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Percutaneous endoscopic gastrostomy complications in a tertiary-care center
Mark A Lockett1, Mia L Templeton, T Karl Byrne
1Department of Surgery, Medical University of South Carolina, Charleston, USA.
Insights
Percutaneous endoscopic gastrostomy (PEG) is a common procedure for enteral access, but complications can occur. Preoperative antibiotics significantly reduce wound infections, making PEG a safe option when infection risks are managed.
Area of Science:
- Gastroenterology
- Surgical Procedures
- Patient Safety
Background:
- Percutaneous endoscopic gastrostomy (PEG) is widely used for enteral access since 1980.
- PEG placement has a notable rate of associated complications.
- Tertiary-care centers manage a significant volume of PEG procedures.
Purpose of the Study:
- To review complications associated with PEG placement.
- To evaluate the impact of antibiotic prophylaxis on wound infections.
- To assess the safety and efficacy of PEG procedures.
Main Methods:
- Retrospective chart review of patients over 17 years old undergoing PEG placement.
- Data collection included indications, antibiotic use, and postoperative complications.
- Analysis of 166 PEG placements between January 1994 and March 1996.
Main Results:
- A total of 166 PEGs were placed, with 27 (16.3%) complications.
- One death (0.6%) was directly related to PEG placement; overall 30-day mortality was 7.8%.
- Wound infections occurred in 5.4% of patients; antibiotic prophylaxis reduced infection rates from 38.5% to 2.6%.
Conclusions:
- PEG is a safe and effective method for enteral access in most patients.
- High mortality rates are often due to underlying medical conditions.
- Preoperative antibiotics are recommended to prevent local wound infections.
Abstract:
Since its introduction in 1980 the percutaneous endoscopic gastrostomy (PEG) has become the procedure of choice for establishing enteral access. However, there is still a relatively high complication rate associated with PEG placement. We reviewed the complications associated with PEG placement at our tertiary-care referral center. A retrospective chart review was conducted on patients over 17 years of age undergoing PEG placement between January 1, 1994 and March 1, 1996. Indications for surgery, antibiotic use, and postoperative complications were determined. There were 166 PEGs placed during this time and 27 (16.3%) complications. There was one death (0.6%) directly related to PEG placement. Thirteen patients (7.8%) died within 30 days of PEG placement and an additional 12 patients (7.2%) died before leaving the hospital. Wound infections occurred in nine (5.4%) patients including one case of necrotizing fasciitis. Only four of 153 (2.6%) patients who received preoperative antibiotics developed wound infections, whereas five of 13 (38.5%) patients without antibiotic prophylaxis developed infections. We conclude that percutaneous endoscopic gastrostomy is a safe and effective way of establishing enteral access in most patients. A relatively high mortality rate can be expected as a result of underlying medical problems. Antibiotics should be given to help prevent local wound infections.