Percutaneous Endoscopic Gastrostomy Insertion Research Articles

Percutaneous gastrostomy, mechanical ventilation and survival in amyotrophic lateral sclerosis : an observational study in an incident cohort

Objective To analyze disease-modifying effects of percutaneous endoscopic gastrostomy (PEG) insertion for supporting nutrition, noninvasive ventilation (NIV), and tracheostomy-assisted ('invasive’) ventilation (TIV) in amyotrophic lateral sclerosis (ALS). Methods We retrospectively analyzed survival in a large population–based incident cohort that was prospectively followed up in our center. Analysis considered several known ALS-related prognostic variables. Results In this population, PEG and NIV in multivariable analysis significantly correlated to survival as computed by disease onset to death/tracheostomy. NIV was associated with better survival while PEG was associated with reduced survival. Other independent prognostic factors were age at ALS onset, diagnostic delay, and flail arm/leg and pure upper motor neuron (PUMN) phenotypes. The length of survival after TIV was significantly associated with age at ALS onset (inverse correlation) whereas other variables did not. The length of survival after TIV correlated to age at ALS onset in such a way that each additional year of age at ALS onset decreased survival by about 0.7 months. Patients who underwent both TIV and NIV did not experience a better survival than those who underwent TIV alone. Conclusion The lack of effect of enteral nutrition on ALS survival probably reflected the timing of PEG insertion in patients with more severe disease. By contrast, patients who used mechanical ventilation had an increased overall survival compared with non-ventilated ones. The study also provided new information showing that the combined use of NIV and TIV did not may prolong ALS survival as compared to TIV alone.

The periprocedural respiratory safety of propofol sedation in patients with a motor neuron disease undergoing percutaneous endoscopic gastrostomy insertion

Motor neuron diseases (MND), such as Amyotrophic Lateral Sclerosis (ALS) and Primary Lateral Sclerosis (PLS), may cause swallowing and respiratory problems, due to muscle weakness. Chronic enteral feeding via percutaneous endoscopic gastrostomy (PEG) is often indicated in these patients. PEG insertion is normally performed with sedation. Some guidelines withhold sedation in MND patients, due to the risk of respiratory complications. These guidelines seem to be defensive however and evidence is lacking. Our aim was to examine periprocedural respiratory complications occurring in MND patients undergoing PEG insertion with propofol sedation. A retrospective monocentre study was conducted in a referral hospital with an experienced PEG team. Patients with MND who underwent PEG insertion with propofol sedation between January 1. 2016 to January 1. 2023 were analysed to identify periprocedural respiratory complications. 46 patients were included. In five patients (10.9%) respiratory adverse events (AE) occurred, of which two serious (4.3%) and four AE (8.7%). Serious AE (SAE) were fatal in both cases: aspiration pneumonia (2.2%) and hypercapnia (2.2%) a few days after insertion. Sedation may have influenced the first case. Respiratory AE consisted of desaturation in two (4.3%), mild aspiration pneumonia in one (2.2%), and apnea in one patient (2.2%). Compared to previous studies respiratory complications and mortality had comparable prevalences.

Timing and impact of percutaneous endoscopic gastrostomy insertion in patients with amyotrophic lateral sclerosis: a comprehensive analysis

Dysphagia is common in amyotrophic lateral sclerosis (ALS) patients, often requiring percutaneous endoscopic gastrostomy (PEG) for enteral nutrition. We retrospectively analyzed data from 188 Korean patients with ALS who underwent PEG tube insertion at five-time points: symptom onset (t1), diagnosis (t2), recommended time for gastrostomy (t3), PEG insertion (t4), and one-year post-insertion (t5). The recommended time point for gastrostomy (T-rec for gastrostomy) was defined as the earlier time point between a weight loss of more than 10% and advanced dysphagia indicated by the ALSFRS-R swallowing subscore of 2 or less. The T-rec for gastrostomy was reached at 22 months after symptom onset, followed by PEG insertion at 30 months, resulting in an 8-month delay. During the delay, the ALSFRS-R declined most rapidly at 1.7 points/month, compared to 0.8 points/month from symptom onset to diagnosis, 0.7 points/month from diagnosis to T-rec for gastrostomy, and 0.6 points/month after the PEG insertion. It is crucial to discuss PEG insertion before significant weight loss or severe dysphagia occurs and minimize the delay between the recommended time for gastrostomy and the actual PEG insertion. A stratified and individualized multidisciplinary team approach with careful symptom monitoring and proactive management plans, including early PEG insertion, should be prioritized to improve patient outcomes.

