7194 Percutaneous endoscopic gastrostomies and percutaneous endoscopic jejunostomies: are they being done in time in developing country?

Abstract

Background and Aims: Percutaneous endoscopic gastrostomy (PEG) or percutaneousendoscopic jejunostomy (PEJ) is considered in patients whorequire prolonged enteral feeding for more than 30 days, and is done moresafely and less expensively than surgical gastrostomy. Increasing numberof patients are being referred for PEG placement in South Korea, but PEGis still delayed and not considered because of refusing by patients andignoring by the physician and surgeons. The aim of our study is to evaluatethe success rate and complications of PEG, and to measure the intervalfrom the onset of indication for enteral feeding to PEG or PEJ placement. Materials and Methods: On 53 patients, 66 PEGs and 4 PEJs were performed by pull-through method. In PEJ placement, jejunal tube was introduced by graping with forceps inserted in endoscope channel through PEG catheter. A retrospective review of all patients who underwent PEG or PEJ placement was performed. Results: In demographics, mean age was 61 years (4-68 years) and 36 patients (68%) were male. PEGs were performed in patients with neurologic dysphagia (n=43), esophageal cancers (n=5), oropharyngeal cancers (n=2), cancer cachexia (n=1), aerophagia (n=1) and mandibular fracture (n=1). PEJs were performed in patients with pyloric obstructions by gastric cancers (n=3) and mediastinitis by esophageal perforation (n=1). All procedures were done successfully without failure. PEG or PEJ was performed in 183 days (7 days-82 months) after onset of indication for enteral feeding. There were major complications in 4 procedures (5.7%) including arterial bleeding on gastric wall (n=1) and wound infections (n=3), and there were minor complications in 15 procedures (25.7%) including PEG dislodge or self-extraction by patients (n=13), minor GI bleeding (n=2), diarrhea (n=2), pain requiring analgesics (n=2) and fever (n=1). Follow-up was possible in 49 patients and mean follow-up was 113 days (26-331 days). There were 4 deaths during follow-up and there was no procedure-related mortality. Three PEGs and 1 PEJ were removed electively for improved oral intake. Conclusions: PEG or PEJ placement is easy, safe and effective method to provide long-term enteral feeding, but is not been doing in time even though in the indication for enteral feeding. More expension of indication for PEG or PEJ should be considered in developing countries. Background and Aims: Percutaneous endoscopic gastrostomy (PEG) or percutaneousendoscopic jejunostomy (PEJ) is considered in patients whorequire prolonged enteral feeding for more than 30 days, and is done moresafely and less expensively than surgical gastrostomy. Increasing numberof patients are being referred for PEG placement in South Korea, but PEGis still delayed and not considered because of refusing by patients andignoring by the physician and surgeons. The aim of our study is to evaluatethe success rate and complications of PEG, and to measure the intervalfrom the onset of indication for enteral feeding to PEG or PEJ placement. Materials and Methods: On 53 patients, 66 PEGs and 4 PEJs were performed by pull-through method. In PEJ placement, jejunal tube was introduced by graping with forceps inserted in endoscope channel through PEG catheter. A retrospective review of all patients who underwent PEG or PEJ placement was performed. Results: In demographics, mean age was 61 years (4-68 years) and 36 patients (68%) were male. PEGs were performed in patients with neurologic dysphagia (n=43), esophageal cancers (n=5), oropharyngeal cancers (n=2), cancer cachexia (n=1), aerophagia (n=1) and mandibular fracture (n=1). PEJs were performed in patients with pyloric obstructions by gastric cancers (n=3) and mediastinitis by esophageal perforation (n=1). All procedures were done successfully without failure. PEG or PEJ was performed in 183 days (7 days-82 months) after onset of indication for enteral feeding. There were major complications in 4 procedures (5.7%) including arterial bleeding on gastric wall (n=1) and wound infections (n=3), and there were minor complications in 15 procedures (25.7%) including PEG dislodge or self-extraction by patients (n=13), minor GI bleeding (n=2), diarrhea (n=2), pain requiring analgesics (n=2) and fever (n=1). Follow-up was possible in 49 patients and mean follow-up was 113 days (26-331 days). There were 4 deaths during follow-up and there was no procedure-related mortality. Three PEGs and 1 PEJ were removed electively for improved oral intake. Conclusions: PEG or PEJ placement is easy, safe and effective method to provide long-term enteral feeding, but is not been doing in time even though in the indication for enteral feeding. More expension of indication for PEG or PEJ should be considered in developing countries.