1
|
Shargo R, Ekblad M, Brown JM, Baran JV, Fagan K, Coughlin E, Fierstein J, Lu PL, Wilsey M. Evaluating gastric emptying in pediatric patients with prior gastrostomy: A retrospective cohort study. J Pediatr Gastroenterol Nutr 2025. [PMID: 40491278 DOI: 10.1002/jpn3.70114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 05/13/2025] [Accepted: 05/24/2025] [Indexed: 06/11/2025]
Abstract
OBJECTIVES Gastrostomy tube placement is a common intervention for pediatric patients requiring long-term enteral feeding, yet the clinical profile and rates of gastric emptying in such population is poorly described. This study aimed to compare the clinical profile, subsequent gastric emptying, and diagnostic rates of gastroparesis in patients with and without prior gastrostomy. METHODS This retrospective study included pediatric patients <18 years undergoing gastric emptying scintigraphy (GES) at a quaternary care center between 2016 and 2020. The variable of interest was prior gastrostomy, defined as percutaneous endoscopic gastrostomy (PEG) or surgical gastrostomy. The primary outcome was gastric half-emptying time (T1/2), with secondary outcomes including gastric retention rates at 1, 1.5, and 2 h, and gastroesophageal reflux (GER) on GES. Statistical analyses included chi-square, Fisher's exact, and Mann-Whitney U tests. RESULTS Of 238 pediatric patients undergoing GES, 59 (24.8%) had prior gastrostomy (50 PEG, 9 surgical). Patients with gastrostomy were younger (p < 0.001), more often male (p = 0.003), and more likely to undergo liquid GES (p < 0.001). There were no significant differences in gastroparesis diagnostic rates (p = 0.836) or T1/2 between patients by gastrostomy status. However, patients with gastrostomy demonstrated significantly higher rates of GER on GES (32.8% vs. 16.7%, p = 0.009). CONCLUSIONS In one of the largest observational cohort studies of pediatric patients with gastrostomy tubes, gastric emptying rates did not differ by prior gastrostomy status. Prospective studies are needed to determine whether a causal relationship exists between gastrostomy placement and altered gastric emptying.
Collapse
Affiliation(s)
- Ryan Shargo
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | | | - Jerry M Brown
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
| | - Jessica V Baran
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
| | - Kimberly Fagan
- Department of Radiology, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Emily Coughlin
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Jamie Fierstein
- Epidemiology and Biostatistics Shared Resource, Epidemiology and Biostatistics Shared Resource, Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Peter L Lu
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Michael Wilsey
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Pediatric Gastroenterology, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| |
Collapse
|
2
|
Wang D, Peng R, Huang Y, Zhou J, Long Z, Wang J, Zhang D. Safety Study of Percutaneous Gastroscopic Gastrostomy in Patients After Ventriculoperitoneal Shunt. Am Surg 2024; 90:3262-3266. [PMID: 39030672 DOI: 10.1177/00031348241265147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
OBJECTIVE To evaluate the safety study of percutaneous gastroscopic gastrostomy in patients after ventriculoperitoneal shunt. METHODS We conducted a retrospective analysis of neurosurgical patients who underwent VPS and PEG at our hospital between January 2012 and November 2023. Patients were divided into 2 groups: VPS group and VPS followed by PEG gruop. Patients received routine antibiotic prophylaxis before the procedure, continued for 48 hours. Follow-up included monitoring immediate complications, particularly wound infection, intracranial infection, neurologic status deterioration, and shunt dysfunction. Routine follow-up visits were conducted post-discharge. RESULTS In the VPS group (n = 778), the incidence of intracranial infection was 3.08%. Among patients with PEG after VPS, the time interval between procedures ranged from 13 to 685 days. The mean follow-up period was 22 (1-77) months, with no deaths or further complications. CONCLUSION Performing PEG more than 13 days after VPS does not significantly increase the risk of intracranial infections or PEG-associated infections, making it a relatively safe procedure.
