Outcomes Of Percutaneous Endoscopic Gastrostomy Research Articles

Timing and Outcomes of Percutaneous Endoscopic Gastrostomy After Ischemic Stroke.

Guidelines recommend using percutaneous endoscopic gastrostomy (PEG) for dysphagia after 2 weeks of stroke onset. We aimed to study the impact of PEG timing on outcomes in patients with ischemic stroke. In this retrospective study of patients with ischemic stroke and PEG between 2014 and 2019, early PEG was defined as PEG tube placed within 14 days of stroke and late PEG after 14 days. Outcomes of 30-day mortality, PEG-related complications, and functional swallow recovery were compared between early and late PEG. Logistic regression model assessed factors associated with PEG timing. The median time of PEG tube placement after stroke was 10.9 days. Of the 161 included patients, 60.9% had early PEG, and its associated patient factors were nursing facility discharge (adjusted odds ratio (OR): 3.4, confidence interval (CI): 1.48 - 7.82) and infection (OR: 0.32, CI: 0.139 - 0.178). Late PEG had 3.27 times greater odds of swallowing recovery, but mortality and complications were not significantly different between early and late PEG. Skilled nursing facility disposition and lack of infection were predictors of early PEG, constituting the majority of PEG placed for ischemic stroke-related dysphagia. Although better odds of swallowing recovery were seen with late PEG, likely implicating better patient selection, overall, the timing of PEG tube placement did not impact short-term mortality and complications.

S746 Outcomes of Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement in Patients With HIV Compared to Non-HIV

S746 Outcomes of Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement in Patients With HIV Compared to Non-HIV

Risk factors for adverse outcomes of percutaneous endoscopic gastrostomy

Introduction. Presently, percutaneous endoscopic gastrostomy is considered to be the operation of choice when long-term enteral feeding in dysphagia syndrome is required. The technique is characterized by low incidence of early and long-term complications due to low traumatic access and operation time. Aim of the work was to assess the risk predictors of percutaneous endoscopic gastrostomy complications and their significance for the postoperative period. Materials and methods. We searched publications and analyzed literature sources using PubMed and MedLine databases and Cochrane Library and elibrary.ru scientific libraries mainly for the last ten years. The search was performed using a set of key words: percutaneous endoscopic gastrostomy, dysphagia syndrome, postoperative complications, risk factors. Results and discussion. The leading and most studied predictors of early and long-term postoperative period complications after gastrostomy are hypoalbuminemia, uncompensated diabetes mellitus, thrombocytopenia, elevated levels of C-reactive protein, Charlson's comorbidity index (4 points or higher), antiaggregant and anticoagulant therapy, morphoconstitutional features of patients. Conclusion. Data analysis has shown that percutaneous endoscopic gastrostomy at high patient flow and gastropectomy supplementation with gastropexy is practically safe and effective if the selection criteria for the operation are observed taking into account the general condition, risk factors and exclusion of absolute contraindications.

Retrospective analysis of the long-term outcomes of percutaneous endoscopic gastrostomy in critically ill patients and the satisfaction of their caregivers.

Long-term benefits of percutaneous endoscopic gastrostomy and satisfaction of patients' caregivers have not been investigated in the literature in detail. Hence, this study was carried out to investigate the long-term nutritional benefits of percutaneous endoscopic gastrostomy in critically ill patients and their caregivers' acceptance and satisfaction rates. The population of this retrospective study consisted of critically ill patients who underwent percutaneous endoscopic gastrostomy between 2004 and 2020. Data about the clinical outcomes were obtained via telephone interviews using a structured questionnaire. The long-term benefits of the procedure in terms of weight change and the current thoughts of the caregivers about percutaneous endoscopic gastrostomy were addressed. The study sample consisted of 797 patients with a mean age of 66.4 ± 17.1 years. Patients' Glasgow Coma Scale scores ranged from 4.0 to 15.0, with a median score of 8. Hypoxic encephalopathy (36.9%) and aspiration pneumonitis (24.6%) were the most common indications. There was neither change in body weight nor weight gain in 43.7% and 23.3% of the patients, respectively. Oral nutrition could be recovered in 16.8% of the patients. Of the caregivers, 37.8% stated that percutaneous endoscopic gastrostomy was beneficial. Percutaneous endoscopic gastrostomy may be a feasible and effective method for long-term enteral nutrition in critically ill patients treated in intensive care units.

Percutaneous endoscopic gastrostomy in children: A tertiary center experience.

