Percutaneous Endoscopic Gastrostomy Procedure Research Articles

Recognition and Prevention of Hospitalised Malnutrition: A Case Report

Rationale: Poly-trauma post road traffic accident often induces a state of malnutrition due to the pathological changes and the insufficient protein and caloric intake for long time. If left unmanaged, malnutrition will have negative consequences on rehabilitation. Nutritional intervention provides caloric requirements and the nutritional support necessary to cover the daily nutritional needs and help contrast hospitalised infections. Our hypothesis is that integration of organised and continuous nutritional assessment and management can enhance prevent the state of malnutrition and increase rehabilitation outcomes.
 Patient Concerns: We present the case of an adult man with Poly-trauma post caused by road traffic. The patient underwent tracheostomy and percutaneous endoscopic gastrostomy (PEG) procedures, had severe consciousness disorder.
 Diagnosis: He has severe consciousness disorder that necessitated the tracheostomy and the PEG.
 Interventions: Our approach included regular nutritional assessment and caloric calculation and implementation of as well as the gradual introduction of diet from NPO to clear liquid, as well as using of supplements and enteral formulas.
 Outcomes: The patient was followed for seven months during which the metabolic/nutritional pattern and the blood tests improved, normal weight restored, and consciousness regained.
 Conclusion: Nutritional intervention integrated has prevented drastic loss in weight, a better recovery, and the stabilization of the metabolic-nutritional framework. Nutritional approach used has contributed to the reduction of recovery times, making the therapeutic path more effective and applicable.

Complications after pediatric percutaneous endoscopic gastrostomy: comparison of the push and pull technique

PurposeVarious complications are associated with percutaneous endoscopic gastrostomy (PEG) procedures in children. The push technique is being increasingly used, but its complications are insufficiently characterized. We aimed to assess all...

Impact of fee-revision policy for gastrostomy on its implementation among older adults with dementia in Japan

ObjectivesThis study aimed to evaluate the impact of the policy to reduce the reimbursement fee for percutaneous endoscopic gastrostomy (PEG) on the number of PEG procedures performed among older adults with dementia. Study designInterrupted time series (ITS). MethodsWe used the monthly aggregated data of the number of PEG procedures in older adults with dementia (both broad and narrow definitions), between 2012 and 2018, from the claims data in Fukuoka Prefecture, Japan. A single ITS design was used to estimate changes in the outcome following each intervention (i.e., first, second, and third interventions performed in 2014, 2015, and 2016, respectively). A controlled ITS design was applied to estimate the effects after the sequence of interventions (pre-intervention: 2012–2014; post-intervention: 2016–2018). The control group comprised patients with malignant head and neck tumors who underwent PEG procedures outside the scope of this policy restriction. ResultsThe number of PEG procedures decreased significantly only in the month wherein the third intervention was introduced (broad definition: IRR = 0.11, CI = 0.03–0.49; narrow definition: IRR = 0.15, CI = 0.03–0.75). No significant difference was observed between the treatment and control groups during the post-intervention phase. ConclusionsThe impact of fee-revision policy for PEG on the decrease in PEG procedures among older adults with dementia is remarkably minimal. It is difficult to reduce unnecessary PEG procedures by relying on this financial incentive alone. Policy decision-makers should consider methods to prevent inappropriate use of artificial nutrition for older adults at their end-of-life stage by reforming the health delivery system.

Percutaneous Endoscopic Gastrostomy: Insertion and Management

Percutaneous endoscopic gastrostomy (PEG) is the modality of choice for long-term enteral feeding in patients in whom oral intake is challenging. Compared with parenteral nutrition, gastrostomy feeding is the preferred choice for sustained nutritional support. Delivery of nutrients directly to the gastrointestinal tract and enhanced cellular immunity associated with this approach are clinically beneficial to patients. Endoscopic gastrostomy is favored for its high clinical success rates and economic advantages and is associated with minor discrepancies with regard to morbidity, mortality, and tube function compared with surgical gastrostomy. PEG procedures can be broadly classified into the pull- and push-types. Although PEG is a comparatively safe procedure, high risk of bleeding is a well-known complication of PEG placement, which necessitates prophylactic antibiotic therapy and careful periprocedural management in patients who receive antiplatelet and anticoagulant agents. Tube dislodgement, peristomal leakage, or infection following PEG placement may require tube replacement or removal. In this review, we investigated the concerns associated with early vs. delayed feeding in concordance with current guidelines. We also describe the indications for PEG tube insertion, post-procedural care strategies, and management of complications.