Collapse
Affiliation(s)
- Dexian Wang
- Department of Gastroenterology, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation, Capital Medical University, Beijing, China
| | - Run Peng
- School of Rehabilitation, Capital Medical University, Beijing, China
| | - Yebin Huang
- Department of Gastroenterology, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Jun Zhou
- Department of Gastroenterology, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Zhihua Long
- Department of General Surgery, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Jianjun Wang
- Department of Neurosurgery, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Dejian Zhang
- Department of Emergency, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China
| |
Collapse
|
3
|
Casas Deza D, Monzón Baez RM, Lamuela Calvo LJ, Betoré Glaria E, Montil Miguel E, Julián Gomara B, Vicente Lidón R. Complications and survival following percutaneous endoscopic gastrostomy tube placement. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:526-531. [PMID: 38767020 DOI: 10.17235/reed.2024.10335/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
INTRODUCTION percutaneous endoscopic gastrostomy (PEG) is considered as a safe and effective method for nutritional support in patients with malnutrition and swallowing impairment with an estimated survival of over two months. Some indications, such as advanced cognitive decline, contraindicate the technique. MATERIALS AND METHODS all patients who underwent PEG placement between January 2001 and May 2019 were included. Clinical data, indication, complications, and mortality were retrospectively analyzed. RESULTS a total of 648 patients (46.5 % male, mean age 70 ± 18.5 years) were included. The most common indications for PEG were advanced cognitive decline (31.5 %) and cerebrovascular disease (18.8 %). The mean follow-up was 12.07 months (IQR 3.27-34.73); 39.5 % of patients experienced complications (systemic 17.9 %, local 28.5 %). The most frequent were bronchoaspiration (9.7 %) and rupture/dysfunction (13.9 %), respectively. The presence of early complications (HR 1.63 [1.20-2.21]) and age (HR 1.02 [1.01-1.02]) was associated with shorter survival time, while female sex was a protective factor (HR 0.78 [0.66-0.94]). CONCLUSIONS PEG is not without complications, with 39.5 % of patients experiencing them. Patients with early complications, male sex and older age have lower survival following PEG placement.
Collapse
|
4
|
Cortés-González R, Hernández Flores LA, Ventosa-Camacho V, Moreno-Licea C, Jaspersen-Álvarez J, Alcázar-Ylizaliturri JL, Del Angel Millán G. Development of a novel technique for esophageal reconstruction via oral-vestibule-enteral anastomosis. J Gastrointest Surg 2024; 28:1424-1429. [PMID: 38876290 DOI: 10.1016/j.gassur.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/15/2024] [Accepted: 06/07/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Narrowing, trauma, tumors, and systemic diseases can cause esophageal dysfunction. Severe cases resist traditional surgery, leading to long-term gastrostomy or jejunostomy tubes, affecting patients negatively. No established surgery ensures both airway and oral function with proper speech. This article introduces the oral-vestibule-enteral anastomosis (OVEA) technique, targeting patients with compromised epiglottic closure competence and loss of cervical esophagus, where conventional methods fall short. METHODS Technique description study evaluated in 13 patients in a single tertiary referral center in Mexico City treated with OVEA from January 1990 to July 2023. RESULTS Of the 13 patients (69% male; mean age, 37.14 ± 12.907 years), preoperative conditions included a mean body mass index of 17.78 ± 2.66 kg/m2, 46% with previous abdominal surgeries, and 31% with a smoking history. After OVEA, complications affected 46%, primarily pneumonia (23%), abscess formations (15%), intestinal necrosis (8%), and airway fistula (8%). Reoperation was needed in 38%, addressing functionality loss, necrosis, stenosis, and jawbone remodeling. No fatalities occurred within the first 6 months after surgery; 84% had successful gastrostomy tube removal, and 8% retained a tracheostomy tube. Currently 13 patients (92%) use the OVEA as their main enteral route of feeding. CONCLUSION The OVEA technique seems promising for cases involving esophageal loss or impaired epiglottic function, enhancing patients' quality of life by enabling oral feeding and restoring regular eating habits. Further research should focus on long-term results and identifying optimal candidates for this innovative surgical method.
