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Khalid SI, Deysher D, Khilwani H, Mirpuri P, Thomson K, Maynard M, Mehta AI. Gastrostomy Sequence With Ventriculoperitoneal Shunting-Does It Matter? Neurosurgery 2023; 93:1154-1159. [PMID: 37283524 DOI: 10.1227/neu.0000000000002553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/12/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Neurological injury requiring ventriculoperitoneal shunt (VPS) placement often necessitates gastrostomy for nutritional support. The sequence of these procedures is debated over concerns for shunt infection and displacement requiring revisional surgery as a consequence of gastrostomy. OBJECTIVE To determine the optimal sequence of VPS shunt and gastrostomy tube placement in adults. METHODS In an all-payer database, adult patients undergoing gastrostomy and VPS placement were identified within 15 days between January 2010 and October 2021. Patients were categorized as receiving gastrostomy before, on the same day as, or after shunt placement. The primary outcomes of this study were rates of revision and infection. All outcomes were evaluated within 30 months after index shunting. RESULTS In total, 3015 patients were identified as undergoing VPS and gastrostomy procedures within 15 days. After a 1:1:1 match, 1080 patient records were analyzed. Revision rates at 30 months were significantly lower among patients who received VPS and gastrostomy procedures on the same day compared with gastrostomy after VPS (odds ratio [OR] 0.61, 95% CI 0.39-0.96). In addition, patients who received gastrostomy before VPS compared with those after had lower revision rates (OR 0.61, 95% CI 0.39-0.96) and infection (OR 0.46, 95% CI 0.21-0.99). No significant differences were noted in mechanical complication or shunt displacement rates. CONCLUSION Patients requiring VPS and gastrostomy may benefit from undergoing both procedures concurrently or with gastrostomy before VPS placement, secondary to lower revision rates. Patients undergoing gastrostomy before VPS have the added benefit of decreased infection rates.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
| | - Daniel Deysher
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
| | - Harsh Khilwani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
| | - Pranav Mirpuri
- Chicago Medical School, Rosalind Franklin School of Medicine and Science, North Chicago , Illinois , USA
| | - Kyle Thomson
- Chicago Medical School, Rosalind Franklin School of Medicine and Science, North Chicago , Illinois , USA
| | - Marquis Maynard
- Case Western Reserve School of Medicine, Cleveland , Ohio , USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
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Champeaux-Depond C, Ramasy Razafindratovo RM, Chevret S. Gastrostomy and internal cerebrospinal fluid shunt in adults. A systematic review and meta-analysis of the risk of infection. Neurochirurgie 2022; 68:e75-e83. [PMID: 36030926 DOI: 10.1016/j.neuchi.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Hydrocephalus is a frequent neurological condition, commonly treated by ventriculoperitoneal shunting (VPS), a neurosurgical procedure with significant risk of infection. Some severely brain-injured hydrocephalic patients with swallowing dysfunction may require percutaneous endoscopic gastrostomy (PEG). There are few data on the safety of PEG in patients with VPS, with contradictory results reported. OBJECTIVE The aim of this systematic review and meta-analysis was to determine the rate of VPS infection in the setting of PEG. METHODS Six databases were searched for the period January 1990 to June 2022. Only original articles reporting the rate of shunt infection in the setting of PEG in adults were included. Random-effects meta-analysis was used to assess the rate of infection. RESULTS Fifteen of the 1,703 identified articles were selected, reporting 701 internal cerebrospinal fluid shunts, with 63 infections. The pooled rate of infection in patients with both PEG and VPS was 7.41% (95% CI [3.67-14.38]). There was a significantly higher risk of VPS infection in the PEG group vs. the control group with VPS without PEG: relative risk (RR)=2.33 (95% CI [1.11-4.89]). On the other hand, the risk of infection was the same whether the PEG was placed before or after the VPS surgery: RR=1.05 (95% CI [0.57-1.92]). CONCLUSION Gastrostomy tube placement is a significant risk factor for VPS infection. However, onset of infection was not related to the sequence of or interval between VPS and PEG. TRIAL REGISTRATION This meta-analysis is registered in https://www.crd.york.ac.uk/PROSPERO/, PROSPERO ID: CRDCRD42022326774.
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Affiliation(s)
- C Champeaux-Depond
- Service de Biostatistique et Information Médicale, Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; INSERM U1153, Center of Research in Epidemiology and Statistics (CRESS), Sorbonne Paris Cité, ECSTRRA team, Université de Paris, Paris, France; Department of Neurosurgery, Lariboisière Hospital, 75010 Paris, France.
