Peristomal Infection Research Articles

Risk factors for the development of a parastomal hernia in patients with enterostomy: a systematic review and meta-analysis.

Parastomal hernia (PSH) is a common and serious complication in patients with enterostomy, but there is no current consensus for the risk factors for PSH from previous studies. Therefore, this study systematically analyzed the risk factors for PSH to provide a reference for prevention and treatment of this condition. Seven databases and 3 registers were systematically searched from database inception to January, 2021. Study quality was assessed by Newcastle-Ottawa Scale. Review Manager 5.3 software was used for statistical analysis. The data that could not be combined quantitatively were only analyzed qualitatively. Sixteen studies with 2031 patients were included. Higher BMI (OR, 1.29; 95% CI,1.02-1.63), older age (OR, 1.04; 95% CI, 1.02-1.07), female (OR, 2.55; 95% CI,1.39-4.67), lager aperture size (OR, 2.8; 95%CI, 1.78-4.42), transperitoneal stoma creation (OR, 2.4; 95% CI, 1.33-4.35), and lager waist circumference (OR, 1.01; 95% CI,1.0-1.01) were significant risk factors for PSH. The laparoscopic approach was not a risk factor for PSH (OR, 2.09; 95% CI, 0.83-5.27). Other risk factors, including the thickness of abdominal subcutaneous fat, no mesh, a stoma not through the middle of the rectus abdominis, atrophy of left lower medial part of rectus abdominis, α1(III) procollagen expression level, emergency surgery, no preoperative stoma site marking, end colostomy, smoking, diabetes, peristomal infection, severe abdominal distention, severe cough, chronic obstructive pulmonary disease, operation time and hypertension, were significant on the multivariate analysis of each individual study. The current available evidence showed that higher BMI, older age, female, larger aperture size, the creation of a transperitoneal stoma, and a larger waist circumference were independent risk factors for PSH. For factors without exact cutoff value, further explorations are needed in the future. In addition, reference to the limited number of studies in the pooled analysis, these factors still need to be interpreted carefully.

Comparative outcomes of endoscopic and radiological gastrostomy tube placement: a systematic review and meta-analysis with GRADE analysis.

Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are invasive interventions used for enteral access. We performed a systematic review and meta-analysis with assessment of certainty of evidence to compare the risk of adverse outcomes and technical failure between PEG and PRG. We queried PubMed, EMBASE, and Cochrane from inception through January 2022 to identify studies comparing outcomes of PEG and PRG. The primary outcome was 30-day all-cause mortality; secondary outcomes included the risk of colon perforation, peritonitis, bleeding, technical failure, peristomal infections, and tube-related complications. We performed GRADE assessment to assess the certainty of evidence and leave-one-out analysis for sensitivity analysis. In the final analysis, 33 studies, including 26 high-quality studies, provided data on 275,117 patients undergoing PEG and 192,691 patients undergoing PRG. Data from high quality studies demonstrated that, compared to PRG, PEG had significantly lower odds of selected outcomes, including 30-day all-cause mortality (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.60-0.95; P=0.02), colon perforation (OR 0.61, 95%CI 0.49-0.75; P<0.001), and peritonitis (OR 0.71, 95%CI 0.63-0.81; P<0.001). There was no significant difference between PEG and PRG in terms of technical failure, bleeding, peristomal infections or mechanical complications. The certainty of the evidence was rated moderate for colon perforation and low for all other outcomes. PEG is associated with a significantly lower risk of 30-day all-cause mortality, colon perforation, and peritonitis compared to PRG, while having a comparable technical failure rate. PEG should be considered as the first-line technique for enteral access.

Comparison of Open Gastrostomy and Percutaneous Endoscopic Gastrostomy in Head and Neck Cancer Patients, Tertiary Care Hospital Experience

