Short and long-term results of percutaneous endoscopic gastrostomy

Abstract

Abstract Aim. Percutaneous endoscopic gastrostomy is the most common method of long-term enteral nutrition. The aim of this study is to evaluate the short and long term efficacy and complications of percutaneous endoscopic gastrostomy. Methods. We included 172 patients who underwent percutaneous endoscopic gastrostomy procedure between 2004 and 2010 in the Gastroenterology Clinic of Akdeniz University. Nutritional status was evaluated on the basis of albumin levels at the sixth month. Patients were evaluated for local and systemic complications of percutaneous endoscopic gastrostomy. Results. Sixty-nine (40.1%) patients who underwent percutaneous endoscopic gastrostomy procedures died due to their primary diseases. Percutaneous endoscopic gastrostomy was placed for stroke in 49 patients , for dementia in 32 patients, for posttraumatic encephalopathy in 53 patients, for post-anoxic encephalopathy in 6 patients, for malignant disorders in 30 patients , and for menigoencephalitis in 2 patients. Patients were evaluated for local and systemic percutaneous endoscopic gastrostomy tube complications. The systemic complications consisted of three cases with peritonitis, two bleeding episodes, nine cases with aspiration pneumonia, four cases with dislocation of catheter, and six cases with abscess of abdominal wall. The local complications consisted of seventeen cases with local wound erythema; fifteen patients had leakage of gastric contents, four cases with granuloma formation, and three cases with pain at percutaneous endoscopic gastrostomy site. Mean albumin level of patients at the six month was 3.2 gr/dL. Removal of percutaneous endoscopic gastrostomy due to return of ability to swallow was observed in ten patients. Conclusion. Percutaneous endoscopic gastrostomy is a safe and effective method which accesses to the gastrointestinal tract when performed according to the guidelines. Complications associated with percutaneous endoscopic gastrostomy are well described and are usually local, but major rare events require surgery or result in death. It is safe in terms of complications. Indications and introduction procedures should be standardized. Follow-up by a dietician or specialist nurse could potentially bridge the gap between primary care and hospitals. Keywords: Gastrostomy, indications, complications Ozet Amac. Perkutan endoskopik gastrostomi en sik kullanilan uzun donem enteral beslenme metodudur. Bu calismanin amaci perkutan endoskopik gastrostominin kisa ve uzun donem etkinligi ile komplikasyonlarini degerlendirmektir. Yontemler. Calismaya Akdeniz Universitesi Gastroenteroloji Klinigi’ nde 2004-2010 yillari arasinda perkutan endoskopik gastrostomi takilmis 172 hasta dahil edildi. Hastalarin beslenme yeterliligi 6.aydaki serum albumin duzeylerine gore degerlendirildi. Hastalar perkutan endoskopik gastrostominin lokal ve sistemik komplikasyonlari acisindan degerlendirildi. Bulgular. Perkutan endoskopik gastrostomi takilan hastalarin 69(% 40.1)’unun olumu primer hastaligina bagliydi. . Hastalarin 49’una inme, 32’sine demans, 53’une postravmatik ensefalopati, 6’sina postanoksik ensefalopati, 30’una malignite, ve 2’sine meningoensefalit nedeniyle perkutan endoskopik gastrostomi islemi uygulandi. Hastalarda lokal ve sistemik perkutan endoskopik gastrostomi tupu komplikasyonlari degerlendirildi. Sistemik komplikasyon olarak; 3 hastada peritonit, 2 hastada periton bosluguna kanama, 9 hastada aspirasyon pnomonisi, 4 hastada perkutan endoskopik gastrostomi dislokasyonu, ve 6 hastada karin duvari absesi gelisti. Lokal komplikasyonlar; 17 hastada lokal yara yeri eritemi, 15 hastada perkutan endoskopik gastrostomi yerinde sizinti, 3 hastada perkutan endoskopik gastrostomi yerinde agri, 4 hastada granulom olusumu ve 11 hastada balon inmesi nedeniyle perkutan endoskopik gastrostomi cikmasi gerceklesti. Hastalarin 6. ayda ortalama serum albumin degeri 3.2 gr/dL olarak saptandi. 10 hastanin yutkunma refleksi geri geldigi icin’ perkutan endoskopik gastrostomileri cekildi. Sonuc. Perkutan endoskopik gastrostomi rehberlerde belirtilen kurallara uygun sekilde yapildiginda gastrointestinal traktuse erisim saglayan guvenli ve etkin bir yontemdir. Perkutan endoskopik gastrostomi yerlestirilmesine bagli komplikasyonlar iyi tanimlanmis olup genellikle lokaldir ancak bazi nadir durumlar cerrahi gerektirebilir veya olumle sonuclanabilir. Komplikasyonlar acisindan islem guvenlidir. Endikasyonlar ve giris islemleri standardize edilmelidir Hastalarin bir diyetisyen ya da ozel bir hemsire tarafindan izlemi; birinci basamak saglik hizmetleri ve hastaneler arasinda potansiyel bir kopru kurulmasini saglayabilir. Anahtar sozcukler: Gastrostomi, endikasyonlar, komplikasyonlar