tokyo , Japan
| | - Masahiko Taniguchi
- f Department of Surgery , Asahikawa Medical University , Asahikawa , Japan
| | - Hiroyuki Furukawa
- f Department of Surgery , Asahikawa Medical University , Asahikawa , Japan
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Ray DM, Srinivasan I, Tang SJ, Vilmann AS, Vilmann P, McCowan TC, Patel AM. Complementary roles of interventional radiology and therapeutic endoscopy in gastroenterology. World J Radiol 2017; 9:97-111. [PMID: 28396724 PMCID: PMC5368632 DOI: 10.4329/wjr.v9.i3.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/12/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Acute upper and lower gastrointestinal bleeding, enteral feeding, cecostomy tubes and luminal strictures are some of the common reasons for gastroenterology service. While surgery was initially considered the main treatment modality, the advent of both therapeutic endoscopy and interventional radiology have resulted in the paradigm shift in the management of these conditions. In this paper, we discuss the patient’s work up, indications, and complementary roles of endoscopic and angiographic management in the settings of gastrointestinal bleeding, enteral feeding, cecostomy tube placement and luminal strictures. These conditions often require multidisciplinary approaches involving a team of interventional radiologists, gastroenterologists and surgeons. Further, the authors also aim to describe how the fields of interventional radiology and gastrointestinal endoscopy are overlapping and complementary in the management of these complex conditions.
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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: 0.9] [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
Malnutrition can adversely affect physical and psychological function, influencing both morbidity and mortality. Despite the prevalence of malnutrition and its associated health and economic costs, malnutrition remains under-detected and under-treated in differing healthcare settings. For a subgroup of malnourished individuals, a gastrostomy (a feeding tube placed directly into the stomach) may be required to provide long-term nutritional support. In this review we explore the spectrum and consequences of malnutrition in differing healthcare settings. We then specifically review gastrostomies as a method of providing nutritional support. The review highlights the origins of gastrostomies, and discusses how endoscopic and radiological advances have culminated in an increased demand and placement of gastrostomy feeding tubes. Several studies have raised concerns about the benefits derived following this intervention and also about the patients selected to undergo this procedure. These studies are discussed in detail in this review, alongside suggestions for future research to help better delineate those who will benefit most from this intervention, and improve understanding about how gastrostomies influence nutritional outcomes.
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Odedra D, Nasirzadeh R, Menard A. Safety of Outpatient vs Inpatient Percutaneous Radiological Gastrostomy Tubes in Patients with Head and Neck Cancers. Can Assoc Radiol J 2016; 67:416-419. [DOI: 10.1016/j.carj.2016.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/15/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Devang Odedra
- Department of Diagnostic Imaging, Kingston General Hospital, Kingston, Ontario, Canada
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Reza Nasirzadeh
- Department of Diagnostic Imaging, Kingston General Hospital, Kingston, Ontario, Canada
- Department of Diagnostic Imaging, Queen's University, Kingston, Ontario, Canada
| | - Alexandre Menard
- Department of Diagnostic Imaging, Kingston General Hospital, Kingston, Ontario, Canada
- Department of Diagnostic Imaging, Queen's University, Kingston, Ontario, Canada
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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: 2.9] [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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Hucl T, Spicak J. Complications of percutaneous endoscopic gastrostomy. Best Pract Res Clin Gastroenterol 2016; 30:769-781. [PMID: 27931635 DOI: 10.1016/j.bpg.2016.10.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 09/18/2016] [Accepted: 10/02/2016] [Indexed: 01/31/2023]
Abstract
Percutaneous endoscopic gastrostomy (PEG) has become the method of choice for mid-to long-term enteral feeding. The majority of complications that occur are minor, but the rare major complications may be life threatening. Some complications occur soon after tube placement, others develop later, when the gastrostomy tract has matured. Older patients with comorbidities and infections appear to be at a greater risk of developing complications. Apart from being aware of indications and contraindications, proper technique of PEG placement, including correct positioning of the external fixation device, and daily tube care are important preventive measures. Adequate management of anticoagulation and antithrombotic agents is important to prevent bleeding, and administration of broad spectrum antibiotics prior to the procedure helps prevent infectious complications. Early recognition of complications enables prompt diagnosis and effective therapy.
