Clinical Outcomes of Percutaneous Endoscopic Gastrostomy in the Surgical Intensive Care Unit

Abstract

Background/Aims: Percutaneous endoscopic gastrostomy (PEG) is usually performed on patients with chronic underlying diseases in the general ward (GW). This study evaluated the clinical outcomes of PEG performed on patients in the surgical intensive care unit (SICU) compared with those of PEG performed in the GW. Methods: The medical records of 27 patients in the SICU and 263 in the GW, who underwent PEG between January 2013 and July 2017, were retrospectively reviewed. Results: The median age of the 27 SICU patients was 66 years, and their median body mass index was 21.1 kg/m 2. In the SICU group, the median baseline Sequential Organ Failure Assessment (SOFA) score was 4, and the median Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 16. The median interval between surgery and PEG in SICU patients was 30 days, with a PEG failure rate of 3.7%. Acute complications in SICU patients included bleeding (7.4%) and ileus (11.1%), while chronic complications included aspiration pneumonia (7.4%) and tube obstruction (3.7%). The rates of acute and chronic complications did not differ significantly between the SICU and GW groups. The 30-day mortality rate was 14.8% in SICU patients and 5.3% in GW patients (p=0.073). Conclusions: PEG is a safe and feasible method of enteral feeding for critically ill patients who require ICU care after surgery. Clin Endosc 2020 Mar 31.

Fluoroscopy-Assisted Percutaneous Endoscopic Gastrostomy (F-PEG)—Single-Center Experience and Outcome

“…Aspiration pneumonia was defined by new development of chest symptoms (cough, purulent sputum, or fever after PEG) with changes in chest radiograph and/or oxygen saturation and/or witnessed aspiration. 20 Dislodgement was defined as complete inadvertent pulling out of gastrostomy tube. 20 Buried bumper syndrome (BBS) was considered when the inner bumper migrates alongside the stoma tract out of the gastric lumen and can be anywhere between the stomach mucosa and the surface of the skin.…”

“…20 Dislodgement was defined as complete inadvertent pulling out of gastrostomy tube. 20 Buried bumper syndrome (BBS) was considered when the inner bumper migrates alongside the stoma tract out of the gastric lumen and can be anywhere between the stomach mucosa and the surface of the skin. BBS was suspected when there was increased leakage around the PEG tube, along with pain or resistance to PEG feeding.…”

Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy

“… 4 , 5 Moreover, it is relatively easy to perform by experienced endoscopists. 6 The success rate of tube placement is as high as 99.5%, whereas the mortality rate is 0.5% to 2%. 7 , 8 PEG tube can remain in place for a minimum of 6 months.…”

A Multicenter Survey of Percutaneous Endoscopic Gastrostomy in 2019 at Korean Medical Institutions

“… 2 - 4 , 8 Percutaneous endoscopic gastrostomy (PEG) provides a safe and effective way to provide supplemental EN to these patients. 5 , 7 , 9 , 10 To date, several novel methods for PEG are performed depending on patient’s characteristics and the endoscopist’s abilities. Although PEG is known a relatively safe procedure, it has the potential risk of serious side effects such as bleeding, aspiration pneumonia, colonic perforation, and even leading to death caused by procedure.…”

“…Although PEG is known a relatively safe procedure, it has the potential risk of serious side effects such as bleeding, aspiration pneumonia, colonic perforation, and even leading to death caused by procedure. 8 , 10 , 11 However, there has been no clear consensus and guidelines on PEG insertion and management in Korea. Recently, the European Society of Gastrointestinal Endoscopy (ESGE) presented a PEG guideline; however, discrepancies with real-world clinical practices in Korea were noted.…”