| | - R M Ramasy Razafindratovo
- Service de Biostatistique et Information Médicale, Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - S Chevret
- Service de Biostatistique et Information Médicale, Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; INSERM U1153, Center of Research in Epidemiology and Statistics (CRESS), Sorbonne Paris Cité, ECSTRRA team, Université de Paris, Paris, France
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3
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Mawatari F, Shimizu T, Miyaaki H, Arima T, Fukuda S, Kita Y, Fukahori A, Ito H, Matsuki K, Ikematsu Y, Ryu N, Nakao K. Survival Rate and Shunt Infection Incidence Following Gastrostomy in Adult Patients with an Existing Ventriculoperitoneal Shunt. Neurol Med Chir (Tokyo) 2021; 61:758-765. [PMID: 34629351 PMCID: PMC8666294 DOI: 10.2176/nmc.oa.2021-0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ventriculoperitoneal shunts (VPS) and gastrostomies are frequently provided in daily practice. This study investigated the incidence of VPS infection and the survival rate among adult patients who underwent gastrostomy at least 1 month after VPS placement. This single-center retrospective cohort study was conducted among patients with a VPS, who underwent a gastrostomy. This procedure was performed on a standby basis after a period of at least 1 month had elapsed since VPS placement. Subsequent VPS infection and survival rates were assessed over a period of at least 6 months. We reviewed 31 patients who had a VPS at the time of gastrostomy. Gastrostomy was performed endoscopically in 29 cases and via open surgery in 2 cases. The average interval between VPS insertion and gastrostomy was 1135.5 ± 1717.1 days. A single case of VPS infection (3.2%) was diagnosed during the study. This infection rate was not significantly different than that among 230 patients who underwent their first VPS placement (without gastrostomy) at our institution during the same time period (P = .57); there was also no significant difference in the survival rate, compared to 38 age-matched patients (with cerebrovascular disease, but without a VPS) who underwent gastrostomy (P = .73). Gastrostomy performed after an interval of at least 1 month after VPS placement was extremely safe in adult patients, and their prognosis was excellent. Additional studies are required to develop appropriate nutritional interventions for patients with a VPS.
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Affiliation(s)
| | | | - Hisamitsu Miyaaki
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Sciences, Nagasaki University
| | | | | | - Yoshiko Kita
- Department of Gastroenterology, Juzenkai Hospital
| | | | | | - Kei Matsuki
- Department of Pulmonology, Juzenkai Hospital
| | | | | | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Sciences, Nagasaki University
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4
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Gerges C, Wijesekera O, Herring E, Adesina A, Wright CH, Woodard J, Stout A, Rothstein B, Selden N, Wright J. Evaluation of Risk of Gastrostomy and Ventriculoperitoneal Shunt Placement in Pediatric Patients: A Systematic Review of the Literature. World Neurosurg 2021; 152:180-188.e1. [PMID: 34033958 DOI: 10.1016/j.wneu.2021.05.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Abstract
A subset of patients with neurologic deficits require ventriculoperitoneal shunt (VPS) placement in addition to gastrostomy tubes (GTs). At present, the literature is inconsistent with respect to the sequence and time period between procedures that yields the lowest risk profile for GT and VPS placement. The purpose of this systematic literature review was to determine if time elapsed between VPS and GT placement was associated with infection (peritoneal and/or CSF). A systematic literature review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines. PubMEd/MEDLINE, Scopus, Ovid, Cochrane, and EMBASE databases were queried. Precise search terminology is available in the body of the manuscript. The initial database query yielded 88 unique articles. After abstract screening, 28 articles were identified and 6 met criteria for inclusion in the final analysis. The included studies were all retrospective analyses and reported data for 217 patients between the years of 1988 and 2016. Across all included studies, the infection rate after VPS and GT placement during the studies' surveillance period was 15.2% (n = 33/217). The cumulative rate of all reported complications in patients with both VPS and GT was 24.0% (n = 52/217). These studies suggest that placement of GT in patients with preexisting VPS does not significantly contribute to increased shunt or intraperitoneal infection. Future studies should determine the optimal time interval between VPS and GT placement and to identify the most appropriate prophylactic antibiotic regimen.
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Affiliation(s)
- Christina Gerges
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Olindi Wijesekera
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Eric Herring
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Adeleso Adesina
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Christina Huang Wright
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jos'lyn Woodard
- Division of Pediatric Neurosurgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Amber Stout
- Core Library, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Brian Rothstein
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Nathan Selden
- Division of Pediatric Neurosurgery, Oregon Health & Science University, Portland, Oregon, USA
| | - James Wright
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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5
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Behbahani M, Rosinski CL, Chaudhry NS, Chaker AN, Chiu RG, Du X, Mehta AI, Arnone GD, Amin-Hanjani S. Optimal timing and sequence of ventriculoperitoneal shunt and gastrostomy placement. Neurol Res 2021; 43:708-714. [PMID: 33944706 DOI: 10.1080/01616412.2021.1922174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: The optimal timing of ventriculoperitoneal shunt (VPS) and gastrostomy placement, relative to the safety of simultaneous versus staged surgery, has not been clearly delineated in the literature.Objective: To study the optimal inter-procedural timing relative to distal VPS infection and pertinent reoperation.Methods: A fifteen-year, retrospective, single-center study was conducted on adults undergoing VPS and gastrostomy within 30-days. Patients were grouped according to inter-procedural interval: 0-24 hr (immediate), 24 hr-7 days (early), and 7-30 days (delayed). The primary endpoint of the study was VPS infection and distal shunt complications requiring reoperation. Potential predictors of the primary end point (baseline cohort characteristics, procedural factors) were examined with standard statistical methods.Results: A total of 188 patients met inclusion criteria. The average interval between procedures was 7 ± 6 days, with 43.1% undergoing VPS prior to gastrostomy. Primary endpoint was encountered in 5 patients (2.7%): 1 (5.9%) of 17 patients undergoing immediate placement, 3 (2.8%) of 107 with early placement, and 1 (1.6%) of 64 with delayed placement. Although not statistically significant, 3.7% of patients undergoing VPS first had the primary endpoint, compared to 1.9% of those with gastrostomy. There were no statistically significant associations between the primary outcome and peri-operative CSF counts, gastrostomy modality, hydrocephalus etiology, chronic steroid use, or extended antibiotic administration.Conclusion: Although the low overall event rate in this cohort precludes definitive determination regarding differential safety, the data generally support a practice of performing the procedures >24-hours apart, with placement of gastrostomy prior to VPS.