Factors Associated With Short-Term Complications After Percutaneous Endoscopic Gastrostomy Tube Insertion: A Retrospective Cohort Study.

Percutaneous endoscopic gastrostomy (PEG) tube placement is generally safe but is associated with a range of complications. Minor complications include infections, granuloma formation, leakage, and blockages, while major complications encompass aspiration pneumonia, hemorrhage, and more serious conditions such as necrotizing fasciitis and colonic fistula. This study aimed to assess the rate of short-term complications within one month of endoscopic PEG insertion, focusing on their correlation with patient characteristics. This retrospective cohort study analyzed data from patients who underwent PEG insertion between January 2020 and December 2022. It evaluated the incidence of complications in relation to variables such as the indication for the procedure, the patient's immune status, albumin and CRP levels, and the setting of the procedure (inpatient vs. outpatient). The study included 121 patients, with a mean age of 69.73 years, comprising 71 males (58.7%) and 50 females (41.3%). Neurological indications accounted for 64.5% of the cases. Notably, 67.8% of the patients were immunocompromised. Within 30 days of PEG insertion, 16.5% experienced complications, including GI bleeding (4.1%), infection at the PEG site (11.6%), and peritonitis (0.8%). Complications were significantly higher in immunocompromised patients and those with non-neurological indications. Higher serum albumin and lower CRP levels were associated with fewer complications, though the association was not statistically significant. The study highlights that gastrostomy site infection is the most common short-term complication following PEG insertion. Immune status and the reason for PEG insertion emerged as key factors influencing the likelihood of complications.

Congenital absent epiglottis causing aspiration in infant

Congenital absent epiglottis is a rare phenomenon which has variable clinical presentation. Most of the cases are asymptomatic and go unnoticed to the adulthood. Some neonates present with stridor and respiratory distress and sometimes the absence give rise to obstructive sleep apnoea features. Further some infants with absent epiglottis may present with significant aspiration of feeds as well as own secretions which occasionally may give rise to life threatening chest infections and growth retardation.Management of aspirating infant is by swallowing therapy, altering the enteral feeding route (Nasogastric tube or percutaneous endoscopic gastrostomy (PEG)) or in rare occasions may require tracheostomy and supraglottic closure. The case discussed here is of a infant with aspiration detected to have absent epiglottis managed by swallowing therapy and PEG insertion.

Percutaneous endoscopic gastrostomy in children receiving peritoneal dialysis: A tertiary centre long-term experience and literature review.

Children with severe chronic kidney disease receiving maintenance peritoneal dialysis (PD) are often malnourished and may require nutritional supplementation. Recent PD guidelines address laparoscopic and open surgical gastrostomy as safe approaches in children established on PD, while existing evidence on percutaneous endoscopic gastrostomy (PEG) is still lacking; as well as the role of perioperative antibiotic and antifungal prophylaxis. Hence, this study aimed to report our experience with PEG placement in patients on PD and compare it with the available literature. We retrospectively reviewed the medical records from patients on PD, who underwent PEG placement at a tertiary referral centre between 2000 and 2020. Data on perioperative management, complications and outcomes were retrieved. An extensive literature search was performed; studies describing PEG placement and perioperative prophylaxis in patients on PD were used as a comparison. Descriptive statistical analysis was conducted. Seven patients (five males) were included. Perioperative antibiotic and antifungal prophylaxis were standard practice. At a median follow-up of 27 months (10-75), the peritonitis rate was 0.2 patient/years. No statistical significance was found between the peritonitis rate before and after PEG placement (p = 0.2). Patients' demographics and postoperative complications were comparable to the reported studies. Based on our experience, our technique of PEG insertion with antimicrobial prophylaxis is feasible and associated with an acceptable complication risk in patients on PD. Further multicentric studies about surgical technique in patients on PD will be necessary to verify the feasibility of PEG and standardise the perioperative protocol.

