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Value of diagnostic upper endoscopy preceding percutaneous gastrostomy
H C Wolfsen1, R A Kozarek, T J Ball
1Virginia Mason Clinic, Seattle, Washington.
The American Journal of Gastroenterology
|March 1, 1990
Summary
Diagnostic upper endoscopy before percutaneous endoscopic gastrostomy (PEG) significantly alters patient management. Pre-PEG endoscopy identified conditions like severe reflux esophagitis and peptic ulcers in 36% of patients, guiding crucial medical decisions.
Area of Science:
- Gastroenterology
- Endoscopy
- Surgical Procedures
Background:
- Percutaneous gastrostomies are increasingly used, often with cost advantages claimed for radiographic placement over endoscopic methods.
- Limited comparative data exist regarding the benefits of pre-procedural endoscopy for percutaneous gastrostomy (PEG) placement.
Purpose of the Study:
- To evaluate the impact of diagnostic upper endoscopy performed prior to attempted percutaneous gastrostomy (PEG) on patient management.
- To identify endoscopic findings that may preclude gastrostomy, necessitate jejunostomy conversion, or alter overall medical strategy.
Main Methods:
- Retrospective review of medical records for 201 patients undergoing upper endoscopy before attempted PEG placement.
- Data collection focused on endoscopic findings and subsequent changes in patient management.
Main Results:
- In 73 out of 201 patients (36%), pre-gastrostomy endoscopy findings led to major changes in medical management.
- Key findings included severe reflux esophagitis (35 patients), peptic ulcers (29 patients), and gastric outlet obstruction (2 patients).
- These conditions, when treated, have the potential to reduce patient morbidity, mortality, and healthcare costs.
Conclusions:
- Diagnostic upper endoscopy is recommended for patients undergoing percutaneous gastrostomy, irrespective of the intended placement method (endoscopic or radiographic).
- Pre-PEG endoscopy can optimize patient care by identifying and allowing treatment of underlying gastrointestinal conditions, potentially improving outcomes and reducing hospital stays.