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Affiliation(s)
- Mandana Behbahani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA
| | - Clayton L Rosinski
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA
| | - Nauman S Chaudhry
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA
| | - Anisse N Chaker
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA.,Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Xinjian Du
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA
| | - Gregory D Arnone
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA.,Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
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6
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Choi SM, Han K, Kim GM, Kwon JH, Lee J, Kim MD, Won JY. Safety of co-placement of ventriculoperitoneal shunt and percutaneous radiologic gastrostomy. Acta Radiol 2020; 61:435-440. [PMID: 31955610 DOI: 10.1177/0284185119870170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is little evidence about the safety of co-placement of percutaneous radiologic gastrostomy in patients with ventriculoperitoneal shunt. Purpose To investigate the safety of co-placement of percutaneous radiologic gastrostomy tube and ventriculoperitoneal shunt. Material and Methods Between July 2006 and June 2018, 1015 patients underwent percutaneous radiologic gastrostomy placement at our institution. Those who had undergone both ventriculoperitoneal shunt and percutaneous radiologic gastrostomy placement were selected. Patient data, including baseline characteristics, percutaneous radiologic gastrostomy types, temporal relationship between the procedures, and ventriculoperitoneal shunt infection, were retrospectively reviewed. Results Nineteen patients received percutaneous radiologic gastrostomy and ventriculoperitoneal shunt co-placement. The percutaneous radiologic gastrostomy types were pigtail-retained gastrostomy (n = 12) and pull-type gastrostomy (n = 7). Ventriculoperitoneal shunt was placed before percutaneous radiologic gastrostomy in 15 patients (79%) and vice versa in four patients (21%). Mean interval between the two procedures was 361 days (range 3–1833 days). Only one case (5.3%) of ventriculoperitoneal shunt infection occurred and it was successfully managed conservatively. There was no significant difference in the incidence of complications between the ventriculoperitoneal shunt before percutaneous radiologic gastrostomy group and the opposite group ( P = 0.789). Moreover, there was no significant difference in complication rates between the two gastrostomy catheter types ( P = 0.368). Conclusions Co-placement of percutaneous radiologic gastrostomy and ventriculoperitoneal shunt seems safe and should not be considered a contraindication. Moreover, the percutaneous radiologic gastrostomy and ventriculoperitoneal shunt should be placed as far from each other as possible.
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Affiliation(s)
- Seung Myun Choi
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junhyung Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Man-Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Yun Won
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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7
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Risk of ventriculoperitoneal shunt infection with coexisting percutaneous endoscopic gastrostomy tube and associated factors. Heliyon 2020; 6:e03523. [PMID: 32211540 PMCID: PMC7082506 DOI: 10.1016/j.heliyon.2020.e03523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/18/2019] [Accepted: 02/28/2020] [Indexed: 01/12/2023] Open
Abstract
Objectives Percutaneous endoscopic gastrostomy (PEG) tubes and ventriculoperitoneal shunts (VPS) are commonly placed in neurologically impaired patients. There is concern about safety of VPS coexisting with PEG tubes due to the potential for an increased risk of infection. In this study, we assess the risk of VPS infection and the amount of time between both procedures. Patients and methods Retrospective chart review of patients from our institution who had VPS and PEG tubes placed during the same hospitalization between 2014 and 2018. Our primary focus was assessing risk of VPS infection and timing of procedures in this patient population. Additionally, we assessed other factors which may contribute to VPS infection including SIRS criteria at time of VPS placement, comorbidities and other procedures performed. None of the SIRS factors were associated with VPS infection. Results 45 patients met inclusion criteria. Our VPS infection rate was found to be 7% (n = 3). These patients had 4, 16, and 36 days between procedures. 89% of our patients had PEG tube placed prior to VPS with 2 of these patients developing a VPS infection. At the time of VPS placement 42% of patients had SIRS. None of the SIRS factors were associated with VPS infection. Conclusion Our VPS infection rate remained low even when they were performed during the same hospitalization as a PEG tube placement. SIRS is not associated with the development of VPS infections and is not an absolute contraindication to placing a VPS.