To push or to pull? A clinical audit on the efficacy and safety of the pull and push percutaneous endoscopic gastrostomy techniques in oncological patients.

The peroral "pull" technique and the direct "push" procedure are the two main methods for percutaneous endoscopic gastrostomy (PEG) placement. Although pull-PEG is generally recommended as the first-line modality, many oncological patients require a push-PEG approach to prevent tumor seeding or overcome tumor-related obstruction. We aimed to compare the efficacy and safety of both PEG procedures in cancer patients. We retrospectively analyzed all consecutive PEG procedures within a tertiary oncological center. Patients were followed up with the hospital databases and National Cancer Registry to assess the technical success rate for PEG placement, the rate of minor and major adverse events (AEs), and 30-day mortality rates. We compared those outcomes between the two PEG techniques. Finally, risk factors for PEG-related adverse events were analyzed using a multivariable Cox proportional-hazard regression model adjusted for patients' sex, age, performance status (ECOG), Body Mass Index (BMI), diabetes, chemoradiotherapy (CRT) status (pre-/current-/post-treatment), and type of PEG. We included 1055 PEG procedures (58.7% push-PEG/41.4% pull-PEG) performed in 994 patients between 2014 and 2021 (mean age 62.0 [±10.7] yrs.; 70.2% males; indication: head-and-neck cancer 75.9%/other cancer 24.1%). The overall technical success for PEG placement was 96.5%. Although the "push" technique had a higher rate of all AEs (21.4% vs. 7.1%, Hazard Ratio [HR] =2.9; 95% CI=1.9-4.3, p<0.001), most of these constituted minor AEs (71.9%), such as tube dislodgement. The methods had no significant difference regarding major AEs and 30-day mortality rates. Previous CRT was associated with an increased risk of major AEs (hazard ratio=2.7, 95% CI=1.0-7.2, p=0.042). The risk of major AEs was comparable between the push- and pull-PEG techniques in cancer patients. Due to frequent tube dislodgement in push-PEG, the pull technique may be more suitable for long-term feeding. Previous CRT increases the risk of major AEs, favoring early ("prophylactic") PEG placement when such treatment is expected.

Enteral tube feeding for amyotrophic lateral sclerosis/motor neuron disease.

Maintaining adequate nutrition is critical for people with amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND). Enteral tube feeding is offered to people experiencing difficulty swallowing (dysphagia) to prevent weight loss and aspiration pneumonia. Among the types of enteral tube feeding, percutaneous endoscopic gastrostomy (PEG) is the typical procedure offered to people with ALS and will be mainly discussed here. To examine the effectiveness of percutaneous endoscopic gastrostomy or other enteral tube feeding in people with ALS, compared to oral feeds without enteral tube feeding on: 1. survival; 2. nutritional status; 3. quality of life. To examine the incidence of minor and major complications of percutaneous endoscopic gastrostomy (PEG) and other enteral tube feeding procedures in people with ALS. On 3 January 2020 and 6 February 2021, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE. Embase, ClinicalTrials.gov and WHO ICTRP. We screened the results to identify randomized controlled studies on enteral tube feeding in ALS. We reviewed all references from the search in published articles to identify any additional references. We included randomized controlled trials (RCTs), quasi-RCTs, and cross-over trials evaluating the effectiveness and complications of PEG or other enteral tube feeding placement in ALS. We used standard methodological procedures expected by Cochrane. We found no RCTs or quasi-RCTs comparing the effectiveness of enteral tube feeding versus oral feeds without enteral tube feeding. There are no RCTs or quasi-RCTs to indicate whether enteral tube feeding is effective compared to continuation of oral feeding for any of the outcome measures. Such RCTs are very unlikely to be performed for ethical reasons. RCTs evaluating the effect of different enteral tube insertion techniques and timings of tube placement on survival and quality of life of people with ALS dysphagia are feasible and warranted.