Percutaneous endoscopic gastrostomy (PEG) is a common procedure in children. The outcomes of PEG could be affected by the associated disease. We aimed to evaluate the outcomes and safety of PEG tube placement in a tertiary care center with special attention to patients with cardiac disease, ventriculoperitoneal (VP) shunt, or peritoneal dialysis (PD) catheter. This retrospective study included 113 pediatric patients who had PEG tube insertion from 2011 to 2021. Eighteen patients (15.93%) had cardiac disease, five patients (4.42%) had PD catheters, and three patients (2.65%) had VP shunt. The median age was 3 years (interquartile range: 1-6), and females represented 55% of our patients. The weight ranged from 2.57 to 60 kg, and the most common indication for insertion was neurological disease (n=56; 49.56%). The median operative time was 30 (20-45) minutes. Pneumonia and vomiting were the most frequent complications (n=20, 17.7%). Thirty-day mortality occurred in four patients (3.54%) and 1-year mortality in 10 patients (8.85%). Nine patients (7.96%) required fundoplication, and four patients (3.53%) had tube removal and reinsertion. There was no association between weight and postoperative complications (odds ratio: 0.97; P=.48). There were no differences in postoperative complications among patients with cardiac diseases, PD catheters, and VP shunts. No complications were reported in patients with VP shunt. One patient with cardiac disease and one patient with PD catheter required fundoplication. Removal and reinsertion were needed in one patient with a PD catheter. PEG is feasible in low-weight infants with a low complication rate. The complication rate is low in patients with VP shunt, PD catheter, and cardiac patients.

Gastrostomy Tube Insertion Complications and Patient Care Outcomes in a Tertiary Care Hospital.

BackgroundPercutaneous 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.MethodsThis 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.ResultsOf 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).ConclusionsThis 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.

S618 Timing and Outcomes of Percutaneous Endoscopic Gastrostomy After Ischemic Stroke

S618 Timing and Outcomes of Percutaneous Endoscopic Gastrostomy After Ischemic Stroke

Clinical Outcomes of Percutaneous Endoscopic Gastrostomy in the Surgical Intensive Care Unit.

Background/AimsPercutaneous endoscopic gastrostomy (PEG) is usually performed on patients with chronic underlying diseases in the general ward (GW). This study evaluated the clinical outcomes of PEG performed on patients in the surgical intensive care unit (SICU) compared with those of PEG performed in the GW. MethodsThe medical records of 27 patients in the SICU and 263 in the GW, who underwent PEG between January 2013 and July 2017, were retrospectively reviewed. ResultsThe median age of the 27 SICU patients was 66 years, and their median body mass index was 21.1 kg/m2. In the SICU group, the median baseline Sequential Organ Failure Assessment (SOFA) score was 4, and the median Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 16. The median interval between surgery and PEG in SICU patients was 30 days, with a PEG failure rate of 3.7%. Acute complications in SICU patients included bleeding (7.4%) and ileus (11.1%), while chronic complications included aspiration pneumonia (7.4%) and tube obstruction (3.7%). The rates of acute and chronic complications did not differ significantly between the SICU and GW groups. The 30-day mortality rate was 14.8% in SICU patients and 5.3% in GW patients (p=0.073). ConclusionsPEG is a safe and feasible method of enteral feeding for critically ill patients who require ICU care after surgery.

Percutaneous endoscopic gastrostomy in children less than 10 kilograms: A comparative study.

Background/Aim:Percutaneous endoscopic gastrostomy tube (PEG) has replaced the standard open surgical gastrostomy for enteral nutrition. However, several complications were reported, especially in children less than 10 kg. Our objective was to report the outcomes of percutaneous endoscopic gastrostomy in children according to their weight.Patients and Methods:163 children had PEG tube insertion in our tertiary referral hospital from January 2007 to March 2019. Patients were divided into two groups according to the weight; group I (less than 10 kg; n = 112) and group II (more than 10 kg; n = 51). Comparisons were made between the two groups for incidence of postoperative complications, the need for reintervention, 30-day, and 1-year mortality.Results:There were 51 males (45.5%) in group I and 27 in group II (52.9%) (P = 0.38). The mean weight at the time of endoscopy was 5.9 ± 1.53 and 17.3 ± 8.23 kg and the mean American Society of Anesthesiologists (ASA) score was 2.6 ± 0.67 and 2.43 ± 0.57 in group I and II, respectively (P = 0.101). The most common associated condition was cerebral palsy (50 (44.6%) and 24 (47.1%) in group I and II, respectively; P = 0.77). The mean operative time was 30.28 ± 11.57 min in group I and 33.62 ± 23.36 min in group II (P = 0.221). Skin complications were the most commonly encountered complications of PEG, and 49% (n = 48) required the removal and replacement of the tube under general anesthesia in group I and 41% (n = 21) in group II (P = 0.84). There was no significant difference in the complication between groups.Conclusion:PEG is a safe technique in children less than 10 kg, and the complications rate is comparable with older children. The use of positive transillumination and small needle for measuring the distance between the skin and the stomach enhances the safety of the procedure. PEG should be considered in children less than 10 kg who need supportive or continuous enteral nutrition for different reasons.

