Percutaneous endoscopic gastrostomy in burn patients
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1Department of Surgery, Division of Burns and Trauma, Bigelow 1302, Massachusetts General Hospital, Shriners Burns Hospital, Harvard Medical School, Boston, MA 02114, USA.
Insights
Percutaneous endoscopic gastrostomy (PEG) offers a comfortable and safe method for prolonged enteral nutrition in severe burn patients. This technique minimizes complications compared to traditional nasogastric tubes.
Area of Science:
- Medical procedures
- Gastroenterology
- Burn care
Background:
- Seriously burned individuals occasionally require prolonged enteral feedings.
- Percutaneous endoscopic gastrostomy (PEG) has been utilized for extended nutritional access in select burn patients.
- This review examines the application of PEG in this patient population.
Purpose of the Study:
- To evaluate the efficacy and safety of PEG for prolonged enteral nutrition in severely burned patients.
- To compare PEG with nasogastric tubes for long-term feeding access in burn survivors.
Main Methods:
- The PEG procedure was performed under general anesthesia in 14 patients, often concurrently with other surgical interventions.
- Various commercially available needle and guidewire kits were used for tube placement.
- Tube placement sites included unburned skin, healed donor sites, healed burns, and grafted burn areas.
Main Results:
- The study included 14 patients with an average age of 55.2 years and burns affecting 38% of their body surface; 11 had inhalation injuries.
- PEG tubes were placed a mean of 57 days post-injury through various skin sites, with one instance of local wound erosion.
- While tubes remained in place for up to 155 days, long-term outcomes post-discharge were largely unknown, with no reported tube-related issues after acute care.
Conclusions:
- Percutaneous endoscopic gastrostomy (PEG) provides a more comfortable alternative to nasogastric tubes for prolonged enteral feeding in selected burn patients.
- The PEG procedure can be performed with minimal morbidity in this patient group.
- PEG facilitates necessary nutritional support for recovery in severe burn cases.
Background:
Prolonged enteral feedings are required occasionally in seriously burned individuals. We have employed percutaneous endoscopic gastrostomy (PEG) in selected patients who require particularly prolonged access, thus prompting this review.
Methods:
The PEG procedure was performed under general anesthesia in combination with another surgical procedure using a variety of commercially available needle and guidewire kits in 14 patients.
Results:
These 14 patients had an average age of 55.2 +/- 6.6 years and a burn involving 38 +/- 8% of the body surface. Eleven of these patients had suffered an inhalation injury. The tubes were placed an average of 57 +/- 10.5 days after injury through unburned and unharvested skin in four patients (28%), healed donor sites in five patients (35%), healed burn in one patient (1%), and grafted burn in four patients (28%). One patient, whose catheter was placed through a grafted fascial excision, developed moderate local wound erosion. Tubes were known to have been left in place as long as 155 days. However, most were removed in rehabilitation hospitals, and we were unable to determine how long most were left in place. We are unaware of any problems with the tubes occurring after discharge from the acute care setting.
Conclusions:
In selected patients, PEG can provide more comfortable access for prolonged enteral feedings than nasogastric tubes and can be placed with minimal morbidity.
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