Fatal outcomes of endoscopy: an analysis from the coronerʼs point of view

Background and study aims This study was designed to provide a profound analysis of fatalities associated with endoscopic procedures. Methods Protocols of all autopsies performed within 20 years in a large Department of Forensic Medicine were retrospectively analyzed to identify all fatalities directly related to an endoscopic procedure. Data were further specified focusing on the type of endoscopy and the final cause of death. Results Of 22,615 autopsies performed between January 2000 and September 2019, 86 deaths were identified as complications of an endoscopic procedure. The average age of these 86 patients was 70.9 years (66.4 (range, 26-89) in males (n = 35) and 74.1 years (range, 22-94) in females (n = 51)). Endoscopic procedures included 29 endoscopic retrograde cholangeopancreatographies (ERCPs), 27 colonoscopies, 18 percutaneous endoscopic gastrostomy (PEG) tube placements, six gastroscopies, two upper endosopic ultrasonographies, and four transesophageal echocardiographies. ERCPs, colonoscopy and PEG procedures together accounted for 74 of 86 (86 %) endoscopy-related deaths. Focusing on the single procedures, post-ERCP pancreatitis (14/29, 48 %), colonoscopy-associated perforation (24/27, 89 %), and peritonitis after PEG placement (16/18, 88 %) were the most common causes of death. Conclusions Even in the thought-to-be-safe and screening endoscopic procedures fatalities do occur. This study gives an overview of endoscopy-related fatalities, stressing the role of ERCP, colonoscopy, and PEG.

Duodenal alpha-Synuclein Pathology and Enteric Gliosis in Advanced Parkinson's Disease.

The role of the gut-brain axis has been recently highlighted as a major contributor to Parkinson's disease (PD) physiopathology, with numerous studies investigating bidirectional transmission of pathological protein aggregates, such as α-synuclein (αSyn). However, the extent and the characteristics of pathology in the enteric nervous system have not been fully investigated. We characterized αSyn alterations and glial responses in duodenum biopsies of patients with PD by employing topography-specific sampling and conformation-specific αSyn antibodies. We examined 18 patients with advanced PD who underwent Duodopa percutaneous endoscopic gastrostomy and jejunal tube procedure, 4 untreated patients with early PD (disease duration <5 years), and 18 age- and -sex-matched healthy control subjects undergoing routine diagnostic endoscopy. A mean of four duodenal wall biopsies were sampled from each patient. Immunohistochemistry was performed for anti-aggregated αSyn (5G4) and glial fibrillary acidic protein antibodies. Morphometrical semiquantitative analysis was performed to characterize αSyn-5G4+ and glial fibrillary acidic protein-positive density and size. Immunoreactivity for aggregated α-Syn was identified in all patients with PD (early and advanced) compared with controls. αSyn-5G4+ colocalized with neuronal marker β-III-tubulin. Evaluation of enteric glial cells demonstrated an increased size and density when compared with controls, suggesting reactive gliosis. We found evidence of synuclein pathology and gliosis in the duodenum of patients with PD, including early de novo cases. Future studies are required to evaluate how early in the disease process duodenal pathology occurs and its possible contribution to levodopa effect in chronic patients. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Assessment of factors affecting mortality in patients with percutaneous endoscopic gastrostomy tube placement in the intensive care unit