Trends and outcomes of percutaneous endoscopic gastrostomy in hospitalized patients with malignant and nonmalignant ascites: a nationwide population study.

BackgroundPatients with ascites resulting from chronic debilitating diseases often require non-oral enteral nutrition and undergo placement of a percutaneous endoscopic gastrostomy (PEG) tube. The aim of our study was to assess the nationwide trends and outcomes of PEG tube placement among patients with ascites.MethodsUsing the Nationwide Inpatient Sample (NIS), we conducted a retrospective analysis of adult patients (≥18 years) who underwent PEG tube placement (n=789,167) from 2010-2014. We divided these patients into 2 groups: with or without ascites. We compared demographics, complications, and in-hospital outcomes between the groups. STATA-13 was used for statistical analysis. Statistical significance was assigned at P<0.05.ResultsPatients with ascites who underwent PEG tube placement were found to have a significantly higher rate of complications, including peritonitis (7.52 vs. 0.72%; P<0.001), aspiration pneumonia (20.41 vs. 2.69%; P<0.001), hemoperitoneum (0.72 vs. 0.19%; P<0.001), procedure-related hemorrhage (1.69 vs. 0.9%; P<0.001) and esophageal perforation (0.51 vs. 0.47%; P<0.001). In addition, these patients also had higher in-hospital mortality (16.33% vs. 7.02%; P<0.001) despite having a relatively lower prevalence of comorbidities. Length of stay was longer in the ascites group (28.08 vs. 19.45 days; 0.001). Over the study period, however, we observed an increasing trend for PEG tube placement in hospitalized patients with ascites.ConclusionPEG tube placement in hospitalized patients with ascites is associated with significantly higher mortality, a longer stay, and more procedure-related complications.

Survival outcomes of percutaneous endoscopic gastrostomy, comparison of cerebrovascular event and non-cerebrovascular event in malnourished patients

Aim: The number of comorbid diseases increased with the rise in the elderly population. In some cases, the state of deficient or absent nutrition emerges. Nevertheless, the contribution of percutaneous endoscopic gastrostomy (PEG) to the quality of life and the survival rate in the elderly with certain diseases remains controversial. Methods: In this prospective cohort study, patients who underwent percutaneous endoscopic gastrostomy (PEG) procedure between 2009 and 2015 were divided into two groups: CVE group consisted of patients with cerebrovascular event (CVE) and non-CVE group comprised patients who suffered from esophageal tumors, head and neck tumors, brain tumors, amyotrophic lateral sclerosis and terminal dementia. In this study, the patients' pre-PEG and post-PEG body mass index (BMI) values, hemoglobin (Hb), albumin (alb), creatinine (Cr) and C-reactive protein (CRP) values, white blood cell counts, demographic characteristics, 30, 90, 180 and 365 day-survival rates, complications (mechanical, metabolic and infectious) and duration of patency of the PEGs were compared. Results: The average age was lower while survival rate on the 90th day was higher in the CVE group. No significant difference was found in terms of other parameters. At the end of the one-year follow-up, 21% of the patients in the CVE group and 12% of those in the non-CVE group were able to be fed without PEG. Conclusion: PEG patency was higher in the CVE group at 3 months but there was no statistically significant difference between the groups at one-year and overall follow-up periods.

Complications and outcome of percutaneous endoscopic gastrostomy in a high-volume centre

Introduction: Percutaneous endoscopic gastrostomy (PEG) is the method of choice for long-term enteral feeding for patients with swallowing disorders and normal gut function. There is limited data regarding the demographics and clinical characteristics of patients from whom PEG was removed.Patients and methods: We performed a retrospective analysis of all consecutive adult patients who underwent first placement of PEG between 1 August 2013 and 31 December 2015 at Karolinska University Hospital in Stockholm, Sweden.Results: In total, 495 PEG were inserted in 495 patients during the study period, 56% male, mean age at insertion 67 years (range 19–95). Most patients belonged to the neurologic group (52%), followed by the oncologic (32%), another diagnosis (9%) and trauma (7%). Major complications occurred in 10 (2.0%) patients. There were no differences in the age or BMI of patients with either minor or major complications but both parameters were risk factors in terms of survival. PEG was removed from 165 (33.3%) patients, most of them from the oncology group, due to the improvement of general status of patients after specific oncologic treatment.Conclusion: Increased age and low BMI were identified as risk factors for mortality but did not correspond with the rate of complications. Antibiotic prophylaxis with sulfamethoxazole and trimethoprim provides good protection for patients with PEG.