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8
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Chiba K, Segawa O, Maki Y, Yamaguchi R, Aihara Y, Kawamata T. Prophylactic Fixation of the Gastric-Abdominal Cavity Wall Can Reduce Complications of Simultaneous Placement of Percutaneous Endoscopic Gastrostomy and Ventriculoperitoneal Shunt. Pediatr Neurosurg 2020; 55:326-329. [PMID: 33176331 DOI: 10.1159/000509927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Kentaro Chiba
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Osamu Segawa
- Department of Pediatric Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yukari Maki
- Department of Pediatric Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryusuke Yamaguchi
- Department of Pediatric Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuo Aihara
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan,
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
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Al-Holou WN, Wilson TJ, Ali ZS, Brennan RP, Bridges KJ, Guivatchian T, Habboub G, Krishnaney AA, Lanzino G, Snyder KA, Flanders TM, Than KD, Pandey AS. Gastrostomy tube placement increases the risk of ventriculoperitoneal shunt infection: a multiinstitutional study. J Neurosurg 2018; 131:1062-1067. [PMID: 30497165 DOI: 10.3171/2018.5.jns18506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/29/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gastrostomy tube placement can temporarily seed the peritoneal cavity with bacteria and thus theoretically increases the risk of shunt infection when the two procedures are performed contemporaneously. The authors hypothesized that gastrostomy tube placement would not increase the risk of ventriculoperitoneal shunt infection. The object of this study was to test this hypothesis by utilizing a large patient cohort combined from multiple institutions. METHODS A retrospective study of all adult patients admitted to five institutions with a diagnosis of aneurysmal subarachnoid hemorrhage between January 2005 and January 2015 was performed. The primary outcome of interest was ventriculoperitoneal shunt infection. Variables, including gastrostomy tube placement, were tested for their association with this outcome. Standard statistical methods were utilized. RESULTS The overall cohort consisted of 432 patients, 47% of whom had undergone placement of a gastrostomy tube. The overall shunt infection rate was 9%. The only variable that predicted shunt infection was gastrostomy tube placement (p = 0.03, OR 2.09, 95% CI 1.07-4.08), which remained significant in the multivariate analysis (p = 0.04, OR 2.03, 95% CI 1.04-3.97). The greatest proportion of shunts that became infected had been placed more than 2 weeks (25%) and 1-2 weeks (18%) prior to gastrostomy tube placement, but the temporal relationship between shunt and gastrostomy was not a significant predictor of shunt infection. CONCLUSIONS Gastrostomy tube placement significantly increases the risk of ventriculoperitoneal shunt infection.
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Affiliation(s)
- Wajd N Al-Holou
- 1Department of Neurosurgery, Wayne State University, Detroit, Michigan
| | - Thomas J Wilson
- 2Department of Neurosurgery, Stanford University, Stanford, California
| | - Zarina S Ali
- 3Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ryan P Brennan
- 4Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Kelly J Bridges
- 5Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon
| | - Tannaz Guivatchian
- 6Department of Internal Medicine, Division of Gastroenterology and Hepatology, and
| | - Ghaith Habboub
- 4Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | - Tracy M Flanders
- 3Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Khoi D Than
- 5Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon
| | - Aditya S Pandey
- 8Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and
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10
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Jack MM, Peterson JC, McGinnis J, Alley J, Chamoun RB. Safety, Efficacy, and Cost-Analysis of Percutaneous Endoscopic Gastrostomy and Ventriculoperitoneal Shunt Placement in a Simultaneous Surgery. World Neurosurg 2018; 115:e233-e237. [DOI: 10.1016/j.wneu.2018.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
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11
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Oterdoom LH, Marinus Oterdoom DL, Ket JCF, van Dijk JMC, Scholten P. Systematic review of ventricular peritoneal shunt and percutaneous endoscopic gastrostomy: a safe combination. J Neurosurg 2017; 127:899-904. [DOI: 10.3171/2016.8.jns152701] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVEVarious international and national gastrointestinal guidelines take different positions on whether ventriculoperitoneal shunt (VPS) insertion is a contraindication to percutaneous endoscopic gastrostomy (PEG). The objective of this meta-analysis was to try to answer the question of whether VPS insertion is a contraindication to PEG.METHODSA systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Electronic databases PubMed and Embase were searched using variations of the terms “ventriculo-peritoneal shunt” and “percutaneous (endoscopic) gastrostomy.” This search resulted in 70 studies, 9 of which were relevant. These were cross-referenced, and 1 additional study was found, resulting in 10 studies in this systematic review.RESULTSThe 10 relevant studies in adult cohorts included 208 patients. All studies save one were retrospective and, in general, poor quality. Among the studies with relevant data, there were 26 (12.5% of 208 cases) VPS infections and 4 (4.4% of 90 cases) VPSs that malfunctioned. In 137 patients the VPS had been placed before the PEG tube, with a VPS infection rate of 4.4%. More VPS infections occurred among the 55 patients who first had a PEG and a subsequent VPS (21.8%) and in the 16 patients who had simultaneous PEG tube and VPS placement (50%). The heterogeneity of the studies in this analysis prohibited statistical comparisons of the timing of VPS and PEG tube placement.CONCLUSIONSThis systematic review indicated that VPS placement in combination with a PEG has a high but acceptable VPS complication rate. Therefore, VPS insertion should not be considered a contraindication to the placement of a PEG tube. Preferably, a PEG tube should be placed after the VPS. Waiting 7–10 days between VPS insertion and a PEG seems reasonable, but this could not be corroborated in this review.
