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Comparison of modified introducer method with pull method for percutaneous endoscopic gastrostomy: prospective
Hiroaki Shigoka1, Iruru Maetani, Kenji Tominaga
1Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
Aim:
The pull method is associated with a high incidence of percutaneous endoscopic gastrostomy (PEG) site infection. The introducer method has been shown to be less likely to cause infection, because it avoids the passage of a tube through the oropharynx. The aim of the present study was to compare the modified introducer method with the pull method for PEG.
Methods:
The study included patients who were scheduled for PEG from April 2008 to April 2010. The patients were randomly assigned to receive PEG by the pull method (Group I) or the modified introducer method (Group II). We evaluated the incidence of PEG site infection, some infection-associated parameters and other complications. Wound infections were evaluated in accordance with the Jain's score.
Results:
Of 62 patients enrolled, 31 patients were assigned to each of the two groups. One patient in Group I died on the day after PEG. The cause of death and relationship with PEG were unclear. Excluding this patient, 61 were included in the per-protocol analysis. The incidence of peristomal infection within 1 week was slightly lower in Group II than in Group I, albeit not statistically significant (12.9% vs 23.3%, P = 0.3354). White blood cell count (WBC) and C-reactive protein (CRP) levels were significantly lower in Group II (WBC: P = 0.0345, CRP: P = 0.0346). None of the patients underwent surgical procedures for the treatment of peristomal infection.
Conclusion:
The results of the present study show that gastrostomy by the modified introducer method may be less likely, although not significantly, to cause peristomal infection than the pull method.
Insights
The modified introducer method for percutaneous endoscopic gastrostomy (PEG) showed a trend toward fewer infections compared to the pull method. This method also resulted in lower inflammatory markers, suggesting a potentially safer approach for PEG procedures.
Area of Science:
- Gastroenterology
- Surgical Procedures
- Infection Control
Background:
- Percutaneous endoscopic gastrostomy (PEG) is a common procedure.
- The pull method for PEG is associated with a higher risk of site infections.
- The introducer method may reduce infection risk by avoiding oropharyngeal passage.
Purpose of the Study:
- To compare the efficacy and safety of the modified introducer method versus the pull method for PEG.
- To evaluate the incidence of PEG site infections and associated parameters between the two methods.
Main Methods:
- A randomized study comparing the pull method (Group I) and modified introducer method (Group II) for PEG.
- Patients were enrolled from April 2008 to April 2010.
- Infection incidence and inflammatory markers (WBC, CRP) were assessed using Jain's score.
Main Results:
- The modified introducer method showed a non-significant trend towards lower peristomal infection rates (12.9% vs 23.3%).
- Significantly lower white blood cell (WBC) and C-reactive protein (CRP) levels were observed in the modified introducer group.
- No patients required surgical intervention for peristomal infections.
Conclusions:
- The modified introducer method for PEG may offer a reduced risk of peristomal infection compared to the pull method.
- Lower inflammatory markers suggest a potentially less invasive or inflammatory process with the modified introducer technique.
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