Do sociodemographic and clinical characteristics affect mortality rates in people with intellectual disability and dysphagia who have a percutaneous endoscopic gastrostomy? A cohort study between 2000 and 2022

AbstractBackgroundPeople with intellectual disability frequently have eating, drinking and swallowing difficulties (dysphagia) and are at greater risk of premature mortality, particularly from aspiration and respiratory infections. The insertion of a percutaneous endoscopic gastrostomy (PEG), as part of a multidisciplinary management plan, may help to maintain and improve nutrition. This study included people with intellectual disability who had ever had a PEG inserted and who presented to the specialist Speech and Language Therapy team in one Greater Manchester borough between 2000 and 2022 and assessed the risk of death and sociodemographic and clinical factors associated with this.MethodsThis was a cohort study using secondary data. Kaplan–Meier estimates were used to construct the probability of mortality curves. Cox proportional hazards were used to compare death rates in the different sociodemographic and clinical characteristic groups and were presented as hazard ratios and 95% confidence intervals.FindingsOf 42 people included in the study, 18 (43%) died from the point of PEG insertion to the end of the study (December 2022). The median (interquartile range) time to death from PEG insertion was 5 (2–10) years, with four people (10%) dying in the first year. Aspiration pneumonia and unspecified pneumonia were responsible for seven (39%) deaths. No significant associations were found between sociodemographic and clinical factors and risk of death.ConclusionIn persons with intellectual disability and a PEG who were followed up between 2000 and 2022, the mortality was around 40% with deaths occurring in the first year and respiratory conditions being an important cause. The lack of association with sociodemographic and clinical characteristics may have been due to a limited sample size. Further research is needed with larger samples and more variables, including quality of life data, to help understand and improve clinical practice in this area.

Moving towards a personalised understanding of the nutritional impact of self-expanding metallic stents (SEMS) in gastro-oesophageal cancer: A retrospective case note review of a tertiary referral oncology centre.

301 Background: Dysphagia is a common life-impacting complication for patients with gastro-oesophageal (O-G) cancer. Options to alleviate dysphagia include insertion of SEMS or percutaneous endoscopic gastrostomy (PEG). SEMS improve quality of life by enabling a person to eat a varied diet, but are associated with complications including pain and need for reintervention. Although studies have shown SEMS improve dysphagia, consequent longitudinal impact on nutritional status has not been evaluated. There is a need to better characterise risks and benefits of SEMS to allow a personalised approach to both insertion and follow-up. Methods: We identified patients with a confirmed diagnosis of O-G cancer, who underwent SEMS insertion at The Christie NHS Foundation Trust in 2021 and 2022. Data was retrospectively collected about patient and stent characteristics, and patient outcomes to quantify benefits and risks of SEMS. Results: 112 patients had 127 SEMS inserted at The Christie. Patients’ International Dysphagia Diet Standardisation Initiative (IDDSI) score significantly improved after SEMS insertion (N=120); prior to SEMS 62% were only managing liquids and purees (IDDSI 3 and 4) and 24% were not able to eat enterally. Post SEMS, 76% tolerated textured foods (IDDSI 5 and above) and only 21.5% were limited to liquids/purees. We observed a significant reduction in the rate of weight loss (% body weight/10 days) following SEMS insertion (-0.010 ± 0.009 vs. -0.001 ± 0.010, P < 0.001). 12% of patients experienced grade 3 SEMS-related toxicity or stent failure within 30 days, and 20% developed significant pain within 24 hours of SEMS insertion. Conclusions: SEMS provide meaningful nutritional benefit in the majority of patients with O-G cancer, as weight loss is significantly slowed following insertion. However, we identified two groups of patients who did not benefit from SEMS; those who continued to lose weight and those who had stent failure. We did not find predictive factors for stent failure from multivariate analysis of baseline demographics or stent characteristics. Therefore, more detailed analysis of tumour factors, imaging findings and SEMS location from a larger cohort of patients may be required to identify patients who are unlikely to benefit from SEMS, and alternative interventions such as PEG feeding could be considered.