Abstract: Objective: The current study was conducted to review and compare PEG and Gastrostomy in terms of early complications in head and neck cancer patients. Materials and Methods: This was prospective comparative study recruited total 60 patients as per the inclusion criteria, 30 in each group. Patients were assigned to the groups based on the surgeon’s choice. Ethical clearance was taken from ethical review board. Informed consent was taken from patients before enrolling them into the study. Non-probability consecutive sampling technique was used to enroll study participants. Data was collected on pre-designed performa and analyzed using SPSS version 16. Setting: Section of Otolaryngology, Department of Surgery, Aga Khan University Hospital Karachi. Results: The two groups did not differ on basis of age, gender and tumor site. The outcomes variables including pain and bleeding from post-operative day1 to day 5 were significantly lower in patients who underwent PEG placement as compared to patients whom we performed OPEN gastrostomy. None the patient had peristomal infection in PEG group throughout the study. However, difference between the groups was statistically significant from post-operative day 3 to day 5. Conclusion: In our study, PEG was associated with lesser complications than open gastrostomy. Recently clinicians are using newer modalities like radiological and laparoscopic gastrostomy at various centres in Pakistan as the first option for placing feeding gastrostomy. Therefore, future studies are warranted to compare their efficacy and post-operative complications PEG. Keywords: Head and neck cancer, Open gastrostomy, Percutaneous endoscopic gastrostomy, Complications, Pain, Peristomal infection, Bleeding

Redetermining the cutoff point of peristomal infection scoring: Methodological research.

Peristomal infections are a frequently encountered problem in enteral nutrition that warrants prompt diagnosis and early antimicrobial treatment. Current practice lacks a consensus on an accepted measurement tool with acknowledged validity and reliability. The Peristomal Infection Scoring System is one such tool that shows promise, yet the optimal cutoff value remains to be determined. This methodological research was conducted with 54 adult participants to evaluate their peristomal areas in terms of infection by two nurse nutritionists and an expert physician in a simultaneous and independent manner, using peristomal infection scoring or the local signs and symptoms of infection. Performance was assessed by the receiver operating characteristic curve, interobserver reliability, and validity metrics. According to the expert physician's opinion, the peristomal infection rate was 9.2%. The agreement between the observers using the Peristomal Infection Scoring System was κ = 1,000, P < .001. The peristomal infection scoring area under the receiver operating characteristic curve was 0.98 (P < .001), and the best cutoff value was found to be 6 points, which correlated positively with a 0.88 coefficient (P < .001) and an accuracy of 98.1% (CI, 90.11%-99.95%). The Peristomal Infection Scoring System with a cutoff value of 6 points is a valid and reliable instrument to diagnose peristomal infections. It can be easily used by healthcare professionals in all settings as needed.

Safety of Percutaneous vs Open Tracheostomy on Intubated Patients in ICU Setting: Which One is Better?

To study the safety of percutaneous vs open tracheostomy approaches on patients requiring long term ventilation in ICU setting. It is a prospective study done over a period of 2years on 105 patients requiring long term ventilation in ICU set up in a tertiary care hospital. Patients were subjected to either open approach or percutaneous tracheostomy bedside in ICU itself. Then patients were followed during their hospital stay to look for any tracheostomy related complications. Data regarding age, gender, indications of long term ventilation and complications were compiled and analysis was done. It was found that most of the patients were of male gender (88.6%) in the age group of 50-59years of age. The most common cause for tracheostomy was head injury secondary to road traffic accident, seen in 79 out of 105 cases. On comparing complications rate, there was no statistically significant difference in both the groups. However rate of peristomal infection is more with open approach group (P < 0.05). Percutaneous tracheostomy can be performed safely in ICU as a bedside procedure. There is significant reduction in peristomal infection with percutaneous tracheostomy and there is no significant difference in other complications between the two groups. Thus percutaneous tracheostomy is as safe as an open approach tracheostomy in properly selected cases.

Radiologically Inserted Gastrostomy (RIG) at a Tertiary Center: Periprocedural Safety including Rationalization of Antibiotic Prophylaxis

Abstract Introduction Long-term percutaneous enteral nutrition forms an important part of treatment for patients with an inability to meet nutrient requirements orally. Radiologically inserted gastrostomy (RIG) is an alternative to the traditionally performed percutaneous endoscopic gastrostomy technique. However, there is marked heterogeneity in the way that RIG is performed. In addition, the role for antibiotic prophylaxis during RIG insertion is not clearly established. This study aimed to assess the safety of RIG insertion using our technique including the role of antibiotics in RIG insertion. Method Retrospective study over 5 years at a tertiary teaching hospital. Periprocedural or early complications within the first 2 weeks of the procedure were collected and correlated with the use of prophylactic antibiotics. Results A total of 116 patients met the inclusion criteria. 18-French tube was used in 96.6%. Note that 58.6% of procedures were done with intravenous sedation. Prophylactic 1 g cefazolin was used in 70 patients with 1 case of infection. Procedures were performed without antibiotics in 46 patients with 3 infections, p = 0.20.There were two major complications (1.7%) consisting of right gastric artery injury requiring embolization and gastric wall injury requiring laparotomy. There were 12 minor complications (10.3%) including 4 cases of infection, 3 of severe pain, 1 of minor bleeding, 2 of early dislodgement, and 2 of leak/bypass of gastric contents around the tube. Conclusion The technique used for RIG insertion at our institution results in a low complication rate. In addition, this study shows no significant difference in early peristomal infection rate with the use of antibiotic prophylaxis.