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Affiliation(s)
- Tomas Hucl
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
| | - Julius Spicak
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Peritonitis following percutaneous gastrostomy tube insertions in children. Pediatr Radiol 2016; 46:1444-50. [PMID: 27173980 DOI: 10.1007/s00247-016-3628-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/16/2016] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children. OBJECTIVE To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy. MATERIALS AND METHODS We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected. RESULTS Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor. CONCLUSION Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome. Patients with peritonitis are delayed starting feeds and have a hospital stay that is an average of 5 days longer than those without.
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Yuan Y, Zhao Y, Xie T, Hu Y, Cochrane Upper GI and Pancreatic Diseases Group. 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: 1.1] [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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Gohel TD, Kirby DF. Access and Complications of Enteral Nutrition Support for Critically Ill Patients. NUTRITION SUPPORT FOR THE CRITICALLY ILL 2016:63-79. [DOI: 10.1007/978-3-319-21831-1_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Richioud B, Louazon T, Beji H, Bertrand A, Roux P, Kalenderian AC, Cuinet M, Pilleul F, Marec-Bérard P. De novo radiologic placement of button gastrostomy: a feasibility study in children with cancer. Pediatr Radiol 2015. [PMID: 26209960 DOI: 10.1007/s00247-015-3426-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Primary placement of percutaneous radiologic button gastrostomy has been successfully performed in adults but research is lacking as to its success in children during cancer treatment. OBJECTIVE To assess the safety and effectiveness of such treatment at a single center. MATERIALS AND METHODS We conducted a 3-year retrospective feasibility study reporting on placement procedure, feeding plan, acute complications and effectiveness of this technique based on the evolution of the weight and weight-to-height during a period of 3 months. RESULTS Eleven gastrostomies were performed in 11 children and young adults (3-20 years old) during oncological treatment. No major complications occurred. Two patients experienced minor side effects -- local leakage and granulation tissue formation -- both easily treated. In all cases, enteral feeding started within 24 h following the button placement. The patients were able to go home within 72 h. After 1 month, 64% (7/11) had gained weight, 18% (2/11) had maintained weight and 9% (1/11) had lost weight. After 3 months, 73% (8/11) had gained weight and 9% (1/11) had lost weight. CONCLUSION The procedure and devices were well tolerated and mostly effective in our cohort.
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Affiliation(s)
- Bertrand Richioud
- Department of Radiology, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France.
| | - Typhaine Louazon
- Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Hedi Beji
- Department of Radiology, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France
| | - Amandine Bertrand
- Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Pascale Roux
- Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | | | - Marie Cuinet
- Department of Radiology, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France
| | - Frank Pilleul
- Department of Radiology, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France
| | - Perrine Marec-Bérard
- Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
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Kato K, Taniguchi M, Iwasaki Y, Sasahara K, Nagase A, Onodera K, Matsuda M, Inaba Y, Kawakami T, Higuchi M, Kobashi Y, Furukawa H. Computed tomography-gastro-colonography for percutaneous endoscopic gastrostomy using a helical computed tomography. Am J Surg 2015; 210:374-381. [PMID: 25912624 DOI: 10.1016/j.amjsurg.2014.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/04/2014] [Accepted: 10/11/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. METHODS In total, 48 individuals underwent computed tomography-gastro-colonography (CT-GC)-guided PEG placement. Study end points included success of CT-GC, inability to thread the PEG tube, the eventual tube location, tube adjustments needed, adverse events, operating time, and PEG tube-related infection. RESULTS A successful CT-GC was achieved in all 48 patients (100%), and we successfully used a standard PEG technique to place the gastrostomy tube in 44 patients (92%). In 4 patients (8%), the laparoscopic-assisted PEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. The overall procedure-related minor complication rate was 8%. CONCLUSION CT-GC is an optional method for the estimation of intra-abdominal, anatomical orientations that may minimize the risk of complications before PEG placement.