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Affiliation(s)
- Leendert H. Oterdoom
- 1Department of Gastroenterology and Hepatology, HAGA Ziekenhuis, The Hague
- 4Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | | | | | | | - Pieter Scholten
- 4Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
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12
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Acute Shunt Failure Due to Perforation of Ventriculoperitoneal Shunt Tubing during Percutaneous Gastrostomy. ACG Case Rep J 2017; 4:e75. [PMID: 28584848 PMCID: PMC5449579 DOI: 10.14309/crj.2017.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/12/2017] [Indexed: 11/17/2022] Open
Abstract
The placement of a percutaneous endoscopic gastrostomy (PEG) in a patient with a pre-existing ventriculoperitoneal shunt is generally regarded as safe. A critical but often overlooked technical consideration is confirmation of the course of the distal shunt tube prior to PEG insertion. We present the case of a 4-month-old male infant with shunted hydrocephalus who experienced shunt malfunction due to perforation of the distal shunt tubing after PEG placement.
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13
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Choi J, Ki SS, Park S. Acute Shunt Malfunction Caused by Percutaneous Endoscopic Gastrostomy without Shunt Infection. J Korean Neurosurg Soc 2014; 56:361-3. [PMID: 25371790 PMCID: PMC4219198 DOI: 10.3340/jkns.2014.56.4.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 09/21/2014] [Accepted: 10/14/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jingyu Choi
- Department of Neurosurgery, Gangwondo Sokcho Medical Center, Sokcho, Korea
| | - Seung Seog Ki
- Department of Gastroenterology, Gangwondo Sokcho Medical Center, Sokcho, Korea
| | - Seoungwoo Park
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Korea
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Li Ching A, Humphrey G, Kamaly-Asl ID. Ventriculoperitoneal shunt survival in children who require additional abdominal surgery--are our estimations of the additional risk accurate? Br J Neurosurg 2013; 28:40-8. [PMID: 24024873 DOI: 10.3109/02688697.2013.815322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Ventriculoperitoneal shunt (VPS)-dependent children require abdominal surgery for many reasons. Our objective was to quantify the risk of abdominal surgery on VPS survival and to determine whether timing of abdominal intervention impacts on shunt outcome. METHODS Retrospective data collection was performed on all children undergoing primary VPS insertion or revision over 2 years (1/1/08-31/12/10). All shunt interventions were categorised into two groups: those undergoing additional "Abdominal surgery" (AS) versus those undergoing "Shunt-only" (SO). Kaplan-Meier survival curves were devised and analysed using log-rank. In the AS group, we compared shunt survival for shunts inserted at various "Time from abdominal surgery" (TAS). We conducted a control analysis to compare shunt survival in AS, SO and a control "clean general surgery" (SG) group. Chi-squared test was used to determine the cause of shunt failure in these three groups. RESULTS Three hundred and forty two shunts from 109 patients were included. Twenty patients contributed 118 shunts to the AS group. Median shunt survival was 3.68 months (95% CI = 1.01-6.47) and 22.6 months (95% CI = 8.76-36.4) in the AS and SO groups, respectively (log-rank = 16.6, p < 0.001). For each additional abdominal intervention, the risk of shunt failure increased by 55.4% (p < 0.001). Median shunt survival was 1.48 months (95% CI = 0.00-3.09, p < 0.001), if shunt insertion occurred within 1 year of abdominal surgery. Beyond 1 year, median shunt survival increased five-fold to 7.65 months (95% CI = 0.00-20.1, log-rank = 23.2, p < 0.001). There was a 29% reduction in risk of shunt failure per year interval between a shunt and an abdominal surgery (95% CI = 0.11-0.44, p < 0.005). Our control analysis confirmed that shunts in the AS group had worst survival and infection (p < 0.001). CONCLUSION Additional abdominal surgery shortens VPS lifetime and increases risk of infection. Delaying abdominal surgery from a shunt intervention or vice versa by at least 1 year may prolong shunt survival.
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Cairns A, Geraghty J, Al-Rifai A, Babbs C. Percutaneous endoscopic gastrostomy and ventriculoperitoneal shunts: a dangerous combination? Dig Endosc 2009; 21:228-31. [PMID: 19961520 DOI: 10.1111/j.1443-1661.2009.00897.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND We report the largest European series of patients in whom both ventriculoperitoneal shunts (VPS) and percutaneous endoscopic gastrostomies (PEG) have been inserted with the aim of determining if this combination is safe or if there is an increased risk of VPS infection. PATIENTS AND METHODS The paper and electronic records of 302 patients who had a ventriculoperitoneal (VP) shunt inserted in the regional Neurosciences unit at Salford Royal NHS Foundation Trust between 2002 and 2007 were reviewed. RESULTS A total of 24 patients with VP shunts had 26 PEG inserted. Thirteen PEG were inserted in 11 patients with a pre-existing VP shunt. The median age was 58 years (21-77 Yrs) with seven male and 17 female patients. In total, five patients developed a shunt infection (20.8%) compared to the overall rate of VP shunt infection for Salford Royal NHS Foundation Trust of 7% (P = 0.017). The increase in number of VP shunt infections when the procedures were done more than 10 days apart (2/14) was not significant (P = 0.25). CONCLUSION In patients who need long-term enteral feeding following a VP shunt insertion it may be prudent to delay insertion of a PEG for at least 10 days to reduce VPS infection. In stable patients who have had a VP shunt inserted on previous hospital admissions PEG insertion need not be avoided because of concern regarding cerebrospinal fluid or shunt infection.
