Percutaneous endoscopıc gastrostomy: results of 50 cases
Över Hamzaoğlu, Hülya
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Objective: To present the results of percutaneous endoscopic gastrostomy (PEG), which has been an alternative method to conventional surgical gastrostomy for the last 20 years. PEG is one of the gastrostomy methods used for patients unable to take food orally. Patients and Methods: Between January 1996 and July 2000, 50 consecutive patients in need of enteral feeding for more than four weeks and undergoing PEG with 20 Fr tube by pull technique were retrospectively evaluated in terms of indication, complications, durability of tube, and mortality. The assessment of wound infection was conducted according to the criteria developed by Jain and Shapiro. Results: A PEG was successfully positioned in 50 of the 52 referred patients (96%). Of the 50 cases 26 (52%) were men and 24 (48%) women with the median age of 63 years (range 2 to 88 years). Indications for PEG placement were cerebrovascular accident in 20, brain tumors in 11, subarachnoidal hemorrhage in 9, several neurologic disorders in 5 (2 infections, 2 Parkinson’s disease, 1 Alzheimer’s disease), head injury in 3, iatrogenic in 1 (esophago- cutaneous fistula), and hypoxic encephalopathy in 1. The durability of the tube was a median of 217.5 days (range 9 to 1669 days). In 9 patients the tube was removed with a median of 158.5 days (range 35 to 427 days) and then oral feeding was started. The tube was changed in 7 patients who had tube dysfunction because of clogging, porosity or fracture with a median interval of 122 days (range 35 to 1252 days). Of these patients, 2 needed replacement tube insertion twice and 3 three times. Two (4%) cases had minor complications (wound infection) during the the first 30 days. During total followup, two wound infections, one buried bumper syndrome, and one aspiration pneumonia developed. The last patient underwent JETPEG which was performed by introducing a 10 Fr jejunal tube through the 20 Fr PEG opening. Total follow-up was 41.8 patient-years with a procedure-related mortality of 0%, 30-day mortality of 8% (4/50), and overall mortality of 32% (16/50). The mortality rate was 63.6% (7/11) for patients who had brain tumor and 23% (9/39) for the rest. Conclusion: PEG is a minimally invasive gastrostomy method with low morbidity and mortality rates, easy to follow-up, easy to replace when clogged.