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Percutaneous endoscopic gastrostomy (PEG): comparison of push and pull methods and evaluation of antibiotic
W L Akkersdijk1, J D van Bergeijk, T van Egmond
1Department of Surgery, Utrecht University Hospital, The Netherlands.
Background And Study Aims:
Infection of the gastrostomy opening after placement of a percutaneous endoscopic gastrostomy (PEG) catheter has been reported to occur quite often, especially when the pull method is used. We therefore compared complications occurring with the pull and push methods, and evaluated the role of antibiotic prophylaxis.
Patients And Methods:
In a prospective study, 100 consecutive patients were randomly assigned to group A (pull plus antibiotic prophylaxis: amoxycillin-clavulanic acid 3 x 1.2 g i.v. over 24 hours; 37 patients), group B (pull without antibiotic prophylaxis; 34 patients) and group C (push without antibiotic prophylaxis; 29 patients). The indications for PEG placement were dysphagia due to oropharyngeal tumors (56%), neurological disease (32%), or other (12%). Patients were evaluated twice weekly for one month after the PEG placement.
Results:
PEG catheters were successfully placed in 96% of the patients. The total procedure-related complication rate was significantly lower in group A than in groups B and C (28%, 58%, and 70%, respectively; p < 0.01). Major complications occurred in one patient in group A (seeding metastasis of a hypopharyngeal carcinoma in the gastrostomy tract), and in four patients in group B (three cases of peritonitis and one aspiration, resulting in two deaths), but in none of the group C patients. Group A patients experienced fewer peristomal infections than the other two groups (14%, 30%, and 41%, respectively: p = 0.05). The risk of peristomal pain was similar (11%, 15%, and 11%, respectively; p = n.s.). In three patients in group C, the PEG catheter had to be replaced by the pull method, due to repeated dislocation of the balloon catheter.
Conclusions:
The complication rate with PEG placement is high with both the push and pull methods. The complication rate with the pull method is significantly reduced when antibiotic prophylaxis is used.
Insights
Antibiotic prophylaxis significantly reduces complications associated with percutaneous endoscopic gastrostomy (PEG) catheter placement, particularly when using the pull method. This approach lowers infection rates and improves patient outcomes.
Area of Science:
- Gastroenterology
- Surgical Procedures
- Infectious Disease Prevention
Background:
- Percutaneous endoscopic gastrostomy (PEG) catheter placement is common, but gastrostomy site infections are frequent, especially with the pull method.
- The role of antibiotic prophylaxis in mitigating PEG-related complications requires further investigation.
Purpose of the Study:
- To compare complication rates between the pull and push methods for PEG placement.
- To evaluate the effectiveness of antibiotic prophylaxis in reducing complications during PEG procedures.
Main Methods:
- A prospective study randomly assigned 100 patients into three groups: pull method with antibiotic prophylaxis, pull method without prophylaxis, and push method without prophylaxis.
- Patients were monitored for complications, including infections, peritonitis, and catheter dislodgement, for one month post-procedure.
Main Results:
- The overall complication rate was significantly lower in the group receiving antibiotic prophylaxis with the pull method (28%) compared to the pull-only (58%) and push-only (70%) groups.
- Antibiotic prophylaxis was associated with fewer peristomal infections (14% vs. 30% and 41%).
- No major complications were observed in the push-only group, but the pull method without antibiotics resulted in peritonitis and aspiration in four patients, leading to two deaths.
Conclusions:
- Both push and pull methods for PEG placement have high complication rates.
- Utilizing antibiotic prophylaxis with the pull method significantly reduces the overall complication rate and peristomal infections.