Collapse
Affiliation(s)
- Rubén Cortés-González
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México.
| | | | | | - Carolina Moreno-Licea
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | | | | | | |
Collapse
|
5
|
Gándara Gutiérrez C, Alonso Felgueroso C, Díaz Naya L, Diéguez Felechosa M, González Martínez S, Gutiérrez Buey G, Lázaro Martín L, Monge Rafael MªP, Veiguela Blanco B, Puente Barbé GO, Pasarón Fernández M, Nozal García L, Suárez-Coalla Bango C, Fernández Iglesias L, Riestra-Fernández M. [Gastrocolic fistula as infrequent cause of chronic diarrhea in a patient with percutaneous radiological gastrostomy]. NUTR HOSP 2024; 41:510-513. [PMID: 38450523 DOI: 10.20960/nh.05035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Introduction Introduction: gastrocolic fistula is an infrequent but severe complication of percutaneous gastrostomy. Clinical suspicion in the presence of chronic diarrhea of unknown etiology manifesting after percutaneous radiological gastrostomy (PRG) tube replacement is key to early detection and treatment. Case report: we report the case of a patient with PRG that began with chronic diarrhea after tube replacement and developed severe malnutrition. Initial treatment was not effective, studies were extended with the finding of this complication in a CT image. The use of this tube was discontinued with resolution of diarrhea and a favorable nutritional outcome. Discussion: this case report shows the importance of considering gastrocolic fistula in the differential diagnosis of persistent diarrhea in a patient with a gastrostomy tube.
Collapse
Affiliation(s)
| | | | - Lucía Díaz Naya
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Cabueñes
| | | | | | | | | | | | | | | | | | - Laura Nozal García
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Cabueñes
| | | | | | | |
Collapse
|
6
|
Dams G, Knapen RRMM, Korenblik R, van Dam RM, de Haan MW, van der Leij C. 12Fr-Pigtail Versus 14Fr-Balloon Percutaneous Radiologic Gastrostomy (PRG), Retrospective Evaluation of Outcomes and Complications; A Maastricht University Medical Centre Study. Cardiovasc Intervent Radiol 2023; 46:1231-1237. [PMID: 37592019 PMCID: PMC10471621 DOI: 10.1007/s00270-023-03527-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE To retrospectively compare tube and placement related results of a 12Fr-pigtail and a 14Fr-balloon gastrostomy tube. MATERIALS AND METHODS All consecutive patients who underwent percutaneous radiologic gastrostomy (PRG) between January 2016 and June 2020 were enrolled in this retrospective single-center analysis. Follow-up for all patients was 180 days. Mortality after 30 days, technical success, days to first complication within 180 days, reason of unexpected visit (tube, anchor or pain related), and tube specific complications (obstruction, pain, luxation, leakage) were taken as outcome measures. Data were obtained from both PACS software and electronic health records. RESULTS A total of 247 patients were enrolled (12Fr-pigtail: n = 139 patients and 14Fr-balloon: n = 108 patients). 30-day mortality was very low in both groups and never procedure related. Technical success was 99% in both groups. The average number of complications within 180 days after initial PRG placement was significantly higher in the 12Fr-pigtail group (12Fr-pigtail: 0.93 vs. 14Fr-balloon: 0.64, p = 0.028). Time to first complication within 180 days was significantly longer in the 14Fr-balloon group (12Fr-pigtail: 29 days vs. 14Fr-balloon: 53 days, p = 0.005). In the 14Fr-balloon group, the rate of tube-related complications (luxation and obstruction) was significantly lower compared to 12Fr-pigtail (29% vs. 45%, p = 0.011). CONCLUSION 14Fr-balloon gastrostomy tubes have significantly lower (tube-related) complications rates and longer time to first complication compared to 12Fr-pigtail tubes. No procedure-related mortality was observed in either group. Technical success was very high in both groups. Level of Evidence Level 3, non-controlled retrospective cohort study.
Collapse
Affiliation(s)
- Glenn Dams
- Department of Radiology and Nuclear Medicine, Zuyderland MC, Sittard-Geleen, Netherlands
| | - Robrecht R M M Knapen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, Netherlands.
- CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands.
| | - Remon Korenblik
- Department of Surgery, Zuyderland MC, Sittard-Geleen, Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Ronald M van Dam
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - Michiel W de Haan
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Christiaan van der Leij
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
7
|
Gangwani MK, Aziz M, Aziz A, Priyanka F, Patel A, Ghaffar U, Weissman S, Asif M, Lee-Smith W, Javaid T, Nawras A, Hart B. Dual Antiplatelet Therapy Does Not Increase Bleeding Risk in Percutaneous Gastrostomy Tube Placement: Network Meta-Analysis. Dig Dis Sci 2023; 68:1966-1974. [PMID: 36720736 DOI: 10.1007/s10620-022-07804-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 12/16/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND/OBJECTIVE Gastrostomy tube (G tube) is a commonly performed procedure for nutritional support. Current guidelines recommend discontinuation of dual antiplatelet therapy (DAPT) prior to G tube placement to reduce bleeding risk. AIMS We aim to compare bleeding risk in single, dual and no antiplatelet therapy during G tube placement. METHODS We searched PubMed, Embase, Cochrane, and Web of Sciences to include comparative studies evaluating single antiplatelet (aspirin, clopidogrel), dual antiplatelet (DAPT, aspirin and clopidogrel), and no antiplatelet therapy. Direct as well as network meta-analyses comparing these arms were performed. Risk Differences (RD) with confidence intervals were calculated. RESULTS 12 studies with 8471 patients were included. On direct meta-analysis, there was no significant difference noted between DAPT compared to Aspirin (RD 0.001 95% CI - 0.012 to 0.014, p = 0.87), Clopidogrel (RD 0.001 95% CI - 0.009 to 0.010, p = 0.92) or no antiplatelet group (RD 0.007 95% CI - 0.011 to 0.026, p = 0.44). Results were consistent on network meta-analysis and no difference was noted in bleeding rates when comparing DAPT with Aspirin (RD 0.001, 95% CI - 0.007 to 0.01, p = 0.76), Clopidogrel (RD 0.001, 95% CI - 0.01 to 0.011, p = 0.90) and no antiplatelet group (RD 0.002, 95% CI - 0.007 to 0.012, p = 0.62). CONCLUSION There is no significant difference in bleeding risk between DAPT, single antiplatelet or no antiplatelet therapy on a population level. On an individual level, risk of ischemic events should be weighed against the risk of bleeding based on patient circumstances and risk profile. Our findings offer to provide additional data to make an informed decision between patients and physicians to make clinical decisions by assessing individual risks and benefits for optimal care of complex patients.
Collapse
Affiliation(s)
- Manesh Kumar Gangwani
- Department of Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH, 43614, USA.
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, 43614, USA
| | - Abeer Aziz
- Division of Medicine, Aga Khan University, Karachi, Pakistan
| | - Fnu Priyanka
- Division of Medicine, Shaheed Mohtarma Benazir Bhutto University, Larkana, Pakistan
| | - Arti Patel
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Umar Ghaffar
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Mahmood Asif
- Department of Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH, 43614, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH, 43614, USA
| | - Toseef Javaid
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, 43614, USA
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, 43614, USA
| | - Benjamin Hart
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, 43614, USA
| |
Collapse
|
8
|
Frequency of adverse events in Levodopa‐carbidopa intestinal gel treatment: A retrospective real life study. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
9
|
Macedo Silva V, Freitas M, Sousa Magalhães R, Cúrdia Gonçalves T, Boal Carvalho P, Marinho C, Cotter J. Gastrostomy Button Diameter and Length Variations after Percutaneous Endoscopic Gastrostomy: One Size Does Not Fit All. Dig Dis 2022; 41:335-342. [PMID: 35508118 DOI: 10.1159/000524310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/23/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is a useful option for long-term enteral nutrition. Low-profile gastrostomy tubes ("buttons") may afterward be placed in the stomach through the abdominal wall following maturation of the preexisting ostomy. Regular verification is essential since inadequate sizing is associated with accidental exteriorization or food leakage. We aimed to evaluate gastrostomy buttons diameter or length variations on the first year after their placement and possible factors associated with these variations. METHODS We analyzed consecutive PEGs between 2016 and 2018. A minimum follow-up of 12 after gastrostomy button placement was required. Diameter or length variations were assessed in a specialized PEG appointment during the follow-up period. RESULTS Final sample included 94 patients, from which 65 (69.1%) were women, and 29 (30.9%) were men, with a mean age of 76.9 ± 13.3 years. Measurements variations occurred in 44 (46.8%) patients. Diameter variation was significantly more frequent in patients living in a nursing home (OR = 5.43; 95% CI = 1.32-22.27; p = 0.019), patients with previous PEG tube dislodgement (OR = 3.84; 95% CI = 1.21-12.20; p = 0.023), and male patients (OR = 3.50; 95% CI = 1.06-11.49, p = 0.039). Length variation occurred more frequently in patients with a weight change during the follow-up period greater than 5 kg (OR = 3.71; 95% CI = 1.14-12.05; p = 0.029). CONCLUSIONS A significant proportion of patients with gastrostomy buttons required a change in their measurements, especially if male, living in nursing homes, having significant weight changes, or accidental tube exteriorization. This emphasizes the importance of having a specialized PEG appointment to regularly assure the best fitted button for each patient and ultimately guarantee an adequate nutritional intake.
