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Related Experiment Videos

PEG with introducer or pull method: a prospective randomized comparison.

Iruru Maetani1, Tomoko Tada, Takeo Ukita

  • 1Third Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan.

Gastrointestinal Endoscopy
|May 31, 2003
PubMed
Summary
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The introducer method for percutaneous endoscopic gastrostomy (PEG) significantly reduces peristomal wound infections compared to the traditional pull method. This finding highlights a safer approach for PEG placement in patients with dysphagia.

Area of Science:

  • Gastroenterology
  • Surgical Procedures
  • Infection Control

Background:

  • Percutaneous endoscopic gastrostomy (PEG) is a common procedure for patients with dysphagia.
  • The conventional pull method for PEG placement is associated with a higher risk of peristomal wound infection.
  • Contamination during catheter passage through the oral cavity is a suspected cause of infection.

Purpose of the Study:

  • To compare the incidence of peristomal wound infection between the pull and introducer techniques for PEG placement.
  • To evaluate the safety and efficacy of both PEG methods in patients requiring nutritional support.

Main Methods:

  • A randomized study comparing the introducer (Group I) and pull (Group II) methods for PEG placement in 60 patients with dysphagia.
  • Daily evaluation of the peristomal area for infection signs (erythema, exudate, induration) for one week post-procedure.

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  • Standardized scoring criteria for infection, prophylactic antibiotics (piperacillin), and single endoscope passage were used.

    • Main Results:

    • Peristomal infection occurred in 0 out of 29 patients in the introducer group versus 9 out of 29 in the pull group (p = 0.00094).
    • Mean daily and median maximum infection scores were significantly lower in the introducer group.
    • No procedure-related mortality or severe wound infections requiring surgical intervention were observed.

    Conclusions:

    • The introducer method for PEG placement is associated with a significantly lower risk of peristomal wound infection compared to the pull method.
    • This suggests the introducer technique offers a safer alternative for PEG procedures.