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Mark I, Hey G, Colliander R, McCracken B, Casauay J, Lucke-Wold B. The Role of G-tube Placement for Neurologic Injury Patients. BIOMEDICAL SCIENCE AND CLINICAL RESEARCH 2022; 1:1-10. [PMID: 36580086 PMCID: PMC9793884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Neurologic injury often influences various bodily functions associated with digestion. It is imperative for an individual to obtain proper nutrients to maintain a healthy lifestyle and recover from injury. In this review, we explore variables and methods of enteral tube placement in neurologic injury patients influencing recovery, specifically G- and J-tubes. We will first review the patient population by identifying leading causes for enteral tube placement among both pediatric and adult neurologic patients. We will then discuss the general procedures for placement and safety considerations for specified patient populations. We will explore interventions limiting placement of the G- and J-tubes by focusing on two interventions: ventriculoperitoneal shunt (VPS) and intrathecal baclofen (ITB). Then, we will highlight nutritional enhancers that may influence general treatment. Finally, we discuss proper weaning procedures and eJective methods fitting patient needs.
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Affiliation(s)
| | - Grace Hey
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Reid Colliander
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | | | - Jed Casauay
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, 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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Rajan A, Wangrattanapranee P, Kessler J, Kidambi TD, Tabibian JH. Gastrostomy tubes: Fundamentals, periprocedural considerations, and best practices. World J Gastrointest Surg 2022; 14:286-303. [PMID: 35664365 PMCID: PMC9131834 DOI: 10.4240/wjgs.v14.i4.286] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/09/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
Gastrostomy tube placement is a procedure that achieves enteral access for nutrition, decompression, and medication administration. Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events (AEs). Appropriate indications, contraindications, ethical considerations, and comorbidities of patients referred for gastrostomy placement should be weighed and balanced. Additionally, endoscopist should consider either a transoral or transabdominal approach is appropriate, and radiologic or surgical gastrostomy tube placement is needed. However, medical history, physical examination, and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.
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Affiliation(s)
- Anand Rajan
- Department ofGastroenterology, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
- Department ofGastroenterology, City of Hope Medical Center, Duarte, CA 91010, United States
| | | | - Jonathan Kessler
- Department ofInterventional Radiology, City of Hope Medical Center, Duarte, CA 91010, United States
| | - Trilokesh Dey Kidambi
- Department ofGastroenterology, City of Hope Medical Center, Duarte, CA 91010, United States
| | - James H Tabibian
- Department ofGastroenterology, UCLA-Olive View Medical Center, Sylmar, CA 91342, United States
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Hallan DR, Rizk E. Ventriculoperitoneal Shunt and Gastrostomy Tube Placement and Timing: A Database Analysis. Cureus 2022; 14:e23776. [PMID: 35530882 PMCID: PMC9067355 DOI: 10.7759/cureus.23776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background Debate exists about the safety of ventriculoperitoneal shunt placement in the presence of a gastrostomy tube and the timing of these procedures from each other. Using a large database, we sought to determine the rates of shunt infection and revision in patients who had both devices placed, based on the timing between procedures. Methods We performed a retrospective database analysis using a multi-institutional database (TriNetX), looking at all patients diagnosed with gastrostomy tube with subsequent ventriculoperitoneal shunt placement and vice-versa. We also evaluated patients who had gastrostomy tubes and shunts placed at the same time. We categorized cohorts into patients with device placement after 1-10 days, 11-30 days, and after one month of the other. Our primary endpoints were shunt infection and shunt revision. Results Patients who had same-day gastrostomy tube and shunt placement had a shunt infection rate of 10.06% within five years, and 14.53% had a shunt revision. With prior shunting and subsequent gastrostomy tube placement within 1-10 days, 12.18% had shunt infections, and 17.88% had shunt revisions; for those who had subsequent gastrostomy tube placement within 11-30 days, shunt infections were seen in 10.57%, and shunt revisions in 19.41%; gastrostomy tube placement after one month or longer of shunt placement resulted in 15.39% of patients having shunt infections and 17.73% with shunt revision. Prior gastrostomy tube patients with subsequent shunt placement, within 1-10 days had shunt infection rates of 8.27% and revision rates of 14.39%; for shunt placement within 11-30 days, shunt infections were seen in 10.82%, and shunt revisions were done in 14.33% of patients; for shunt placement after one month or longer, shunt infection rate was 11.68%, and revision rate was 16.80%. Conclusions Our results demonstrate no significant difference in shunt infection rates and shunt revision rates between same-day gastrostomy tube and shunt placement versus placement within 1-10 days, 11-30 days, or any time after one month from one another.
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Affiliation(s)
- David R Hallan
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Elias Rizk
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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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.
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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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Affiliation(s)
- Colin G DeLong
- Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Eric M Pauli
- Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA.