Aim: It was aimed to evaluate the clinical outcomes, complications, and factors affecting mortality of percutaneous endoscopic gastrostomy (PEG) applied to patients in the intensive care unit (ICU).Material and Method: PEG procedures which were performed in the ICU between January 2016 and January 2021 and patients' age, gender, comorbidities, trauma history, serum CRP, albumin levels, CRP albumin ratios (CAR), and PEG-related complications were reviewed. Patients were divided into two groups, patients without mortality (Group 1) and patients with mortality (Group 2), and a comparison between groups was made.Results: Of all patients, 49 (39.2%) patients had mortality. The mean age of the patients in group 2 was 69.57±16.78 years, which was higher than the other group (p&amp;lt;0.001). Nephrological diseases and diabetes were significantly more common in Group 2, whereas neurologic diseases were less common (p=0.005, p=0.005, 0.044, respectively). The median length of stay (LOS) of the patients in Group 1 was 50 days, while the median LOS of the patients in Group 2 was found to be significantly higher, with 81 days (&amp;lt;0.001). The mean CRP of Group 2 was 81.63±54.06, which was higher than the other group, while the mean of albumin was found to be 2.29±0.5 and was lower than Group 1 (p&amp;lt;0.001, p&amp;lt;0.001). The mean CAR of Group 1 was 15.96±16.81, which was significantly lower than that of Group 2 (p&amp;lt;0.001). The optimal CAR cut-off value for mortality discrimination was found to be 20,216 with a sensitivity of 73.5%, a specificity of 78.9%, a positive predictive value of 69.2%, a negative predictive value of 82.2%, and 76.8% test accuracy. A CAR value of ≥ 20.216 increased the odds of death 9.3-fold (OR 10.385, CI 95% 4.481-24.065, p&amp;lt;0.001). Conclusion: We suggest that CAR ratio, low albumin, and high CRP levels could be predictors of early mortality. Considering that PEG is an elective procedure, we believe that it can be a safe and effective procedure when nutritional support is provided by alternative means and appropriate conditions are met.

Does enteral nutrition through a percutaneous endoscopic gastrostomy, attenuate Helicobacter pylori colonization?: is it worth mentioning?

In patients who experience difficulties in oral feeding, alimentary intake can be supported by creating direct access into the stomach through a percutaneous endoscopic gastrostomy. The present study purposed to compare naïve and exchanged percutaneous endoscopic gastrostomy tubes in terms of Helicobacter pylori infection and other clinical characteristics. A total of 96 cases who underwent naïve or exchanged percutaneous endoscopic gastrostomy procedures with various indications were incorporated into the study. The patients' demographic data, such as age and gender, etiology of percutaneous endoscopic gastrostomy, anti-HBs status, Helicobacter pylori status, the presence of atrophy and intestinal metaplasia, biochemical parameters, and lipid profiles, had been analyzed. In addition, the anti-HCV and anti-HIV statuses had also been evaluated. The most common indication for percutaneous endoscopic gastrostomy placement was dementia in 26 (27.08%) cases (p=0.033). The presence of Helicobacter pylori positivity was significantly lower in the exchange group compared to the naïve group (p=0.022). Total protein, albumin, and lymphocyte levels were significantly higher in the exchange group compared to the naïve group (both p=0.001), and the mean calcium, hemoglobin, and hematocrit levels were statistically significantly higher in the exchange group (p<0.001). Preliminary outcomes of the present study revealed that enteral nutrition attenuates the incidence of Helicobacter pylori infection. Considering the acute-phase reactant, the significantly lower ferritin values in the exchange group suggest that there is no active inflammatory process in the patients and that immunity is sufficient.

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.

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.