Antibiotic Prophylaxis for Percutaneous Endoscopic Gastrostomy in Children: A Randomised Controlled Trial.

Paediatric studies on the role of antibiotic prophylaxis in the prevention of postoperative infections in children undergoing percutaneous endoscopic gastrostomy (PEG) are lacking. The aim of this study was to assess if a single dose of co-amoxiclav before PEG can decrease the rate of peristomal wound and systemic infection in children. In this prospective, randomised, double-blind, multicentre trial, children undergoing PEG were randomized to antibiotic prophylaxis with co-amoxiclav versus placebo and the rate of local and systemic infections were assessed. Of the 106 patients considered for inclusion, 49 patients were randomized. In the per-protocol analysis, the occurrence of wound infection was 5% (1/20) in the antibiotic group and 21% (4/19) in the placebo group (P = 0.13, 16% difference in proportions, odds ratio [OR] 0.19, 95% confidence interval [CI] 0.02-1.9). The occurrence of systemic infection was 9% (2/22) in the antibiotic group and 27.2% (6/25) in the placebo group [P = 0.17, 18% difference in proportions, OR 0.32, 95% CI 0.06%-1.80%]. Similar results were obtained in intention-to-treat analysis. Interestingly, the overall infection rate was significantly higher in the placebo group as compared with the antibiotic group (40% vs 13.6%; P = 0.04) and the duration of hospital stay was significantly longer in the placebo group as compared with the antibiotic group (4.4 ± 1.6 vs 3.5 ± 1.05; P = 0.02). The number-needed-to-treat (NTT) to prevent 1 peristomal infection on average are 6.7 patients. A preoperative dose of co-amoxiclav reduces the overall infection rate and the duration of hospital stay. Our data suggest that antibiotic prophylaxis should be recommended in every children undergoing PEG placement.

Study of percutaneous endoscopic gastrostomy compared to nasogastric tube feeding in patients requiring prolong enteral nutritional support

Background: The aims and objectives of this article were to compare the advantages, disadvantages associated with percutaneous endoscopic gastrostomy (PEG) and nasogastric (NG) tube and also to compare complications, to measure the outcomes in terms of hospital stay, mortality and improvement in nutritional status.Methods: In this prospective and interventional study 25 patients were selected in each group on an alternate basis. Study was conducted on cases of traumatic brain injury and cerebrovascular accident patients admitted in Department of General Surgery, IGGMC for a period of November 2013- November 2015 with a need to provide prolonged enteral nutritional support. Each patient was assessed by a dietician and received a standard enteral feeding according to their body weight. The main outcome was measures at 4 weeks were complications (tube dislodgement, aspiration pneumonia, tube blockade and peristomal infections) and nutritional status.Results: The anthropometric parameters (mid arm circumference, biceps skin fold thickness and triceps skin fold thickness) and serum albumin showed a rise in PEG group at 4 weeks when compared to baseline (0 week) whereas they showed a decline in NG group at follow up (4 weeks). The NG group has got higher mortality 4 (17%) when compared to PEG group 2 (7%) due to aspiration pneumonia. Hence, PEG is better tolerated with lesser complications better nutritional support as assessed by the anthropometric parameters at 4 weeks.Conclusions: We conclude that whenever feasible percutaneous endoscopic gastrostomy (PEG) feeding is a choice over nasogastric (NG) feeding in patients requiring long term enteral support.

Laparoscopic tubularized continent gastrostomy: an alternative to tube gastrostomies.