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Affiliation(s)
- Alastair Cairns
- Gastroenterology Department, Salford Royal NHS Foundation Trust, Manchester, UK.
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Kim JS, Park YW, Kim HK, Cho YS, Kim SS, Youn NR, Chae HS. Is percutaneous endoscopic gastrostomy tube placement safe in patients with ventriculoperitoneal shunts? World J Gastroenterol 2009; 15:3148-52. [PMID: 19575495 PMCID: PMC2705738 DOI: 10.3748/wjg.15.3148] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether percutaneous endoscopic gastrostomy (PEG) tube placement is safe in patients with ventriculoperitoneal (VP) shunts.
METHODS: This was a retrospective study of all patients undergoing PEG insertion at our institution between June 1999 and June 2006. Post-PEG complications were compared between two groups according to the presence or absence of VP shunts. VP shunt infection rates, the interval between PEG placement and VP shunt catheter insertion, and long-term follow-up were also investigated.
RESULTS: Fifty-five patients qualified for the study. Seven patients (12.7%) had pre-existing VP shunts. All patients received prophylactic antibiotics. The complication rate did not differ between VP shunt patients undergoing PEG (PEG/VP group) and non-VP shunt patients undergoing PEG (control group) [1 (14.3%) vs 6 (12.5%), P = 1.000]. All patients in the PEG/VP group had undergone VP shunt insertion prior to PEG placement. The mean interval between VP shunt insertion and PEG placement was 308.7 d (range, 65-831 d). The mean follow-up duration in the PEG/VP group was 6.4 mo (range, 1-15 mo). There were no VP shunt infections, although one patient in the PEG/VP group developed a minor peristomal infection during follow-up.
CONCLUSION: Complications following PEG placement in patients with VP shunts were infrequent in this study.
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Vervloessem D, van Leersum F, Boer D, Hop WCJ, Escher JC, Madern GC, de Ridder L, Bax KNMA. Percutaneous endoscopic gastrostomy (PEG) in children is not a minor procedure: risk factors for major complications. Semin Pediatr Surg 2009; 18:93-7. [PMID: 19348998 DOI: 10.1053/j.sempedsurg.2009.02.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Percutaneous endoscopic gastrostomy (PEG) provides for enteral nutrition in children with feeding problems. PEG, however, is not without complications. The present study has a twofold aim: (1) comparing our incidence of major complications after PEG with the incidence in other centers, and (2) identifying risk factors for major complications. All patients receiving a PEG or laparoscopic-assisted PEG (lap PEG) in the period 1992-2008 were reviewed. Primary outcome was the occurrence of major complications, defined as the need for surgery, non-prophylactic antibiotics, or blood transfusion, and procedure-related death. Potential risk factors, eg, age under 1 year, mental retardation, scoliosis, constipation, hepatomegaly, upper abdominal surgery, ventriculoperitoneal shunt, peritoneal dialysis, esophageal stenosis, and coagulopathy, were analyzed. Of the 467 patients (448 PEG, 19 lap PEG), 12.6% developed major complications. The complication rate significantly decreased (P = 0.003) over the years. A significantly higher complication rate of 32% (P = 0.02) occurred in children with a ventriculoperitoneal shunt. None of the lap PEG procedures was associated with a major complication, but the difference was not significant, perhaps because of the small numbers in the latter group. The major complication rate after PEG in children is high. Preexisting ventriculoperitoneal shunt is a significant risk factor. Laparoscopically assisted PEG procedures seem to be associated with a lesser major complication rate.
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Affiliation(s)
- Dirk Vervloessem
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
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Percutaneous transesophageal gastrotubing: alternative tube nutrition for a patient with a ventriculoperitoneal shunt. SURGICAL NEUROLOGY 2008; 72:278-9; discussion 280. [PMID: 18617229 DOI: 10.1016/j.surneu.2008.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Accepted: 04/10/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND We report a patient who underwent percutaneous transesophageal gastrotubing (PTEG), that is, nonsurgical esophagostomy under ultrasonographic control, as an alternative to percutaneous endoscopic gastrostomy (PEG). CASE DESCRIPTION The PTEG was placed for shunt protection from inadvertent infection in a 29-year-old male patient in whom a ventriculoperitoneal (VP) shunt had previously been inserted. During the 3-year follow-up period, no complications associated with PTEG were experienced. CONCLUSION Percutaneous transesophageal gastrotubing is a good alternative to PEG in a patient with a VP shunt. Further investigation concerning the risk of infection related to PTEG and PEG in VP shunt patients is needed.