Perkutan Endoskopik Gastrostomi: Tek Merkezli Çalışma

Aim: Percutaneous endoscopic gastrostomy (PEG) is a common method for patients who cannot be oral-fed. This study aims to evaluate the demographic characteristics, indication of PEG and early ( days) complications of PEG patients performed in our hospital over four years.&#x0D; Material and Method: The study is a retrospective study. This study includes patients who underwent percutaneous endoscopy gastrostomy between 2016-2020 in the endoscopy unit and intensive care units in the general surgery clinic of our hospital. The age, gender, comorbidities, length of hospital stay, PEG indications, the day of hospitalization, the complications, if any, and the day the complications developed were recorded on the computer. Complications before 30 days were divided into groups as early complications and those developing after 30 days of late complications.&#x0D; Results: A total of 207 patients the PEG procedure. When PEG indications were examined, it was observed that the most common cause was cerebrovascular events with a rate of 44.93%. Complications were observed in 19 (9.18%) of the patients after the procedure. 68.42% (13) of complications were seen before 30 days. In the evaluation, which was grouped as non-complicated and complicated patients, no significant difference was observed between age, gender, systemic diseases, time to PEG procedure, endoscopic or surgical opening, and mortality rates.&#x0D; Conclusion: Although PEG is a more invasive method compared to other methods in terms of enteral nutrition, it is the most preferred feeding method due to its low complication rate, fast and easy application, and low cost. PEG is recommended for eligible patients who are scheduled for long-term enteral nutrition.

Is endoscopy beneficial in pediatric laparoscopic gastrostomy insertion; A 9-year comparative study.

ObjectivesAdvancements in pediatric percutaneous endoscopic gastrostomy placement (PEG), laparoscopic-assisted gastrostomy (LAG) technique, and laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) procedure have opened up new options for gastrostomy tube placement. LAPEG utilizes endoscopy and laparoscopy for gastrostomy insertion. This review compares the outcomes and complications of LAG and LAPEG techniques in children.MethodsAll LAG and LAPEG gastrostomy tube placements in children from September 2010 to September 2019 were reviewed retrospectively. Patient demographic, along with procedural and 1-year complication data, were collected.ResultsIn total, 92/181 of gastrostomies were LAG and 89/181 were LAPEG. The mean age, weight and patient characteristics were comparable. Conversion rate was 1% in both groups (p = 0.74), there was no peritoneal leak in either group, a minor serosal injury to the stomach was seen in 1 patient in LAG with no bowel injury in LAPEG cohort (p = 0.51), need for re-operation was 1 and 2% in LAG and LAPEG, respectively (p = 0.49), early tube dislodgement was in 8 (9%) patients in LAG and 7 (6%) in LAPEG (p = 0.53) and wound infection was 13/92 in LAG and 11/89 in LAPEG (p = 0.8). The median operative time for LAPEG was less than LAG (p < 0.001) by 11 min but the median length of hospital stay was not significantly different (p < 0.096).ConclusionBoth LAG and LAPEG techniques in children are safe with comparable complication rates and length of hospital stay, the addition of endoscopy to LAG allowed for shorter operative time in the LAPEG technique.

An Analysis of Percutaneous Endoscopic Gastrostomy Complications.

To determine the indications of early and late complications in 224 patients who underwent Percutaneous Endoscopic Gastrostomy (PEG) procedure. Observational study. Department of General Surgery, Karatay University and Medipol University, Turkey, from January 2014 to December 2020. Patients' age, gender, primary diseases, PEG indications, morbidity, mortality, and complications were recorded by performing the PEG procedure. Hospitalisation, follow-up periods of the patients, and the re-insertion of PEG were evaluated. The most common indication for PEG tube insertion was nutritional disorder associated with cerebrovascular diseases in 81 (37%) patients. No mortality was perceived due to the PEG tube insertion. However, mortality was observed in 84 (38.4%) patients in the first six months, in 6 (2.7%) patients between the sixth and twelfth month, and in 8 (3.7%) patients after the twelfth month. All these mortalities were attributed to the primary disease. In the early and late periods, complications were observed in the total of 45 (20.4%) patients. Among them, 17 (7.7%) patients experienced early period complications, whereas 28 (12.7%) patients experienced late period complications. Enteral nutrition should be preferred in order to avoid complications of parenteral nutrition in the patients who need long-term nutrition. In enteral nutrition, PEG should be preferred to surgical gastrostomy because it has less morbidity and mortality, can be done at the bedside and outpatiently when necessary, does not require general anesthesia, and is cheaper and practical. Gastrostomy, Percutaneous Endoscopic gastrostomy, Enteral nutrition, PEG complications.

