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Conceição D, Gomes LC, Francisco F, Frade I, Gramacho J, Faias S, Claro I. Fast-track discharge following percutaneous endoscopic gastrostomy removal in head and neck cancer patients after remission: a feasibility and safety study. J Gastrointest Surg 2024:S1091-255X(24)00371-8. [PMID: 38555186 DOI: 10.1016/j.gassur.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/03/2024] [Accepted: 03/09/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Daniel Conceição
- Department of Gastroenterology, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal.
| | - Luís Correia Gomes
- Department of Gastroenterology, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal
| | - Fátima Francisco
- Department of Gastroenterology, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal
| | - Ivone Frade
- Department of Gastroenterology, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal
| | - Joana Gramacho
- Department of Gastroenterology, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal
| | - Sandra Faias
- Department of Gastroenterology, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal; Católica Medical School, Rio de Mouro, Portugal
| | - Isabel Claro
- Department of Gastroenterology, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal
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Elmahdi A, Eisa M, Martindale R, Omer E. Persistent Ostomy Following Percutaneous Endoscopic Gastrostomy Removal: Treatment Strategies. Curr Gastroenterol Rep 2024; 26:53-56. [PMID: 38194110 DOI: 10.1007/s11894-023-00912-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW The purpose of this article is to review available literature on management of persistent ostomy following PEG tube removal. We will discuss the incidence of persistent gastrocutaneous fistula (GCF) following PEG tube removal, risk factors for their development, and management strategies that have been proposed and their efficacy. RECENT FINDINGS The use of over the scope clips (OTSC) have evolved recently in the management of gastrointestinal bleeding, perforation, and fistula closures. OTSC has become more readily available and proven to be effective and safe. Suturing devices have shown promising results. Persistent gastrocutaneous fistula following PEG removal is a rare yet serious complication that can lead to continuous skin irritation and leakage of gastric contents and acid. There are several postulated risk factors but the most important of these is duration of placement. Management can include medical therapy which has recently been shown to be somewhat effective, endoscopic therapy and surgery as a last resort. Overall, the data on GCFs is limited and further study with larger sample size is needed.
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Affiliation(s)
- Alsiddig Elmahdi
- Virginia Commonwealth University Health Systems, Richmond, VA, USA
| | - Mohamed Eisa
- Allegheny Center for Digestive Health, Allegheny Health Network, Pittsburgh, PA, USA
| | - Robert Martindale
- Department of Surgery, Oregon Health Sciences University, Portland, OR, USA
| | - Endashaw Omer
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, 530 S Jackson St ACB bldg 3rd floor, 40202, Louisville, KY, USA.
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Waseem A, Wawrzynski J, Maselli DB, Kucera A, Wooley C, McGowan C. Endoscopic removal of a weight-loss device with stoma closure using a tack-and-suture device. VideoGIE 2023; 8:441-442. [PMID: 38026712 PMCID: PMC10665149 DOI: 10.1016/j.vgie.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Video 1.
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Marlor D, Noor S, Beck J, Taghlabi KM, Al-Kasspooles M. Jejunojejunal intussusception of a sutured enterotomy site after takedown and primary repair of persistent enterocutaneous fistula: a case report. J Surg Case Rep 2022; 2022:rjac399. [PMID: 36158243 PMCID: PMC9491862 DOI: 10.1093/jscr/rjac399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 11/12/2022] Open
Abstract
Enterocutaneous fistula (ECF) is a common complication of many abdominal surgeries. Although most ECF resolve spontaneously, there are many factors that can lead to persistence of the fistula. Management of persistent enterocutaneous fistula usually involves surgery with recurrence of fistula being the most common complication. Here we describe a case of 67-year-old female who presented with intussusception following repair of a persistent enterocutaneous. Given the rare finding of intussusception in adults, this case report presents an interesting complication.