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Infections of pediatric cerebrospinal fluid shunts related to fundoplication and gastrostomy. J Neurosurg Pediatr 2007; 107:365-7. [DOI: 10.3171/ped-07/11/365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Backman T, Berglund Y, Sjövie H, Arnbjörnsson E. Complications of video-assisted gastrostomy in children with or without a ventriculoperitoneal shunt. Pediatr Surg Int 2007; 23:665-8. [PMID: 17487495 DOI: 10.1007/s00383-007-1930-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2007] [Indexed: 10/23/2022]
Abstract
The aim of the study was to test the hypothesis that the presence of a ventriculoperitoneal shunt (VPS) influences the frequency of postoperative complications after video-assisted gastrostomy (VAG) in children. When using a power of 80%, a critical value for significance of 5% and an assumed population-based standard deviation of 0.4, it will be required to have a sample size of at least 14 children to show that a difference of 0.6 is significant when using Student's t test for paired samples. Thus, 15 consecutive children with VPSs were included in the present study. All the children had nutritional problems and underwent a VAG operation at a tertiary care university hospital. After the operation, the children were prospectively followed up. Specially trained nurses documented all complications according to a protocol. For the purpose of comparison, we had a control group of neurologically disabled children without VPSs, matched for age and operated with VAG. The children did not present with any serious postoperative intra-abdominal complications or central nervous system infection. There was no significant difference in the frequency of minor complications between the studied group and the control group. This study did not reveal that children with VPSs who undergo a VAG button placement are at high risk for infection and subsequent shunt malfunction. They did not have more postoperative problems than a matched control group of neurologically disabled children.
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Affiliation(s)
- Torbjörn Backman
- Section for Paediatric Surgery, Department of Paediatrics, University Hospital, 221 85, Lund, Sweden
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Roeder BE, Said A, Reichelderfer M, Gopal DV. Placement of gastrostomy tubes in patients with ventriculoperitoneal shunts does not result in increased incidence of shunt infection or decreased survival. Dig Dis Sci 2007; 52:518-22. [PMID: 17195119 DOI: 10.1007/s10620-006-9311-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 03/11/2006] [Indexed: 12/09/2022]
Abstract
The objective of this study was to examine if G-tube (G-tube) placement in patients with ventriculoperitoneal (VP) shunts results in shunt infection or impacts patient survival. We performed a retrospective cohort study. Patients underwent VP shunt and G-tube placement. Incidence of shunt infection and patient survival were calculated. Fifty-five patients qualified for the study. Shunt infection occurred in seven patients (12.5%). The incidence of shunt infection did not differ between surgically placed G-tubes (2/7=29%) and PEG tubes (5/7=71%; P=0.69). There was no difference in the risk of VP infection based on the order of placement (OR=0.61 [0.12-3.02]; P=0.69). No predictors for shunt infection were identified. Kaplan-Meier mortality estimates demonstrated a 21% 1-year mortality rate. There were no predictors of patient survival. We conclude that placement of G-tubes in patients with shunts is safe. The order of placement of G-tube and VP shunt does not affect the incidence of shunt infection or survival.
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Affiliation(s)
- Brent E Roeder
- Section of Gastroenterology and Hepatology, University of Wisconsin-School of Medicine and Public Health, Madison, WI 53792-5124, USA
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Nabika S, Oki S, Sumida M, Isobe N, Kanou Y, Watanabe Y. Analysis of risk factors for infection in coplacement of percutaneous endoscopic gastrostomy and ventriculoperitoneal shunt. Neurol Med Chir (Tokyo) 2006; 46:226-9; discussion 229-30. [PMID: 16723814 DOI: 10.2176/nmc.46.226] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Patients with severe neurological impairment requiring tube feeding may have concomitant hydrocephalus. Coplacement of percutaneous endoscopic gastrostomy (PEG) and ventriculoperitoneal (VP) shunting is currently standard in such cases. The present study investigated the risk factors for shunt infection in such patients. The medical records of 23 patients with PEG and VP shunting were retrospectively reviewed. Correlations between shunt system infection and potential risk factors were analyzed including order of PEG and VP shunting, position of abdominal shunt catheter, diabetes mellitus, tracheostomy, and activities of daily living. Twelve patients underwent VP shunting after PEG and 11 underwent PEG after VP shunt placement. Four patients experienced shunt infection, and three required shunt revision. Three of these four patients underwent VP shunting after PEG. The period between PEG and VP shunt placement was 18, 19, and 25 days, shorter than the mean period of 29.3 days. VP shunting can be combined with PEG, but a larger study is required to clearly identify the risk factors. Administration of prophylactic antibiotics and a period of at least 1 month between the procedures are recommended, particularly if the shunt is placed after the PEG tube.
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Affiliation(s)
- Shinya Nabika
- Department of Neurosurgery, Hiroshima City Asa Hospital, Japan.