Collapse
Affiliation(s)
- Vítor Macedo Silva
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Marta Freitas
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui Sousa Magalhães
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Carla Marinho
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| |
Collapse
|
10
|
Alsunaid S, Holden VK, Kohli A, Diaz J, O'Meara LB. Wound care management: tracheostomy and gastrostomy. J Thorac Dis 2021; 13:5297-5313. [PMID: 34527367 PMCID: PMC8411156 DOI: 10.21037/jtd-2019-ipicu-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/27/2020] [Indexed: 01/12/2023]
Abstract
Percutaneous dilatational tracheostomy (PDT) and percutaneous endoscopic gastrostomy (PEG) tube placements are routine procedures performed in the intensive care units (ICUs). They are performed to facilitate care and promote healing. They also help prevent complications from prolonged endotracheal intubation and malnutrition. In most cases, both are performed simultaneously. Physicians performing them require knowledge of local anatomy, tissue and vascular relationships, along with advance bronchoscopy and endoscopy skills. Although PDTs and PEGs are considered relatively low-risk procedures, operators need to have the knowledge and skill to recognize and prevent adverse outcomes. Current published literature on post-procedural care and stoma wound management was reviewed. Available recommendations for the routine care of tracheostomy and PEG tubes are included in this review. Signs and symptoms of early PDT- and PEG-related complications and their management are discussed in detail. These include hemorrhage, infection, accidental decannulation, tube obstruction, clogging, and dislodgement. Rare, life-threatening complications are also discussed. Multidisciplinary teams are needed for improved patient care, and members should be aware of all pertinent care aspects and potential complications related to PDT and PEG placement. Each institute is strongly encouraged to have detailed protocols to standardize care. This review provides a state-of-the-art guidance on the care of patients with tracheostomies and gastrostomies specifically in the ICU setting.