Outcomes of percutaneous endoscopic gastrostomy, percutaneous endoscopic gastropexy gastrostomy and radiologically inserted gastrostomy in patients at a district general hospital in 2016

Enteral tube feeding has proven to be safe and effective for patients requiring assisted feeding in the long term. There are various methods of tube insertion, namely: Percutaneous Endoscopic Gastrostomy (PEG), Percutaneous Endoscopic Gastropexy Gastrostomy (PEGG) and Radiologically Inserted Gastrostomy (RIG). The guidelines released by the British Society of Gastroenterologists1 in 2010, formulated after the 2004 National Confidential Enquiry into Patient Outcome and Death (NCEPOD)2 after gastrostomy were adopted in our trust. Following that we had observed an improvement in the 30-day mortality rate compared to earlier published data and we had reported the findings in our 2016 study at BAPEN. The purpose of this study is to evaluate and compare patient outcomes in 2016 post gastrostomy procedures with our previous findings in our local district hospital trust. The following were considered: procedure type, waiting time, sex, complications, mortality at 30 days, and mortality after 1 year.

Outcomes of Percutaneous Endoscopic Gastrostomy (PEG) Placement in the Endoscopy Lab versus the Operating Room

Introduction: Percutaneous endoscopic gastrostomy (PEG) has traditionally been placed by gastroenterologists (GI) or by general surgery. Outcomes of placement in the endoscopy lab vs. the operating room (OR) has shown various results. This study aimed to evaluate patient outcomes of PEG placement in the endoscopy lab vs. the OR. Methods: A retrospective review of patients identified using electronic medical records that underwent PEG from October 1, 2017 to April 1, 2018 was conducted. Characteristics including demographics, history of cancer, use of antiplatelet or anticoagulation therapy, hospital length of stay, ICU admission, indication for PEG, procedure length, time spent in recovery, and type of anesthesia used were studied. Complications within 30 days after PEG placement, as well as a cost analysis were also observed. Results: A total of 112 patients were identified that underwent PEG placement, either in the endoscopy lab or the OR. After exclusions, 41 patients had PEG placed in the OR vs. 31 patients in the GI lab. The mean BMI, number of ICU admissions, number of patients with cancer, procedure time, time spent in recovery, and use of general anesthesia was significantly higher in the OR group vs. the GI group. There was no statistically significant difference between post procedure complications, length of stay, or cost associated with the setting of PEG placement. Conclusion: Patients who underwent PEG placement in the endoscopy lab had decreased procedure time, and less time spent in recovery compared to the OR group. Surgical patients were also significantly more likely to receive general anesthesia and less likely to receive MAC. Based on existing literature on post anesthesia care, we hypothesize that patients in the GI PEG group experienced less anesthesia complications such as nausea or hypotension given the reduced amount of time spent in recovery and as there were fewer patients who received general anesthesia. Moreover, less time spent in recovery for GI placed PEGs translates to potential healthcare savings by minimizing the need for staff and fewer delays in daily cases. These results should influence healthcare providers' decisions in PEG placement setting.1064_A Figure 1. Baseline Patient Characteristics1064_B Figure 2. PEG Placement Results