Clinical correlation of cholelithiasis in patients undergoing percutaneous endoscopic gastrostomy

The risk factor for cholelithiasis include low physical activity. With an aging society, the number of bedridden patients who undergo percutaneous endoscopic gastrostomy (PEG) has increased, and cholelithiasis has often been found in these patients. This study aimed to evaluate the risk factors correlated with cholelithiasis in adults who underwent PEG. This retrospective single-center design study reviewed patients who underwent PEG and were confirmed to have cholelithiasis through imaging from March 1996 to December 2021. The investigated variables were age, sex, body mass index (BMI, kg/m2), cause of PEG insertion, initial physical activity status, laboratory findings on PEG insertion day, and incidence of acute cholecystitis. The differences between categorical and continuous variables were analyzed using Student’s t test and chi-square test. We enrolled 576 eligible patients who underwent PEG insertion. A total of 161 patients were detected with cholelithiasis (28.0%). The overall independent risk factors for cholelithiasis in patients who underwent PEG insertion were increased C-reactive protein (CRP) levels and decreased physical activity status (bedridden state). The incidence of cholelithiasis was increased by up to 30.7%, especially in patients with bedridden status. However, the incidence of acute cholecystitis among cholelithiasis group was only 5.6%. BMI and total cholesterol were positively correlated with the size of gallbladder (GB) stones. One of the major risk factors for cholelithiasis is decreased physical activity, especially in patients who underwent PEG insertion. Abdominal imaging is recommended to confirm the presence of cholelithiasis and to consider prophylaxis for cholelithiasis, especially in bedridden patients with elevated initial CRP levels at the time of PEG insertion.

Solunum Yoğun Bakım Ünitesinde Perkütan Endoskopik Gastrostominin Klinik Sonuçları

Aim: Percutaneous endoscopic gastrostomy (PEG) is a feeding method used in patients who are expected to require enteral nutrition for more than 2-3 weeks. We aimed to evaluate PEG indications, complications, and post-procedural patient prognosis in patients followed up in our intensive care unit and fed via PEG.
 Materials and Methods: We retrospectively reviewed 51 patients receiving PEG between January 1, 2017, and December 31, 2022, in the Respiratory Intensive Care Unit.
 Results: Among the patients receiving PEG, 30 (58%) were male. The average age was 63.9, ranging from 23 to 90. The mean scores for the Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Sepsis Related Organ Failure Assessment (SOFA) were 8.47, 22, and 7.45, respectively. The mean duration until PEG placement was 24.8 days, and the average intensive care unit (ICU) hospitalization was 48.8 days.PEG was performed in 21 patients (41.2%) due to cerebrovascular disease, in 19 patients (37.3%) due to Alzheimer, dementia, or Parkinson's disease, and 18 patients (35.3%) due to prolonged mechanical ventilation. The complication rate associated with PEG was 13.7%. Among the patients who underwent PEG, 35 (68.6%) were discharged, while 16 (31.4%) died.
 Conclusion: Considering its easy use at bedside, low complication, and mortality rates, PEG insertion is appropriate for continuing enteral therapies, especially in intensive care patients with insufficient oral intake.

How far is the endoscopist to blame for a percutaneous endoscopic gastrostomy complication?

Percutaneous endoscopic gastrostomy (PEG) is a well-established, minimally invasive, and easy to perform procedure for nutrition delivery, applied to individuals unable to swallow for various reasons. PEG has a high technical success rate of insertion between 95% and 100% in experienced hands, but varying complication rates ranging from 0.4% to 22.5% of cases. To discuss the existing evidence of major procedural complications in PEG, mainly focusing on those that could probably have been avoided, had the endoscopist been more experienced, or less self-confident in relation to the basic safety rules for PEG performance. After a thorough research of the international literature of a period of more than 30 years of published "case reports" concerning such complications, we critically analyzed only those complications which were considered - after assessment by two experts in PEG performance working separately - to be directly related to a form of malpractice by the endoscopist. Malpractice by the endoscopist were considered cases of: Gastrostomy tubes passed through the colon or though the left lateral liver lobe, bleeding after puncture injury of large vessels of the stomach or the peritoneum, peritonitis after viscera damage, and injuries of the esophagus, spleen, and pancreas. For a safe PEG insertion, the overfilling of the stomach and small bowel with air should be avoided, the clinician should check thoroughly for the proper trans-illumination of the light source of the endoscope through the abdominal wall and ensure endoscopically visible imprint of finger palpation on the skin at the center of the site of maximum illumination, and finally, the physician should be more alert with obese patients and those with previous abdominal surgery.

Risk Factors and Role of Antibiotic Prophylaxis for Wound Infections after Percutaneous Endoscopic Gastrostomy.

