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Successful control of peristomal infection by introducer-type percutaneous endoscopic gastrostomy: a retrospective
Chul-Hyun Lim1, Jae Myung Park, Yu Kyung Cho
1Department of Internal Medicine, The Catholic University of Korea College of Medicine, 505, Banpo-dong, Seocho-gu, Seoul, 137-070, Korea.
Background:
The techniques of percutaneous endoscopic gastrostomy are classified as the pull and introducer methods. Peristomal infection is the most common procedure-related complication in the pull method.
Objectives:
The objective of this study was to compare procedure-related complications between the two methods and to assess the outcome of long-term use of the introducer method.
Methods:
Between January 1999 and November 2009, 116 patients received percutaneous endoscopic gastrostomy at Seoul St. Mary's Hospital in Korea. Before June 2006, the pull method was used for all patients; since then, every patient had been treated using the introducer method. We compared outcomes and complications within 180 days of gastrostomy placement for the two methods.
Results:
The pull method was performed on 63 patients and the introducer method on 53 patients. The occurrence of peristomal infection within 30 days was significantly lower in the introducer method group than in the pull method group (1.9% vs. 36.5%, P = 0.001). Methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the major organisms isolated from the peristomal infection. The requirement for catheter reinsertion because of displacement, obstruction, or damage to the catheter between 30 and 180 days was significantly higher in the introducer method group than in the pull method group (40.5% vs. 0%, P = 0.001).
Conclusions:
Our results suggest the superiority of the introducer method in terms of infection control. However, the balloon-type catheter is associated with problems such as balloon insufficiency in long-term use.
Insights
The introducer method for percutaneous endoscopic gastrostomy significantly reduces peristomal infections compared to the pull method. However, long-term use of the introducer method
Area of Science:
- Gastroenterology
- Surgical Techniques
- Infection Control
Background:
- Percutaneous endoscopic gastrostomy (PEG) utilizes pull and introducer techniques.
- Peristomal infection is a common complication associated with the pull method.
Purpose of the Study:
- Compare procedure-related complications between PEG pull and introducer methods.
- Evaluate the long-term outcomes of the introducer method for PEG placement.
Main Methods:
- A retrospective study compared 116 patients undergoing PEG between 1999 and 2009.
- 63 patients received the pull method, while 53 received the introducer method.
- Outcomes and complications were analyzed within 180 days post-placement.
Main Results:
- The introducer method showed significantly lower peristomal infection rates within 30 days (1.9% vs. 36.5%).
- Common pathogens included MRSA, Pseudomonas aeruginosa, and Klebsiella pneumoniae.
- Catheter reinsertion due to displacement or damage was higher with the introducer method (40.5% vs. 0%) between 30-180 days.
Conclusions:
- The introducer method offers superior infection control for PEG procedures.
- Long-term use of introducer method balloon-type catheters may lead to issues like balloon insufficiency.