Outcomes of percutaneous endoscopic gastrostomy: One surgeon experience

Aim: We aimed to present our experience and findings in patients which in we applied percutaneous endoscopic gastrostomy (PEG) tube insertion because of the oral nutritional deficiency. Material andMethods: The data of 41 patients who had PEG tube insertion between 2014 and 2018 years in the General Surgery Clinic of Medicine Faculty of Ordu University were evaluated retrospectively. The indications, complications, mortality and short-term outcomes of the patients were analyzed. Results: 43 patients underwent gastroscopy due to insertion of PEG. In 41(95.3%) patients, PEG insertion was successful. In 2(4.7%) patients, peg insertion failed due to obesity. 16(39%) of the PEG patients were males and 25 (61%) were females. The mean age was 77.68 ± 13.9 (20-94) years. PEG indications were chronic neurological disease in 22 (53.6%) patients, cerebrovascular disease in 15 (36.6%) patients and malignancy in 4 (9.8%) patients. Minor complications in 11(26.8%) patients and major complications in 2 (4.9%) patients were observed. 10 (24.4%) of the complications were in the early period and 3 (7.3%) were in the late period. During the follow up, the PEG tube in 3 (7.3%) patients was pull out. No mortality due to PEG insertion was observed. During the mean follow-up period of 9.37 ± 7.8 months, 14 (34.1%) of the PEG-treated patients died due to their primary disease. Conclusions: PEG tube insertion is an easy method with the low rates of the complication and mortality in the patients with poor oral intake who have a functional gastrointestinal system. PEG is the first choice for long-term enteral nutrition in appropriate patients.

Outcomes of percutaneous endoscopic gastrostomy, percutaneous endoscopic gastropexy gastrostomy and radiologically inserted gastrostomy in patients at a district general hospital

Outcomes of percutaneous endoscopic gastrostomy, percutaneous endoscopic gastropexy gastrostomy and radiologically inserted gastrostomy in patients at a district general hospital

Outcomes of Percutaneous Endoscopic Gastrostomy (PEG) in Octogenarians and Nonagenarians

Outcomes of Percutaneous Endoscopic Gastrostomy (PEG) in Octogenarians and Nonagenarians

Indication and Clinical Outcomes of Percutaneous Endoscopic Gastrostomy: A Single-center Retrospective Analysis

Indication and Clinical Outcomes of Percutaneous Endoscopic Gastrostomy: A Single-center Retrospective Analysis

PTU-099 A Large Prospective Audit of Morbidity and Mortality in Patients with Feeding Gastrostomies Placed for Head and Neck Cancer: Abstract PTU-099 Table 1

Introduction Feeding patients undergoing radical treatment for head and neck cancer via a percutaneous endoscopically or radiologically placed/inserted gastrostomy (PEG, RIG) is common practice. PEG/RIG insertion is not entirely safe and complications may occur with long-term usage. We did a prospective audit of PEG/RIG related complications in patients having them placed prior to surgery for head and neck cancer. Methods Community dietitians reviewed all patients with a gastrostomy placed prior to surgery or radiotherapy for head and neck cancer. They prospectively recorded morbidity and mortality between 2008–2014. In addition hospital databases and case notes were examined. Recorded morbidity included insertion site infection, leakage, over granulation, haemorrhage and buried bumper. Results In the 206 patients there was one death within 30 days from placement, no deaths attributable to gastrostomy placement. One patient underwent a laparotomy for peritonitis. 95 minor complications occurred in 72 (35%) patients or 1:887 days of having a gastrostomy. The commonest complication was peristomal site infection occurring in 55 (27%) patients or 1:1531 days of having a gastrostomy, all of which settled with antibiotics. There was no buried bumpers or tumour implantation at the insertion site reported in the study. There was no procedure related 30 day mortality. Conclusion We have shown a low rate of major complications (0.5%) and a relatively high minor complications rate (35%) of PEGs and RIGs in patients with head and neck cancer. Wound infection can be reduced by careful sterile technique, preoperative antibiotics, a 1 cm abdominal incision and avoiding tightness of the crossbar. We conclude that the use of PEG tubes is a safe method of delivering non-oral nutritional support for patients undergoing treatment for head and neck cancer. References 1 Gauderer MW, Ponsky JL, Izant RJ, Jr. Gastrostomy without laparotomy: A percutaneous endoscopic technique. J Pediatr Surg 1980; 15 :872–5. 2 Mansoor H, Masood MA, Yusuf MA. Complications of percutaneous endoscopic gastrostomy Tube insertion in Cancer patients: A retrospective study. J Gastrintest Cane 2014; 45 :452–459. 3 Burney RE, Bryner BS. Safety and long-term outcomes of percutaneous endoscopic gastrostomy in patients with head and neck cancer. Surg Endosc 2015; 29 (12):3685–9. 4 Hunter JG, Lauretano L, Shellito PC. Percutaneous endoscopic gastrostomy in head and neck Cancer patients. Ann Surg 1989; 210 :42–46. Disclosure of Interest None Declared

Analysis of nationwide trends and outcomes of percutaneous endoscopic gastrostomy (PEG) tube placement in hospitalized cancer patients over a 13 year period.

10135Background: The decision to provide enteral feeding in cancer patients is complex and is based on several factors. Outcomes of PEG tube placement in cancer patients have not been studied and c...