Gastrostomy tubes, placed either endoscopically or laparoscopically, are the most widely used method to deliver enteral feeding to patients unable to be fed by mouth. Tube gastrostomy is quick and low cost and allows the health care professionals for a convenient route to deliver enteral nutrition to their patients. Nevertheless, bearing an indwelling gastric tube could not be as convenient for patients. Complications, such as bowel perforation, tube dislodgement, peristomal infection or bleeding occur in up to 17% of patients, and some other drawbacks of gastric tubes, such as peristomal pain, are often understated. We present our technique for laparoscopic creation of a tubularized continent gastrostomy, originally conceived for the emergency treatment of patients with a dislodged percutaneous endoscopic gastrostomy, to provide them with a reliable new route for gastric feeding. After healing, this gastrostomy does not need an indwelling tube to stay patent, requires only a light gauze dressing and can be used by intermittent catheterization at conventional feeding times during the day. Laparoscopic tubularized continent gastrostomy can be offered to patients as a reliable alternative to tube gastrostomy.

Superior Mesenteric Artery Syndrome Improved by Enteral Nutritional Therapy: A Retrospective Case-Series Study in a Single Institution

Introduction: Superior mesenteric artery syndrome (SMAS) is a relatively rare cause of chronic duodenal obstruction, owing to the compression of the third portion of the duodenum. Objectives: This retrospective study aims to discuss the efficacy of enteral nutrition (EN) therapy in nutritional status and symptom improvement at a short-term follow-up for SMAS patients. Methods: We retrospectively analyzed clinical data of patients diagnosed as SMAS and treated with EN from September 2012 to January 2019. Results: Twenty-six patients were included (16 women; mean age 24.96 ± 11.77 years), none was excluded, and one was lost to follow-up. The patients’ mean body weight was 40.94 ± 10.16 kg, mean weight loss 11.73 ± 7.58 kg, and mean body mass index (BMI) 14.82 ± 2.52 kg/m². The mean duration of EN therapy was 10.10 ± 4.66 months. Serum level of nutritional indicators, BMI and body weight increased after EN therapy. During a median follow-up of 24 months (9–44) after EN therapy, the mean symptom score decreased from 24.28 ± 9.57 to 8.06 ± 8.29 (p < 0.0001), and 65% of patients’ symptoms resolved and 15% of patients’ symptoms improved. In total, 16 complications occurred, including tube blockage, peristomal wound infections, peristomal leakage, granulomas, and nasopharyngeal pain. Conclusion: EN therapy may be an effective option for SMAS patients. While it might not remove all symptoms, it can improve the nutritional status to support subsequent treatments.

General principles for the prevention and treatment of complications of percutaneous endoscopic gastrostomy (review of literature)

We considered the views of researchers presented in the modern literature on both the problem as a whole and discussion questions regarding the causes of development, preventive measures, and methods of treating percutaneous endoscopic gastrostomy complications, such as clogging of the gastrostomy tube, peristomal wound infections, necrotic fasciitis, pneumoperitoneum, buried bumper syndrome, growth of granulations in the gastrostomy zone, postoperative bleeding and intraparietal hematoma of the gastric wall, traumatic dislocation of the gastrostomy tube, peritonitis after percutaneous endoscopic gastrostomy, peristomal leakage, сolonic fistula, liver injury and abdominal wall metastasis at the percutaneous endoscopic gastrostomy site.

Efficacy of Gastrostomy Tube Coated With Povidone-iodine for Reducing Peristomal Infection Rate After PEG Insertion

Efficacy of Gastrostomy Tube Coated With Povidone-iodine for Reducing Peristomal Infection Rate After PEG Insertion

Long-term outcomes of catheterizable continent urinary diversion in children

Introduction/Objective. The use of bladder augmentation and/or continent urinary diversion has gained wide acceptance, particularly in children with small, abnormally developed bladder or high-pressure bladder that poses great risk for renal deterioration and incontinence. We discuss indications, results, and complications with various types of continent vesicostomy (CV) in children. Methods. Sixty-eight patients with CV are retrospectively reviewed (51 boys and 17 girls) 1987?2008. The median follow-up time was 17.8 years (3?22 years). CV included appendicovesicostomy in 31 (41.3%), vesicostomy with distal ureter in 27 (36.0%), and preputial CV in 10 (13.3%) patients. CV in patients with augmented bladder was in 18 (26.47%) children. The indications for performing CV were various types of neurogenic and myogenic dysfunctions of urine bladder with incontinence due to the following pathoanatomical substrates: anomalies of the brain?spine segment development (27), bladder exstrophy (10), posterior urethral valve (15), expansive processes (4), and other anatomical defects in 12 patients. Results. Continence was achieved in 94.64% of the cases, without statistically significant difference between particular types of the stoma (p = 0.065). Early complications included stoma necrosis, stoma bleeding, peristomal infection in 5/68 (7.35%) patients, and late complications included calculosis, in 20/68 (29.4%), stomal stenosis, in 8/68 (11.5%), and difficulties of catheterization, in 3/68 patients (4.08%). Calculosis was predominant in appendicovesicostomy (p = 0.012). Conclusion. CV is a safe procedure applied with the main purposes of achieving continence, preservation of renal function, and improvement of the quality of life, along with an acceptably low rate of complications.