Üçüncü Basamak Bir Sağlık Merkezinin Perkütan Endoskopik Gastrostomi Deneyimi

Aim: Percutaneous endoscopic gastrostomy (PEG) is a low-risk, inexpensive, accessible and technically easier enteral procedure that can be performed in endoscopy units or at the bedside, in which intravenous or local agents can be used for sedation. In our study, we aimed to evaluate the indications, complications and outcomes of the patients who underwent PEG in our clinic. Methods: Patients who underwent percutaneous endoscopic gastrostomy (PEG) procedure between January 2015 and March 2021 in the general surgery endoscopy unit of a tertiary healthcare center were included in the study. The clinical data of the cases, complications due to PEG, and mortality were investigated. Results: Of 260 patients with PEG, 158 (60.7%) were male and 102 (39.3%) were female. The mean age of the patients was 65.23 years (range 18-92 years). The clinic that requested PEG most frequently was the anesthesia and reanimation intensive care clinic (n=146; 56.1%). The most common indication for PEG was oral intake disorder due to cerebrovascular disease (n=194, 74.6%). Complications (6 early and 10 late) developed in 16 (6.1%) patients after PEG application. The most common early complication was peristomal infection (n=4, 1.5%). The most common late complication (n=7; 2.7%) was PEG catheter occlu-sion. While no mortality was observed in any patient due to PEG application, mortality secondary to primary disease was observed in 62 (23.8%) patients in the first 30 days. Conclusions: Percutaneous endoscopic gastrostomy is a fast, safe and cost-effective method that does not require general anesthesia and can be performed by an experienced team in patients who require enteral nutrition.

Prevalence of Helicobacter pylori infection in patients with Dementia who underwent Percutaneous Endoscopic Gastrostomy (PEG) and the effect of preventive single dose ceftrixone plus pantaprazole therapy on Helicobacter pylori infection

Objective: This was a retrospective study of the hospital database from April 2020 to January 2021 to reveal the rate of Helicobacter pylori infection among Dementia patients who underwent percutaneous endoscopic gastrostomy (PEG) procedure. Other aim of this study is examine the effect of a single dose (two grams) intravenous ceftriaxone plus pantoprazole (40 mg) before PEG procedure on H.pylori infection in Dementia patients. Material and Methods: This is a retrospective observational study of hospital database from April 2020 to January 2021 examining the effect of using a single dose (two grams) of intravenous ceftriaxone plus pantoprazole (40 mg) on H.pylori infection in Dementia patients. A total of 77 patients, (43 (64%) of them were female) with Dementia were included whose 67 had previously been diagnosed as Dementia and underwent PEG procedure. The control group (67 subjects; 40 of them were female and the mean age was 75.8±11 years) was selected from age and gender-matched dyspeptic subjects who underwent endoscopy Results: While the mean age in the Dementia group was 75.8±12 years, the mean age of the control group was 77.8 ±11 years (p=0.054). There were also no gender differences between groups (p=0.594). While the mean levels of serum albumin, urea, creatinine, hemoglobin were significantly lower than control subjects (All p values were below 0.001), the mean of serum ferritin level was higher than control subjects (p&lt;0.01). The presence of H.pylori on gastric biopsy specimens was significantly lower in the Dementia group compared to control subjects (19.4% versus 55.2%). Conclusion: Our study indicated that the rate of H.pylori infection was lower than estimated and using single-dose intravenous ceftriaxone at a dose of 2 grams could be beneficial for treating H.pylori infection in patients with Dementia who faced difficulties related to lack of swallowing many drugs against H.pylori infection.

Underlying disease for percutaneous endoscopic gastrostomy tube placement predicts short- and long-term mortality.

