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Percutaneous endoscopic gastrostomy: avoiding complications
1Division of Otolaryngology, Southern Illinois University School of Medicine, USA.
Insights
This study reviews complications from percutaneous endoscopic gastrostomy (PEG) tube placement and management. Modifications to techniques have significantly reduced minor complications and addressed major ones, improving patient safety.
Area of Science:
- Otolaryngology
- Gastroenterology
- Surgical Complications
Background:
- Percutaneous endoscopic gastrostomy (PEG) tubes are crucial for nutritional support.
- Complications associated with PEG tube placement and management require careful evaluation.
- Otolaryngologists performed PEG placements between 1991 and 1997.
Purpose of the Study:
- To evaluate complications directly or indirectly related to PEG tube placement and management.
- To provide recommendations for avoiding PEG-related complications.
- To analyze patient records for diagnoses, procedures, and outcomes.
Main Methods:
- Retrospective review of 71 patients who underwent PEG tube placement.
- Analysis of diagnoses, combined procedures, and recorded complications.
- Modification of PEG placement and management techniques based on complication analysis.
Main Results:
- Major complications included retained PEG hub and a fatal delayed colon abscess.
- Minor complications involved skin abscesses, cellulitis, and vasovagal responses.
- An airway emergency occurred during an attempted PEG placement, leading to abortion.
Conclusions:
- Identified causes of minor complications led to technique modifications, preventing recent occurrences.
- Management strategies were altered to avoid the identified major complication.
- Recommended techniques are detailed to enhance PEG tube placement and management safety.
Abstract:
This study evaluates our complications arising directly or indirectly from placement or management of percutaneous endoscopic gastrostomy (PEG) tubes and provides recommendations for avoidance of complications. Seventy-one patients received PEG tube placement by otolaryngologists between January 1991 and May 1997. Records were reviewed for diagnoses, combined procedures, and complications. Addressing potential causes of complications prompted modification of our technique of PEG tube placement and management. Twenty-three patients received PEG for dysphagia/aspiration unrelated to neoplasia, 11 received PEG with staging endoscopy, 11 received PEG after treatment for head and neck neoplasm, and 26 received PEG at the time of primary resection. Major complications included retained PEG hub and delayed colon abscess ultimately resulting in death. Minor complications included skin abscesses, cellulitis, and early and late vasovagal response with PEG tube removal. An airway emergency, on attempted oral airway intubation, resulted in an aborted PEG attempt and constituted another complication outside the 4 groups stated above. The major complication was not found within a literature review. We have modified our management for avoidance of this complication. We believe the causes of the minor complications have been identified, and with additional modifications in our technique, we have not had any similar complications recently. The recommended techniques are discussed in detail.