565 Prophylactic Antibiotics for PEG Tube Placement: An Updated Meta-Analysis of Randomized Controlled Trials

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) tube placement is associated with a risk of infection. It is currently a standard of practice to administer prophylactic antibiotics with PEG tubeplacement. However, several recent studies have reported mixed results. We performed an updated meta-analysis to assess the efficacy of prophylactic antibiotics for PEG tube placement. METHODS: MEDLINE, Google scholar, Embase PubMed, Cochrane Database, and abstracts from gastroenterology scientific meetings were searched. Only randomized controlled trials (RCTs) of adult subjects comparing prophylactic antibiotics to no prophylactic antibiotics for PEG tube placement were included. Study quality was accessed by assigning a quality score. Two independent reviewers used standard forms to extract data and the differences were resolved by mutual agreement. Meta-analysis for the effects of prophylactic antibiotics was analyzed by calculating pooled risk or odds ratio for peristomal infections, systemic infections, and mortality using both fixed and random effects models. Heterogeneity among studies was assessed by calculating I2 measure of inconsistency. Publication bias was also assessed. RESULTS: Thirteen RCTs (636 controls/764 treatment arm) met the inclusion criteria. All trials were published between 1985 and 2016. Eight trials predominantly used cephalosporins and 5 trials used penicillins. Eleven trials reported the technique of PEG tube placement: 8 used pull technique, 1 push technique, 1 both and 1 used the introducer method. In the treatment arm 1.07% of the patients got peristomal infection and in the control arm it was 2.55%. Prophylactic antibiotics with PEG tube placement resulted in a significant reduction in the risk of peristomal infection (RR 0.49, 95% CI: 0.39–0.63, P &lt; 0.001, NNT = 8) and systemic infection. On subgroup analysis, both cephaloporins and penicillin based prophylaxis resulted in statistically significant reduction in risk of infections. Both single dose and multiple doses of antibiotics resulted in a reduction in the risk of infection. No significant difference was noted for mortality. Heterogeneity among studies was not significant. Funnel plots revealed no significant publication bias. Majority of the studies received a high score for quality. CONCLUSION: Current evidence supports the administration of prophylactic antibiotics prior to PEG tube placement. Further studies need to explore different PEG tube placement techniques that might obviate the need for antibiotics.

2046 Peristomal B-Cell Lymphoma in a Patient With Complicated Ulcerative Colitis

INTRODUCTION: Ulcerative colitis (UC) is an inflammatory disease that predominantly involves the colon and rectum often requiring treatment with corticosteroids and immunomodulators. However chronic use of immunomodulators is usually associated with increased risk for lymphoma. Extranodal involvement of GI tract is typically seen however primary GI lymphoma is very rare. Here we present a unique case of B-cell lymphoma diagnosed from stomal biopsies. CASE DESCRIPTION/METHODS: A 76-year-old caucasian male with history of Ulcerative Colitis for almost 28 years, status post multiple abdominal surgeries including ventral hernia repair, ileostomy and colostomy presented with ongoing stoma complications for about 6 months. These complications included new fistula formation around the colostomy and ileostomy sites. Despite aggressive wound care, lesions did not regress, and continued to grow producing sharp, burning type of pain. There was ongoing purulent discharge from new fistula formation. Peri-ostomal biopsy from both ileostomy and colostomy was positive for B-cell lymphoma. On further history, patient endorsed fever, night sweats, and 30-lb weight loss over 5 months. PET scan showed increased uptake in both the stomas as well as liver. Chemotherapy options were discussed with Oncology, however patient opted for hospice as the prognosis was deemed poor. DISCUSSION: Primary GI lymphoma is common in stomach. Small intestine and colonic lymphoma account for 9% and 1% respectively. There have been multiple reports published citing association of lymphoma in IBD patients treated with immunomodulators. Our patient had two stomas (ileostomy and colostomy). Both periostomal biopsies were positive for B cell lymphoma. Periostomal lymphoma has been rarely reported. Parnesh et al (Case 1) reported a similar case of stomal lymphoma in a patient with history of Ulcerative Colitis. Levecq et al (Case 2) reported a stromal lymphoma in a patient with transfusion related AIDS who underwent total colectomy and ileostomy for indeterminate colitis. The lymphoma was diagnosed at 20 years (Case 1) and 2 years (Case 2) post stoma formation. Lymphoma should be in the differential of stoma being complicated by peristomal tissue proliferation, fistula and infection.