PEG (percutaneous endoscopic gastrostomy) is a well established endoscopic procedure for enteral feeding. However, patients with a shorter life expectancy will not benefit from PEG tube placement. Furthermore, some specific evolving diseases will never benefit from PEG. The aim of the study focuses on short and long term mortality rates after PEG tube placement in a referral gastroenterology centre (Geneva University Hospital). 219 patients were enrolled in this study. All patients scheduled for a PEG procedure between January 2011 and December 2014 were included. Nine patient parameters were collected for further analysis as well as the main underlying disease requiring PEG tube placement. Patients were subsequently divided into 4 groups according to underlying disease: Group 1) swallowing disorders of neurologic origin; Group 2) swallowing disorders associated with upper digestive tract neoplasia ; Group 3) nutritional support for a non GI reason ; Group 4) Other. 219 patients had undergone a PEG tube placement. 33 patients died within 60 days after the procedure. After one year, 71 patients died. Global survival was 870 days. The nutritional support group had the better survival rate with 1276 days compared to the swallowing groups and others. The multivariate analysis has highlighted the underlying disease as the only associated parameter with short and long term mortality. PEG tube placement is associated with high short and long term mortality depending on the underlying disease. We outlined the potential role of PEG tube insertion as a supportive transient approach for nutritional support.

Is preparation of a sterile operative field before percutaneous endoscopic gastrostomy necessary? A cost-effectiveness analysis.

Despite the non-sterile nature of the alimentary tract, percutaneous endoscopic gastrostomy (PEG) procedures are often performed after creating a sterile surgical field to reduce infection risk. Our group has previously demonstrated no statistically significant difference in the rate of surgical site infection (SSI) following PEG performed with or without sterile operative fields. The purpose of this study is to evaluate the cost-effectiveness of working with or without sterile operative fields during PEG. A decision tree model of PEG with and without sterile operative fields was created to evaluate the cost-effectiveness of these two methods. The primary outcome was incremental cost-effectiveness ratio with a ceiling willingness to pay threshold assumed of $100,000 per quality-adjusted life year (QALY). Costs were from the perspective of the healthcare system with a time horizon for the model of 90days. Sensitivity analyses were performed on all model parameters. In the base case analysis, sterile operative field PEG was cost-effective resulting in 0.2225 QALYs at an expected cost of $2,099. PEG procedures without a sterile operative field yielded less QALYs (0.2224) at a higher cost ($2,199) and were dominated. These procedures became cost-effective when the expected cost was < $1618 (e.g., $140 less than sterile operative field PEG) or when the SSI rate was < 1.6% (e.g., 0.2% higher than sterile operative field PEG) while holding all other variables constant. PEG procedures performed without a sterile operative field can be cost-effective compared to procedures performed with a sterile operative field if the rates of SSI remain similar. Cost savings from foregoing a sterile operative field appear to be offset if the SSI rate increases > 0.2% above that of sterile operative field PEG procedures.

Nutritional Impact of Percutaneous Endoscopic Gastrostomy: A Retrospective Single-center Study.

Several conditions may cause difficulties with oral feeding. Percutaneous endoscopic gastrostomy (PEG) is commonly performed on patients who require enteral feeding for >2-3 weeks. This study examined the nutritional state of patients who required enteral feeding and underwent PEG to quantify the benefits of the procedure. This retrospective study included patients who underwent PEG at the Chungnam National University Hospital between January 2013 and December 2018. A gastroenterologist performed all PEG procedures using the pull technique, and all patients were followed up for >3 weeks postoperatively. The BMI and lymphocyte count, along with the levels of hemoglobin, total protein, albumin, total cholesterol, BUN, and creatinine pre-PEG and between 3 weeks and 6 months post-PEG were evaluated. Overall, 151 patients (116 males; mean age 64.92 years) were evaluated. Of these patients, 112 (74.2%), 34 (22.5%), and five (3.3%) underwent PEG tube insertion because of neurological diseases, malignancy, and other conditions, respectively. The BMI and the hemoglobin, total protein, albumin, and total cholesterol levels were significantly higher post-PEG than pre-PEG. These findings highlight the usefulness of PEG in the management of nutritionally poor patients with difficulties in feeding orally.