The incidence of wound infections after percutaneous endoscopic gastrostomy (PEG) varies widely in recent studies. The present study systematically investigates the underlying risk factors for the development of wound infections in a large cohort of patients over a long-term follow-up period. A retrospective cohort study of patients undergoing PEG insertion using either the pull or push technique was conducted and patients followed up for 3 years. Tube-related wound infections were identified, and pathogens regularly cultured from wound swabs. Adjusted analysis was performed via univariate and multivariate logistic regression analysis. 616 patients were included in this study. A total of 25% percent of patients developed wound infections upon PEG tube insertion and 6.5% showed recurrent infections. Nicotine abuse (p = 0.01), previous ischemic stroke (p = 0.01) and head and neck cancer (p < 0.001) showed an increased risk for wound infection after PEG placement. Moreover, radio-chemotherapy was associated with the occurrence of wound infections (p < 0.001). Infection rates were similar between pull and push cohorts. The most common bacterial pathogen detected was Enterobacterales (19.2%). Staphylococcus aureus, Pseudomonas aeruginosa and enterococci were frequently detected in recurrent infection (14.2%, 11.4% and 9.6%, respectively). Antibiotic prophylaxis showed no effect on infection rates. Wound infections after PEG placement are common and occasionally occur as recurrent infections. There is potential for improvement in everyday clinical practice, particularly regarding antibiotic prophylaxis in accordance with guidelines.

Survival Following Percutaneous Endoscopic Gastrostomy in Neurology Intensive Care Unit Patients

Background: We aimed to determine factors affecting mortality and survival after Percutaneous endoscopic gastrostomy (PEG) in patients who were hospitalized in the neurology intensive care unit during the coronavirus disease-2019 (COVID-19) pandemic Materials and Methods: The clinical and demographic data of 29 patients aged 18 years and older who received PEG tube insertion during hospitalization in the Neurology Intensive Care Unit of XXX Hospital, Turkey, between February 2020 and May 2021 were examined retrospectively. Patients’ demographics, clinical characteristics, and survival status were recorded. Results: We included 29 patients (16 females and 13 males) into our study. Median age was 71 (33–89) years among survivors and 75.5 (48–90) years among those who died. The groups were similar with respect to age (p = 0.119) and sex (p = 0.806). Mortality rate after PEG insertion was 66%. Mean overall survival after PEG tube insertion was 129.49 days (95% CI: 91.21–167.78). Cox regression revealed that having multiple comorbidities increased the likelihood of mortality by 2.822-fold (95% CI: 1.001–7.968, p = 0.049). Conclusions: These findings show that having multiple comorbidities was the most important factor associated with mortality among PEG recipients who were admitted to the Neurology Intensive Care Unit during the COVID-19 pandemic. Since multiple comorbidities cause shorter survival, it appears that the decision to insert PEG tubes must be made extremely cautiously among these patients. However, more comprehensive studies should be conducted to clarify the effect of COVID-19 on mortality rates and survival time after PEG.

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY RESULTS IN A SECONDARY STATE HOSPITAL

Introduction: The aim of this study was to determine the indications of Percutaneous endoscopic gastrostomy (PEG) patients treated in a secondary state Burdur hospital over a period of three years, the unit where the patient was hospitalized, survival time with PEG therapy, and the complications observed in these patients. Methods: Patients who underwent PEG in the endoscopy unit of our hospital, between January 2019 and January 2022, were retrospectively evaluated. Age, gender, the unit of inpatient, indications for PEG therapy, complications after PEG, and survival status of the patients were recorded in the form of case reports. Patients with coagulation disorders, hemodynamic instability, peritonitis, sepsis, infection at the insertion area, peritonitis carcinomatosis, a history of total gastrectomy and gastric varices were excluded. Results:The median age of the 120 patients included in the study was 79 (17–100) years, and 66 (55%) of the patients were male. Complications were observed in 14 (11.7%) patients, all of which were minor, including seven (5.8%) PEG site infections, three (2.5%) PEG site leakages, three (2.5%) PEG occlusions, and one (0.9%) PEG removal. It was determined that 73 (60.8%) patients survived at least 30 days; the patients were most frequently referred by the neurology unit, with a rate of 52.7%. The most common indications for PEG insertion were cerebrovascular disease (56.7%) and dementia (29.2%). Conclusion: Maintenance of nutritional requirements via PEG allows for the preservation of mucosal integrity and barrier function, intestinal immune response, and normal flora. It is superior to other enteral feeding methods due to the lower risk of aspiration. In conclusion, our study, which presented the experiences of the PEG insertion and therapy in a secondary state hospital, stated that the complication rates, indications, and referring clinics were found to be consistent with available literature.