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Schulman AS, Sawyer RG. The safety of percutaneous endoscopic gastrostomy tube placement in patients with existing ventriculoperitoneal shunts. JPEN J Parenter Enteral Nutr 2006; 29:442-4. [PMID: 16224038 DOI: 10.1177/0148607105029006442] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Because the insertion of percutaneous endoscopic gastrostomy tubes (PEG) involves disruption of the gastrointestinal tract with potential peritoneal contamination, patients with indwelling ventriculoperitoneal (VP) shunts could be at increased risk of meningitis, a potentially devastating infection. The safety of PEG placement in the presence of a VP shunt is unclear. METHODS A retrospective chart review was performed that included all adult patients with existing VP shunts requiring PEG placement at a single university medical center over an approximate 9-year period from July 1995 to March 2004. RESULTS Thirty-nine patients who underwent PEG placement 2-564 days after shunt placement were identified. Two patients (5%) subsequently developed meningitis. Cerebrospinal fluid cultures demonstrated Staphylococcus aureus and Enterococcus faecalis. These infections occurred 2 and 15 months after PEG placement, respectively. At the time of PEG placement, 17 patients (44%) were receiving antibiotics for reasons other than operative prophylaxis, and 11 patients (28%) received prophylactic antibiotics. Both infected patients had received antibiotics at the time of PEG placement. CONCLUSIONS These data constitute the largest series of patients with existing VP shunts undergoing PEG placement reported to date. When compared with the published 2%-5% infection rate for patients with VP shunts alone, our data do not suggest an increased risk of infection for patients after PEG placement. As the total number of adult patients requiring a PEG after VP shunt placement is low, multicenter studies should be carried out to better stratify this risk.
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Minicucci MF, Silva GF, Matsui M, Inque RMT, Zornoff LAM, Matsubara LS, Paiva SARD. O uso da gastrostomia percutânea endoscópica. REV NUTR 2005. [DOI: 10.1590/s1415-52732005000400010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A gastrostomia percutânea endoscópica foi introduzida na prática clínica como via alternativa de alimentação enteral. É procedimento que não necessita de anestesia ou laparotomia, como a gastrostomia cirúrgica. A gastrostomia percutânea endoscópica tem como objetivos a manutenção do aporte nutricional e a melhoria da qualidade de vida e sobrevida dos pacientes. É indicada quando o paciente necessita de dieta enteral por período superior a um mês. A freqüência de complicações varia de 1,0% a 10,0% e a mortalidade de 0,3% a 1,0%. É propósito deste trabalho abordar aspectos relevantes desse método de alimentação enteral, aprimorar seu manejo, bem como facilitar o manejo pelos pacientes que dele se utilizam. Para isso, vamos comentar as indicações e contra-indicações da gastrostomia percutânea endoscópica, técnica de colocação, material das sondas, antibiótico profilático, início de utilização, custo do procedimento, além de suas complicações, aspectos legais e éticos.
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Baird R, Salasidis R. Percutaneous gastrostomy in patients with a ventriculoperitoneal shunt: case series and review. Gastrointest Endosc 2004; 59:570-4. [PMID: 15044902 DOI: 10.1016/s0016-5107(04)00004-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are few data on the safety of PEG in patients with a ventriculoperitoneal shunt. METHODS Medical records for patients seen in 3 tertiary care, university-affiliated hospitals between January 1, 1991, and January 1, 1999, were reviewed. OBSERVATIONS Six patients underwent PEG after ventriculoperitoneal shunt placement during the study period. There was no immediate complication. One patient died of pneumonia 2 months after PEG insertion. There was no instance of shunt malfunction, intra-abdominal complication, or wound infection in the study group. There was no long-term complication, with either the ventriculoperitoneal shunt or the PEG. CONCLUSIONS Although the number of cases was small, PEG placement with prophylactic administration of antibiotics appears to be safe in patients with a pre-existing ventriculoperitoneal shunt.
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Affiliation(s)
- Robert Baird
- Department of General Surgery, McGill University Health Center, Montreal, Canada
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Chan Y, Datta NN, Chan KY, Rehman SU, Poon CYF, Kwok JCK. Extrusion of the peritoneal catheter of a VP shunt system through a gastrostomy wound. SURGICAL NEUROLOGY 2003; 60:68-9; discussion 70. [PMID: 12865019 DOI: 10.1016/s0090-3019(03)00027-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A variety of complications can occur following ventriculoperitoneal shunt. We report a case of extrusion of the catheter tip through the old scar of the percutaneous endoscopic gastrostomy (PEG) wound. CASE DESCRIPTION A 70-year-old male suffered from an intracerebral hemorrhage and then developed hydrocephalus. He required a ventriculoperitoneal shunt. This patient required a PEG for gastroenteric feeding. The PEG was removed 4 years after the insertion because of infection. The tip of the distal shunt tube extruded through the scar of the PEG wound 2 years later. CONCLUSION The catheter end of VP shunt can extrude through the weak point of an old PEG scar. This kind of complication should be brought to mind while performing abdominal surgery in patients with VP shunts.
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Affiliation(s)
- Yung Chan
- Department of Neurosurgery, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong, ROC
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George DE, Dokler M. Percutaneous endocopic gastrostomy in children. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2002. [DOI: 10.1053/tgie.2002.37439] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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