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Khdair Ahmad F, Younes D, Al Darwish MB, Aljubain MA, Dweik M, Alda'as Y. Safety and outcomes of percutaneous endoscopic gastrostomy tubes in children. Clin Nutr ESPEN 2020; 38:160-164. [DOI: 10.1016/j.clnesp.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 01/14/2023]
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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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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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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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Ong AW, Lapham DA, Psarros S. Infectious Complications in Patients with Ventriculoperitoneal Shunts after Intra-Abdominal Procedures. Am Surg 2016. [DOI: 10.1177/000313481608200707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Adrian W. Ong
- Department of Surgery Section of Trauma and Acute Care Surgery Reading Hospital Reading, Pennsylvania
| | - David A. Lapham
- Department of Surgery Philadelphia College of Osteopathic Medicine Philadelphia, Pennsylvania
| | - Stamatios Psarros
- Division of Neurosurgery Department of Surgery Reading Hospital Reading, Pennsylvania
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14
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Enteral access in adults. Clin Nutr 2015; 34:350-8. [DOI: 10.1016/j.clnu.2014.10.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/08/2014] [Accepted: 10/30/2014] [Indexed: 12/17/2022]
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Miller KR, McClave SA, Kiraly LN, Martindale RG, Benns MV. A Tutorial on Enteral Access in Adult Patients in the Hospitalized Setting. JPEN J Parenter Enteral Nutr 2014; 38:282-95. [DOI: 10.1177/0148607114522487] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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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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Yavuz C, Demırtas S, Calıskan A, Kamasak K, Karahan O, Guclu O, Yazıcı S, Mavıtas B. Reasons, procedures, and outcomes in ventriculoatrial shunts: A single-center experience. Surg Neurol Int 2013; 4:10. [PMID: 23493480 PMCID: PMC3589837 DOI: 10.4103/2152-7806.106284] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 12/18/2012] [Indexed: 12/02/2022] Open
Abstract
Background: Ventricular shunts are used to drain cerebrospinal fluid into extra-cranial spaces. Ventriculoatrial (VA) shunts are provided to transfer cerebrospinal fluid from the cerebral ventricle into the right atrium of the heart. A single center experience of indications, procedure, and clinical outcomes in VA shunt was presented in current study. Methods: VA shunts were applied in 10 patients who had repeated previous shunt dysfunction or infection. The reasons, clinical findings, replacement methods, and postoperative clinical follow-ups and outcomes were recorded retrospectively. Results: There were seven female (70%) and three (30%) male patients; their ages ranged from 5 to 13 years (mean ± SD; 8.5 ± 2.6 years). Shunt re-placement reasons were as follows: Shunt occlusion in five patients, intraperitoneal infection in four patients and a distal catheter was kinked and knotted in one patient. Postoperative early complications were seen in one patient as early catheter thrombosis and catheter revision were applied. Late complications were seen in two patients as follows: Catheter infection and infective endocarditis occurred in one patient and pulmonary thrombus occurred in one other patient. There was not any catheter-related mortality observed at the one year follow-up period. Conclusion: VA shunts may be an option for cerebrospinal fluid drainage at necessary conditions. However, sterilization and general training on asepsy and antisepsy are the most important determinants affecting the clinical outcome due to the cardio systemic relationship.
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Affiliation(s)
- Celal Yavuz
- Department of Cardiovascular Surgery, Medical School of Dicle University, Diyarbakir, Turkey
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Braun J, Bein T, Wiese CHR, Graf BM, Zausig YA. [Enteral feeding tubes for critically ill patients]. Anaesthesist 2011; 60:352-65. [PMID: 21136033 DOI: 10.1007/s00101-010-1800-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The use of enteral feeding tubes is an important part of early enteral feeding in intensive care medicine. In other faculties with non-critically ill patients, such as (oncologic) surgery, neurology, paediatrics or even in palliative care medicine feeding tubes are used under various circumstances as a temporary or definite solution. The advantage of enteral feeding tubes is the almost physiologic administration of nutrition, liquids and medication. Enteral nutrition is thought to be associated with a reduced infection rate, increased mucosal function, improved immunologic function, reduced length of hospital stay and reduced costs. However, the insertion and use of feeding tubes is potentially dangerous and may be associated with life-threatening complications (bleeding, perforation, peritonitis, etc.). Therefore, the following article will give a summary of the different types of enteral feeding tubes and their range of application. Additionally, a critical look on indication and contraindication is given as well as how to insert an enteral feeding tube.
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Affiliation(s)
- J Braun
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, Germany
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19
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Abstract
Gastrostomy placement for nutritional support for patients with inadequate oral intake has been attempted using surgical, endoscopic, and, more recently, percutaneous radiologically guided methods. Surgical gastrostomy has been superseded by both endoscopic and radiologic gastrostomy. We describe herein the indications, contraindications, patient preparations, techniques, complications, and aftercare with regard to radiologic gastrostomy. In addition, we discuss the available tube types and their perceived advantages. There remain some controversies regarding gastropexy performance and primary percutaneous gastrojejunostomy. Percutaneous jejunostomy is indicated for patients whose stomach is inaccessible for gastrostomy placement or for those who have had a previous gastrectomy.
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Affiliation(s)
- Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kwon RS, Banerjee S, Desilets D, Diehl DL, Farraye FA, Kaul V, Mamula P, Pedrosa MC, Rodriguez SA, Varadarajulu S, Song LMWK, Tierney WM. Enteral nutrition access devices. Gastrointest Endosc 2010; 72:236-48. [PMID: 20541746 DOI: 10.1016/j.gie.2010.02.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 02/03/2010] [Indexed: 12/12/2022]
Abstract
The ASGE Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, performing a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but, in many cases, data from randomized, controlled trials are lacking. In such situations, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the ASGE Governing Board. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through August 2009 for articles related to endoscopy in patients requiring enteral feeding access by using the keywords "endoscopy," "percutaneous," "gastrostomy," "jejunostomy," "nasogastric," "nasoenteric," "nasojejunal," "transnasal," "feeding tube," "enteric," and "button." Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.
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