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[Indications and complications of percutaneous endoscopic gastrostomy]
Gerhard Aschl1, Andreas Kirchgatterer, Stephan Allinger
1I. Interne Abteilung/Gastroenterologie, Allgemein öffentliches Krankenhaus der Barmherzigen Schwestern v. Hl. Kreuz, Wels, Osterreich. gerhard.aschl@khwels.at
Insights
Percutaneous endoscopic gastrostomy (PEG) is vital for patients with swallowing issues. This study found a high complication rate, particularly wound infections, despite PEG being considered a minor procedure.
Area of Science:
- Gastroenterology
- Surgical Procedures
- Patient Nutrition
Background:
- Percutaneous endoscopic gastrostomy (PEG) is crucial for nutritional support in patients with dysphagia.
- Understanding PEG indications and complications is essential for patient care.
Purpose of the Study:
- To prospectively record indications for PEG placement.
- To analyze the incidence and types of complications following PEG procedures.
- To evaluate mortality rates associated with PEG placement.
Main Methods:
- Prospective investigation of patients undergoing PEG placement over a one-year period.
- Daily monitoring of the exit site and 30-day telephone follow-up.
- Documentation of indications, wound infections, other complications, and mortality.
Main Results:
- 93 PEG procedures were performed; neurological diseases were the most common indication (65%).
- Complications occurred in 33% of patients, with wound infections (30%) being most frequent.
- Serious local infections and sepsis led to mortality in one patient; overall mortality reflected underlying disease severity.
Conclusions:
- While PEG is generally a low-morbidity procedure, a significant complication rate was observed.
- Wound infections represent a notable complication, with systemic antibiotics failing to prevent them in 25% of cases.
- High mortality rates underscore the critical condition of patients requiring PEG.
Background:
Percutaneous endoscopic gastrostomy (PEG) plays an important role in maintaining enteral nutrition in patients with swallowing disorders of different etiologies. The aim of our study was to record indications and complications of PEG-placement in a one-year period.
Methods:
All patients were investigated prospectively regarding indications, wound infections, other complications and mortality between 1999-10-01 and 2000-09-30. The exit site was examined daily, after 30 days a follow-up by telephone was carried out.
Results:
The PEG-procedure was performed in 93 patients, one patient received a percutaneous endoscopic jejunostomy. The mean age of the patients was 65.4 years (range 7 months--92 years). The most frequent indications were neurological diseases (n = 61, 65%). 21 patients had a PEG-placement because of malignancies (22%), 9 patients following brain injury (10%) and 3 patients (3%) due to other benign swallowing disorders. 63 patients (67%) had no complications, 28 patients (30%) had wound infections, and in two patients hemorrhage was observed (small hematoma requiring no further intervention). One patient had laparotomy because of suspected perforation--however, laparotomy was negative. In 7 patients (7%) wound infections (n = 28) were mild and needed only local or no therapy. In 18 patients (19%) we found a relevant infection that required systemic antibiotic therapy. 2 patients had serious local infections that caused further interventions. One patient died from sepsis caused by wound infection. Patients receiving antibiotic therapy at the time of PEG-placement suffered from wound infections in 25%. Patients with malignant diseases more often had wound infections. 8 patients died after 7 days and 19 patients after 30 days (8% and 19%, respectively) from their underlying disease.
Conclusions:
PEG is regarded as a small intervention with low morbidity and mortality. However, our analysis of daily practice shows a remarkable rate of complications. The high mortality in our study reflects the seriousness of the comorbidities. Antibiotic therapy failed to prevent wound infection in 25% of our patients.