Collapse
Affiliation(s)
- Sammar Alsunaid
- Division of Pulmonary & Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Van K Holden
- Division of Pulmonary & Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Akshay Kohli
- Department of Internal Medicine, Medstar Washington Hospital Center, Georgetown University, Washington, DC, USA
| | - Jose Diaz
- Division of Acute Care Emergency Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Lindsay B O'Meara
- Division of Acute Care Emergency Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| |
Collapse
|
11
|
Abstract
BACKGROUND The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position paper from 2015 on percutaneous endoscopic gastrostomy (PEG) required updating in the light of recent clinical knowledge and data published in medical journals since 2014. METHODS A systematic review of medical literature from 2014 to 2020 was carried out. Consensus on the content of the manuscript, including recommendations, was achieved by the authors through electronic and virtual means. The expert opinion of the authors is also expressed in the manuscript when there was a lack of good scientific evidence regarding PEGs in children in the literature. RESULTS The authors recommend that the indication for a PEG be individualized, and that the decision for PEG insertion is arrived at by a multidisciplinary team (MDT) having considered all appropriate circumstances. Well timed enteral nutrition is optimal to treat faltering growth to avoid complications of malnutrition and body composition. Timing, device choice and method of insertion is dependent on the local expertise and after due consideration with the MDT and family. Major complications such as inadvertent bowel perforation should be avoided by attention to good technique and by ensuring the appropriate experience of the operating team. Feeding can be initiated as early as 3 hours after tube placement in a stable child with iso-osmolar feeds of standard polymeric formula. Low-profile devices can be inserted initially using the single-stage procedure or after 2-3 months by replacing a standard PEG tube, in those requiring longer-term feeding. Having had a period of non-use and reliance upon oral intake for growth and weight gain-typically 8-12 weeks-a PEG may then safely be removed after due consultation. In the event of non-closure of the fistula the most successful method for closing it, to date, has been a surgical procedure, but the Over-The-Scope-Clip (OTSC) has recently been used with considerable success in this scenario. CONCLUSIONS A multidisciplinary approach is mandatory for the best possible treatment of children with PEGs. Morbidity and mortality are minimized through team decisions on indications for insertion, adequate planning and preparation before the procedure, subsequent monitoring of patients, timing of the change to low-profile devices, management of any complications, and optimal timing of removal of the PEG.
Collapse
|
12
|
de Sousa Magalhães R, Cúrdia Gonçalves T, Sousa-Pinto B, Rosa B, Marinho C, Cotter J. Percutaneous endoscopic gastrostomy: dealing with the issue of dislodgement. Scand J Gastroenterol 2020; 55:485-491. [PMID: 32202441 DOI: 10.1080/00365521.2020.1740779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 02/04/2023]
Abstract
Introduction: Percutaneous Endoscopic Gastrostomy (PEG) is accepted as an efficient method to provide long-term enteral nutrition. PEG accidental dislodgement (device exteriorization confirmed by expert evaluation) rate is high and can lead to major morbidity.Objective: To identify independent risk factors for PEG accidental dislodgement.Methods: Retrospective, single-center study, including consecutive patients submitted to PEG procedure, for 38 consecutive months. Every patient had 12 months minimum follow-up after PEG placement. Univariate analysis selected variables with at least marginal association (p < .15) with the outcome variable, PEG dislodgement, which were included in a logistic regression multivariate model. Discriminative power was assessed using area under curve (AUC) of the receiver operating curve (ROC).Results: We included 164 patients, 67.7% (111) were female, mean age was 81 years. We report 59 (36%) PEG dislodgements, of which 13 (7.9%) corresponded to early dislodgements. The variables with marginal association were hypoalbuminemia (p = .095); living at home (p = .049); living in a nursing home (p = .074); cerebrovascular disease (CVD) (p = .028); weight change of more than 5 kg, either increase or decrease (p = .001); psychomotor agitation (p < .001); distance inner bumper-abdominal wall (p = .034) and irregular appointment follow-up (p = .149). At logistic multivariate regression, the significant variables after model adjustment were CVD OR 4.8 (CI 95% 2.0-11.8), weight change OR 4.7 (CI 95%1.6-13.9) and psychomotor agitation OR 18.5 (CI 95% 5.2-65.6), with excellent discriminative power (AUC ROC 0.797 [CI95% 0.719-0.875]).Conclusion: PEG is a common procedure and accidental dislodgement is a frequent complication. CVD, psychomotor agitation and weight change >5 kg increase the risk of this complication and should be seriously considered when establishing patients' individual care requirements.
Collapse
Affiliation(s)
- Rui de Sousa Magalhães
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Carla Marinho
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| |
Collapse
|
13
|
Sánchez-Muñoz LA, Silvagni-Gutiérrez H, Usategui-Martín I. Dementia and feeding problems: PEG feeding tube or not? Med Clin (Barc) 2019; 153:e59-e60. [PMID: 31122718 DOI: 10.1016/j.medcli.2019.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/31/2019] [Indexed: 11/19/2022]
Affiliation(s)
| | - Hana Silvagni-Gutiérrez
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Iciar Usategui-Martín
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España
| |
Collapse
|