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Affiliation(s)
- Derek Marlor
- Department of General Surgery, University of Kansas Medical Center , Kansas City, KS , USA
| | - Sibat Noor
- University of Kansas School of Medicine , Kansas City, KS , USA
| | - Justin Beck
- Department of General Surgery, University of Kansas Medical Center , Kansas City, KS , USA
| | - Khaled M Taghlabi
- Department of General Surgery, University of Kansas Medical Center , Kansas City, KS , USA
| | - Mazin Al-Kasspooles
- Department of General Surgery, University of Kansas Medical Center , Kansas City, KS , USA
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Abdelfattah T, Kaspar M. Gastroenterologist's Guide to Gastrostomies. Dig Dis Sci 2022; 67:3488-3496. [PMID: 35579798 DOI: 10.1007/s10620-022-07538-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/22/2022] [Indexed: 12/09/2022]
Abstract
Gastroenterologists are frequently consulted for evaluation feeding tube placement, or for management of complications in an existing feeding tube. Though a frequent topic of consultation for GI Fellows, there are few comprehensive resources for feeding tube placement and troubleshooting available. In this review, we discuss different types of feeding tubes, when each should be considered, and various methods and techniques for placement. Considerations for when one type, method, technique, or specialty may be preferred over the other will be discussed. Additionally, we discuss management of the many complications of indwelling feeding tubes. Our goal is to create a comprehensive review for gastroenterologists to cover clinically relevant questions related to feeding tube placement and management.
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Affiliation(s)
- Thaer Abdelfattah
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, 1200 E Broad Street, West Hospital, 14th Floor, Box 980341, Richmond, VA, USA.
| | - Matthew Kaspar
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, 1200 E Broad Street, West Hospital, 14th Floor, Box 980341, Richmond, VA, USA
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Jovani M, Zhang L, Huang Y, Kumbhari V. Multi-layer endoscopic suturing: a novel method of gastric fistula closure. Endosc Int Open 2021; 9:E1520-E1523. [PMID: 34540544 PMCID: PMC8445670 DOI: 10.1055/a-1517-4405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background and study aims Current endoscopic methods of treating gastric fistulas are either too complex or have high rates of recurrence. We aimed to provide a novel endoscopic method for robust fistula closure. Patients and methods This was a single-center, retrospective study of five patients who underwent multi-layer endoscopic suturing for closing of a chronic fistula (> 4 weeks). Devitalization of the fistula tract was achieved with argon plasma coagulation, followed by endoscopic suturing of the fistula. Then, endoscopic suturing of the gastric wall surrounding the fistula was performed, creating an overlay of healthy gastric mucosa around the fistula. Results Technical success (fistula closure on the day of the procedure) was achieved in all five patients, with no complications. After a median follow up of 5 months (range 2-23 months), there was a 100 % clinical success rate (no fistula recurrence). Conclusions Our single-operator method of multi-layer endoscopic suturing provides a robust fistula closure with minimal to no risk of recurrence. In light of limitations of current fistula closure methods, further investigations are warranted to better define long-term outcomes with it compared to alternative methods.
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Affiliation(s)
- Manol Jovani
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Linda Zhang
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Yuting Huang
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States,Gastroenterology and Hepatology, Mayo Clinic, Florida, United States
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Boeykens K, Duysburgh I. Prevention and management of major complications in percutaneous endoscopic gastrostomy. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000628. [PMID: 33947711 PMCID: PMC8098978 DOI: 10.1136/bmjgast-2021-000628] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 12/17/2022] Open
Abstract
Background Percutaneous endoscopic gastrostomy is a commonly used endoscopic technique where a tube is placed through the abdominal wall mainly to administer fluids, drugs and/or enteral nutrition. Several placement techniques are described in the literature with the ‘pull’ technique (Ponsky-Gardener) as the most popular one. Independent of the method used, placement includes a ‘blind’ perforation of the stomach through a small acute surgical abdominal wound. It is a generally safe technique with only few major complications. Nevertheless these complications can be sometimes life-threatening or generate serious morbidity. Method A narrative review of the literature of major complications in percutaneous endoscopic gastrostomy. Results This review was written from a clinical viewpoint focusing on prevention and management of major complications and documented scientific evidence with real cases from more than 20 years of clinical practice. Conclusions Major complications are rare but prevention, early recognition and popper management are important.
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Affiliation(s)
- Kurt Boeykens
- AZ Nikolaas, Nutrition Support Team, Sint-Niklaas, Oost-Vlaanderen, Belgium
| | - Ivo Duysburgh
- AZ Nikolaas, Nutrition Support Team, Sint-Niklaas, Oost-Vlaanderen, Belgium
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