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Affiliation(s)
- Kazuya Kato
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan.
| | - Masahiko Taniguchi
- Department of Surgery, Asahikawa Medical University, 1-1, 2-1, Midorigaoka, Asahikawa City 078-8510, Japan
| | - Yoshiaki Iwasaki
- Department of Gastroenterology and Hepatology, Okayama University, 2-5-1, Shikata Town, Okayama City, Okayama 700-8558, Japan
| | - Keita Sasahara
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan
| | - Atsushi Nagase
- Department of Surgery, Asahikawa Medical Center, 4048, 7 cyome, Hanasaki-cyo, Asahikawa City 070-8644, Japan
| | - Kazuhiko Onodera
- Department of Surgery, Hokuyu Hospital, 5-1, 6-6 Higashi-Sappro, Shiroishi-ku, Sapporo City 003-0006, Japan
| | - Minoru Matsuda
- Department of Surgery, Nihon University, 1-8-13 Surugadai Kanda, Chiyoda-ku, Tokyo 010-8309, Japan
| | - Yuhei Inaba
- Department of Internal Medicine, Asahikawa Medical University, 1-1, 2-1, Midorigaoka, Asahikawa City 078-8510, Japan
| | - Takako Kawakami
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan
| | - Mineko Higuchi
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan
| | - Yuko Kobashi
- Department of Radiology, Jikei University, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroyuki Furukawa
- Department of Surgery, Asahikawa Medical University, 1-1, 2-1, Midorigaoka, Asahikawa City 078-8510, Japan
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Practice variation in PEG tube placement: trends and predictors among providers in the United States. Gastrointest Endosc 2015; 82:37-45. [PMID: 25845635 PMCID: PMC4469567 DOI: 10.1016/j.gie.2014.12.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 12/21/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Enteral access placement is performed among a variety of providers and specialties, yet there is a dearth of literature on trends and factors related to enteral access placement in the United States. OBJECTIVE To examine trends in the incidence of enteral access procedures performed by gastroenterologists in the United States. DESIGN Retrospective review of upper endoscopic procedures that involved PEG tube placement between 2000 and 2010. SETTING Endoscopy sites participating in the Clinical Outcomes Research Initiative (CORI). PATIENTS Patients undergoing upper endoscopy. INTERVENTIONS PEG tube placement. MAIN OUTCOME MEASUREMENTS Number of PEG tubes placed. RESULTS Overall PEG tube placement by a provider from 2000 to 2010 was 1.7% (number of PEG tubes performed/number of upper endoscopies performed), with the majority of them being performed by gastroenterologists. Very young and very old, non-white racial background (Hispanic: odds ratio [OR] 1.21; 95% CI, 1.13-1.28; black: OR 2.24; 95% CI, 2.12-2.36), and men (OR 1.44; 95% CI, 1.39-1.50) were patient characteristics associated with greater PEG tube placement. In terms of practice setting, PEG tube placement occurred more frequently in community and/or health maintenance organization environments and on the East Coast. With respect to provider characteristics, male providers were less likely than female providers to perform a PEG tube insertion (OR 0.67; 95% CI, 0.64-0.71), and there was a trend that as providers were further out of medical school they were less likely to perform a PEG tube procedure. Interestingly, surgeons (OR 6.69; 95% CI, 6.18-7.24) and other providers (non-pediatric/non-general practice) (OR 3.22; 95% CI, 2.63-3.94) were more likely to perform PEG tube procedures than were gastroenterologists. LIMITATIONS Participation in CORI is voluntary and may not capture data on non-gastroenterologist providers. CONCLUSION Significant practice variation was noted in PEG tube placement in the United States with respect to patient and provider characteristics, geographic region, and endoscopy settings.
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