The Outcomes and Quality of Life in Children with Neurodevelopmental Disabilities with Percutaneous Endoscopic Gastrostomy at Queen Sirikit National Institute of Child Health

Objective: To evaluate the quality of life (QoL) in children with neurodevelopmental disabilities after percutaneous endoscopic gastrostomy (PEG) insertion consisting of health-related problems and family satisfaction. Materials and Methods: A cross-sectional descriptive study using a questionnaire survey was conducted. Parents of all patients performed PEG at QSNICH between 2012 and 2019 participated in the questionnaire survey. Data gathering included demographic data, health-related QoL of patients, and family satisfaction. Results: One hundred nine cases were performed PEG at QSNICH and 60 cases had follow-ups. Of the 39 cases that completed the questionnaire, twenty cases or 51.3% were male. The median age was 103 months with a range of 30 to 178 months. Underweight, stunting, and wasting were found at 46.2%, 38.5%, and 25.6%, respectively. The most common cause of neurodevelopmental disability was spastic cerebral palsy (CP) in 32 cases (82.1%). There was no significant improvement in nutritional status after PEG insertion for six months and three years. The frequency of hospitalization caused by aspiration pneumonia in times per year, decreased significantly, at a median of 1 versus 0.5, p&lt;0.001. Additionally, 84.6% of the families reported that respiratory tract infection was decreased, and family satisfaction was 94.9%. Conclusion: PEG insertion decreased the number of hospitalization and improved health-related problems and QoL in pediatric neurodevelopmental patients. Keywords: Percutaneous endoscopic gastrostomy; Quality of life; Neurodevelopmental

Retrospective analysis of the methods and complications following the insertion of a PEG tube in children

IntroductionA long-term intragastric feeding is the indication for percutaneous endoscopic gastrostomy (PEG) placement in a patient. The procedure is performed in children with central nervous system (CNS) disorders, congenital heart defects and neoplastic or metabolic diseases. The PEG placement procedure is most commonly performed by a gastroscopy procedure.AimThe study aimed to retrospectively analyse the methods applied and complications following PEG tube insertion in patients of the Regional Specialist Children's Hospital in Olsztyn, Poland, in the years 2000–2019.Material and methodsA retrospective analysis was conducted of medical histories and records of children qualified for PEG placement procedure. PEG procedure was performed on 48 children: 24 boys and 24 girls. The mean age was 7 years. PEG was inserted in cerebral plasy in 30 patients, congenital defects in 11 and genetic disorders in 7.Results and discussionThe reasons for PEG insertion included dysphagia in 30 children, no weight gain in 7, aspiration of gastric contents to the bronchial tree in 6, and feeding difficulties in 10. Two methods for performing PEG insertion procedure were employed: a gastroscopy alone (31 cases) and a laparoscopic-assisted gastroscopy (17). The following complications were: local complications at the incision site (28), PEG dysfunction (13), vomiting (9), sepsis (2), buried bumper syndrome (1), oesophagitis (1), and gastrointestinal fistula (1).ConclusionsThe PEG placement procedure is burdened with a significant number of complications, however, they are mainly related to local inflammation or PEG dysfunction.

Complication rates of direct puncture and pull-through techniques for percutaneous endoscopic gastrostomy: Results from a large multicenter cohort.

Background and study aims Two different techniques for percutaneous endoscopic gastrostomy (PEG) have been developed: classical pull-through and direct puncture techniques. This study compared the complication rate for both techniques in a large retrospective patient cohort. Patients and methods Clinical data from patients who received a PEG in four high-volume centers for endoscopy were included retrospectively between January 2016 and December 2018. Patient characteristics and complication rates were correlated in univariate and multivariate analyses. Results Data from 1014 patients undergoing a PEG insertion by the pull-through technique were compared to 183 patients for whom the direct puncture technique was used. The direct puncture technique was associated with a 50 % reduction in minor and 85.7 % reduction in major complications when compared to the pull-through technique. Multivariate analysis of these data revealed an odds ratio of 0.067 (0.02-0.226; P < 0.001) for major complications in the direct puncture group. Conclusions Compared to the pull-through technique, the direct puncture technique resulted in a significant reduction in complications. Despite the retrospective design of this study, these results suggest that the direct puncture technique may be preferable to improve patient safety.