3132 Duodenal Spindle Cell Lipoma as a Rare Cause of Upper GI Bleeding

INTRODUCTION: Spindle cell lipomas are benign tumors commonly seen arising from subcutaneous tissue. Incidence of duodenal lipoma as a cause of GI bleed is very rare, however spindle cell variant of duodenal lipoma has never been reported per our review. To our knowledge this is the first case of duodenal spindle cell lipoma in an atypical location presenting as upper GI bleed. CASE DESCRIPTION/METHODS: A 68 year old lady with medical history significant for coronary artery disease with stents and GERD came in with complaints of shortness of breath. She also complained of melena and weight loss without any hematemesis or abdominal pain. Vitals were stable. Labs remarkable for Hb 9.9, iron panel suggestive of significant iron deficiency with serum iron of 16, ferritin 17. Endoscopy showed a 5 cm non bleeding submucosal lesion with ulceration which was concerning for GIST and a possible source of chronic bleeding. Mass was not biopsied, however patient later underwent duodenal bulb lesion resection with end to end gastroduodenostomy. Pathology of intestinal resection showed duodenal mucosa with an associated spindle cell lipoma. Immunohistochemical stain of duodenal lesion was positive for S100 and CD34, and immuno-negative for remaining stains (CD117, beta-catenin, and EMA), thus consistent with spindle cell lipoma. On follow up, Hb increased and pt reported clinical improvement. DISCUSSION: Primary GI lymphoma is common in stomach. Small intestine and colonic lymphoma account for 9% and 1% respectively. There have been multiple reports published citing association of lymphoma in IBD patients treated with immunomodulators. Our patient had two stomas (ileostomy and colostomy). Both peristomal biopsies were positive for B cell lymphoma. Peristomal lymphoma has been rarely reported. Parnesh et al. (Case 1) reported a similar case of stomal lymphoma in a patient with history of Ulcerative Colitis. Levecq et al. (Case 2) reported a stromal lymphoma in a patient with transfusion related AIDS who underwent total colectomy and ileostomy for indeterminate colitis. The lymphoma was diagnosed at 20 years (case 1) and 2 years (Case 2) post-stoma formation. Lymphoma should be in the differential of stoma being complicated by peristomal tissue proliferation, fistula and infection.

Prophylactic percutaneous endoscopic gastrostomy in patients with head and neck cancer: Influence on nutritional status, utilisation rate and complications.

Patients with head and neck cancer (HNC) are at high risk for malnutrition because of tumour localisation and therapy. Prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement is common practice to prevent malnutrition. To investigate the benefits of prophylactic PEG tube placement for HNC patients in terms of the influence on patients' nutritional status, utilisation rate, complications and to identify the predictors of PEG tube utilisation. All consecutive HNC patients who underwent prophylactic PEG tube insertion between 1 January 2011 and 31 December 2012 prior to therapy were enrolled. The PEG tube utilisation rate, complications, the patients' nutritional status and tumour therapy were evaluated with the help of electronic patient charts and telephone interviews. A total of 181 patients (48 female, median 67.5years) were included. The PEG utilisation rate in the entire cohort was 91.7%. One hundred and forty-nine patients (82.3%) used the PEG tube for total enteral nutrition, 17 patients (9.4%) for supplemental nutrition and 15 patients (8.3%) made no use of the PEG tube. Peristomal wound infections were the most common complications (40.3%) in this study. A high Nutritional Risk Screening (NRS) score prior to tube insertion was found to be independently associated with PEG utilisation. No significant weight changes were observed across the three patient subgroups. The overall PEG tube utilisation rate was high in this study. However, given the high rate of infections, diligent patient selection is crucial in order to determine which patients benefit most from prophylactic PEG tube insertion.

Stoma Bridge Types and Their Impact on Patient Outcomes: A Retrospective Analysis and Prospective Global Survey of Surgical Practice.