Our experience with percutaneous endoscopic gastrostomy and long-term follow-up results

Aim: Percutaneous endoscopic gastrostomy (PEG) is the preferred method for long-term enteral feeding of patients who cannot be fed orally for various reasons and have a functioning gastrointestinal system. In this study, we aimed to present and discuss the demographic characteristics, indications, and early and late complications of patients implanted with the endoscopic PEG in our center.&#x0D; Material and Method: In this study, we retrospectively evaluated age, gender, chronic diseases, indication for PEG, complications during the procedure, complications arising from PEG during patient follow-up, and survival times of 84 patients who underwent PEG between January 2016 and January 2020 from the electronic medical file system.&#x0D; Results: Of the 84 patients enrolled in the study, 59.5% (n=50) were male and 40.5% (n=34) were female. The mean age of the patients was 61.35±19.52 years. The endoscopic PEG success rate was 97.6%. Of the requests for PEG, 58.6% (n=50) were for patients in intensive care units. The most common indications for PEG insertion were cerebrovascular accident (CVA), chronic nervous system disease, and hypoxic-ischemic encephalopathy. Complications related to PEG were observed in 11 patients. All complications were mild, and no severe complications were observed. While one of the complications developed in the early period ( 30 days). No deaths from causes related to the PEG procedure have been observed.&#x0D; Conclusion: In patients with inadequate oral intake, PEG is a safe and appropriate option for continuous enteral feeding because of its low complication and mortality rates.

What is the current provision of service for gastrostomy insertion in England?

BackgroundSignificant morbidity and mortality can be associated with gastrostomy insertion, likely influenced by patient selection, indication and aftercare. We aimed to establish what current variation in practice exists and how...

S2569 Bleeding From Peg Tube Insertion Site due to a Gastroepiploic Artery Pseudoaneurysm

Introduction: Percutaneous endoscopic gastrostomy (PEG) is generally regarded as a safe procedure with rare complications. Gastroepiploic artery aneurysms (GEAAs) are extremely rare with only 22 cases reported in the literature and constituting 3-4% of all splanchnic artery aneurysms. GEAAs carry a mortality rate of 70% due to a 90% rate of rupture and can lead to complications like hemorrhagic shock. Therefore, early detection and management is necessary for survival. Case Description/Methods: A 55-year-old male with PEG tube placed for ALS-associated dysphagia presented with bleeding around the PEG tube site 10 days after placement. He was admitted twice for the complaint. On his first admission, EGD was normal and it was suspected that he had bleeding subcutaneously around the PEG site that self-resolved. He was discharged but promptly returned the next day with profuse bleeding around PEG tube. Emergent repeat EGD was again negative. This time, the diagnosis was confirmed with CTA of the abdomen that demonstrated a branch of the gastroepiploic artery that had an 8mm pseudoaneurysm. Interventional radiology successfully performed US-guided thrombin injection with successful thrombosis of the pseudoaneurysm. The patient’s PEG site bleeding stopped, and patient successfully discharged. Discussion: Gastric bleeding following PEG tube placement is rare and usually occurs secondary to injury of the small gastric vessels. Due to the rotated configuration of stomach, caution should be exercised when penetrating during the PEG insertion. The gastroepiploic artery (GEA) runs along the greater curvature and may be injured during PEG tube placement although this is rare. The bleeding in our patient was due to a pseudoaneurysm of the GEA as evident from CT scan. GEA peudoaneurysms are a very rare complication that occur due to iatrogenic injury to the artery. GEA pseudoaneurysms can present as abdominal pain, bleeding, and even shock due to intraperitoneal hemorrhage. Due to the risk of fatal bleeding by GEA pseudoaneurysms, early detection and management is needed. Our patient was treated with percutaneous thrombin injection leading to resolution of bleeding. Other treatment options include trans arterial embolization and more invasive including surgical repair. Systemic embolization is the main complication of thrombin injection and can be prevented by placing the needle tip away from the neck of the pseudoaneurysm. (Figure).Figure 1.: A (axial) and B (sagittal): Arrows represent a small 8 mm pseudoaneurysm off of the gastroepiploic artery at the level of the gastrostomy tube insertion site.