The purpose of this study was to describe the effect of rigid or flexible stoma bridges used for loop ostomy diversions on peristomal skin integrity. Additional aims were to describe surgeon practices related to stoma bridges, and determine the availability of an ostomy nurse specialist. Retrospective chart review and cross-sectional survey. The sample used to address the first aim (effect of stoma bridges) comprised 93 adult patients cared for at Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, an acute care facility. Data provided by 355 colorectal surgeons from 30 countries were used to describe surgeon practice in this area and determine the availability of an ostomy nurse specialist. Respondents were invited from an international roster of colorectal surgeons obtained with permission from the American Society of Colon and Rectal Surgeons (ASCRS). In order to accomplish the initial aim, we retrospectively reviewed medical records of patients who underwent ostomy surgery from 2008 to 2015 and met inclusion criteria. In order to meet our additional aims, analyzed data were obtained from a survey of colorectal surgeons that queried practices related to stoma bridges, and availability of an ostomy nurse specialist. Patients managed with a rigid bridge were significantly more likely to experience leakage beneath the pouching system faceplate than were patients managed by a flexible bridge (42% vs 11%, P < .001). Slightly less than one quarter of patients who developed leakage (n = 22, 24%) experienced pressure and moisture-related peristomal skin complications. Peristomal wounds, inflammation, and infection were significantly higher when a rigid bridge was used (χ test, P < .003). The surgeon's survey (N = 355) showed variability in the use of bridges. Ninety-three percent of all surgeons indicated an ostomy nurse specialist was part of their health care team. Rigid ostomy bridges were associated with a higher likelihood of leakage from underneath the faceplate of the pouching system and impaired peristomal skin integrity. Analysis of colorectal surgeon responses to a survey indicated no clear consensus related to bridge use in patients undergoing loop ostomies.

Liver abscess as a rare complication of PEG

Introduction: Percutaneous endoscopic gastrostomy (PEG) is one of the most effective methods of providing long-term enteral nutrition in patients with the impossibility of oral intake. Complications are relatively common. The most common is peristomal wound infection at the site of the insertion and leakage along the cannula. Lesscommon complications are colo-cutaneous fistulas and peritonitis. A very rare complication is liver abscess. Case report: The authors describe a case of a 51-year-old man with a hepatic abscess with inoperable pharyngeal carcinoma with PEG. The patient was admitted to hospital with a developing septic condition due to a liver abscess. The liverabscess resulted from the buried bumper syndrome of the PEG and subsequent complete dislocation of the bumper into the left liver lobe area.. This condition was treated by a surgical review with abscess drainage and the construction of classical gastrostomy. Conclusion: Buried bumper syndrome with its complications, such as a liver abscess is a relatively rare complication, but challenges both the diagnosis and therapy of the syndrome itself. Its management requires a close cooperation between a gastroenterologist and a surgeon. Early recognition and treatment can prevent the progression of the condition to sepsis or a septic shock, which can lead to death.

Percutaneous endoscopic gastrostomy for enteral nutrition: a 5-year clinical experience with 324 patients.

Percutaneous endoscopic gastrostomy (PEG) is considered the route of choice for long-term enteral nutrition. In this study, we evaluated the short term outcomes of PEG and aimed to identify the risk factors for in-hospital mortality as well as adverse events such as aspiration pneumonia. Three hundred and twenty-four patients who received PEG for enteral nutrition between January 2007 and December 2011 were included in this study. Data regarding baseline characteristics, preoperative biomarkers and clinical outcomes were collected and analyzed. The average patient age was 82.3±10.9 (SD) years old. 149 patients (46%) were men and 199 patients (61%) had stroke as a comorbidity. Postoperatively, feeding-related aspiration pneumonia was observed in 72 patients (22%), diarrhea in 40 patients (12%) and peristomal infection in 34 patients (11%). The average postoperative length of stay was 34.6 days. 51 patients (16%) died before discharge, 22 (6.8%) of them within 30 days after PEG. Two deaths (0.6%) were considered procedure-related (bleeding). Multivariate analysis revealed the male gender, lower serum albumin levels and higher blood urea nitrogen (BUN) levels as significant prognostic factors for in-hospital mortality. Higher C-reactive protein levels and BUN levels were found to be independently associated with the occurrence of postoperative aspiration pneumonia. Our experience reconfirmed PEG as a minimally invasive and safe procedure for long-term enteral nutrition in patients with impaired oral intake. However, significant prognostic factors should be taken into account during the preoperative evaluation of patients. Deferral of procedure or specialized postoperative care may be indicated in high risk patients.