Complications and early mortality in percutaneous endoscopic gastrostomy placement in lombardy: A multicenter prospective cohort study

Anderloni, Andrea; Leo, Milena Di; Barzaghi, F.; Semeraro, R.; Meucci, G.; Marino, Roberta; Amato, Loretta; Frigerio, Mauro; Saladino, Valeria; Toldi, Anna; Manfredi, Guido; Redaelli, A.; Feliziani, Marcella; Roberto, Giuseppe; Boni, Francesca; Scacchi, Gianlorenzo; Mosca, Davide; Devani, Massimo; Arena, Monica; Massidda, Marco; Zanoni, Paolo; Ciscato, Camilla; Casini, Valentina; Beretta, P; Forti, Edoardo; Salerno, Raffaele; Caramia, Vitantonio; Bianchetti, Mario G.; Tomba, Carolina; Evangelista, Andrea; Repici, Alessandro; Soncini, Marco; Maconi, Giovanni; Manes, Gianpiero; Gullotta, R.

doi:10.1016/j.dld.2019.03.024

Cited by 39 publications

(48 citation statements)

References 15 publications

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“…According to a Mexican study, these significant associations of comorbidities and albumin level were observed more in the older population, as they independently predicted long-term mortality [33]. C-reactive protein level on presentation has also been studied as a predictor of early mortality [13-15], as has severe hypernatremia, especially in the immediate preprocedural period [34]; however, because of insufficient data, our study did not include these variables for testing.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies concerning risk prediction for PEG-related adverse events were a reflection of the center’s own level of performance. Fewer studies, however, aimed to explore the factors associated with adverse events and prolonged hospitalization for patients with a PEG tube placed in various centers [15]. Our study attempts to rectify that deficiency by collecting data from the pool of patients who underwent PEG insertion in our center, as well as in other centers, and were admitted under our service with PEG-related adverse events.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of risk of adverse events related to percutaneous endoscopic gastrostomy: a retrospective study

Shangab

Shaikh

2019

aog

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Background: Percutaneous endoscopic gastrostomy (PEG) is a popular method for long-term enteral feeding. Our aim was to determine potential risk factors for adverse events related to PEG, as well as consequent prolonged hospitalization. Methods: Data were retrospectively collected from the admission records of a tertiary center between July 2015 and June 2018. Possible predictors of the 3 following outcomes were evaluated: minor PEG-related adverse events, major PEG-related adverse events, and length of hospital stay. Data were tested for correlation using the Spearman coefficient and for association using Kruskal-Wallis tests for significance. Results: A total of 362 admissions involving 146 patients were included in the study. Of the admissions, 221 (61.0%) had only minor adverse events, 100 (27.6%) had only major adverse events, and 41 (11.3%) had both. Eighty (22.1%) had PEG-site infection and 128 (35%) had aspiration pneumonia. Serum albumin levels at presentation were negatively correlated with the length of hospitalization (P<0.001), which also differed between patients presenting with major and minor adverse events (P<0.001 and P=0.026). The Charlson comorbidity index was positively correlated with the duration of hospitalization (P<0.001). Higher index scores were found more among patients presenting with aspiration pneumonia (P=0.004) and lower scores were found among patients presenting with PEG site infection and inadvertent PEG removal compared with those presenting with a major complication (P<0.001). Conclusion: The patient’s general medical condition and nutritional status are the greatest risk predictors for developing adverse events related to their PEG feeding, as well as a consequent extended hospital stay.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prediction of risk of adverse events related to percutaneous endoscopic gastrostomy: a retrospective study

Shangab

Shaikh

2019

aog

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“…Complications were divided into two groups based on onset time being within 30 days or 30 days or more after the PEG procedure ( Table 2). Early acute complications were defined as bleeding or perforation related to PEG and included early severe complications according to a previous report 5 . Severe acute complications were defined as those requiring surgical intervention within 30 days after PEG construction.…”

Section: Methodsmentioning

confidence: 99%

“…Complications within 30 days after PEG were recorded in 62 patients, among which wound bleeding was the most frequent (32 cases), followed next by wound infection (five cases). Based on the evaluation criteria 5 , there were 42 cases with early acute complications. Complications at 30 days or more after PEG were observed in 18 patients ( Table 2).…”

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confidence: 99%

Relationship of early acute complications and insertion site in push method percutaneous endoscopic gastrostomy

Suzuki

Joshita

Nagaya

et al. 2020

Sci Rep

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Percutaneous endoscopic gastrostomy (PEG), which is frequently used for nutrition management in patients having difficulty with oral intake, is considered a safe procedure. However, serious complications may occur depending on site of the puncture. This study aimed to clarify whether push method PEG construction at the posterior wall (PW) of the greater curvature (GC) had a higher risk of complications. We retrospectively investigated the relationship between puncture site at the PW of the GC and early acute complications in 540 patients receiving PEG. Early acute complications were defined as bleeding or perforation within 30 days after the PEG procedure. PEG-related complications were observed in 80 patients in total, with early acute complications detected in 42 patients. PEG construction at the PW of the GC in 12 cases exhibited a significantly higher occurrence of early acute complications versus PEG at other sites (41.7% vs. 7.0%, p = 0.001). Further, multivariate analysis revealed PW at the GC to be independently associated with early acute complications (OR 9.59, 95% CI 2.82–32.61; p = 0.0003). It may be desirable to avoid PEG at the PW of the GC. If performed, clinicians should pay careful attention to early acute complications.

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“…Therefore, bleeding from some vessel placed in the path of the puncture or, rarely, a hematoma of the wall, may occur. A recent multicenter prospective cohort study, including 950 patients undergoing PEG placement or replacement, showed a 1% bleeding rate[ 90 ].…”

Section: Risk Of Bleeding Associated With Endoscopic Proceduresmentioning

confidence: 99%

Management of antiplatelet or anticoagulant therapy in endoscopy: A review of literature

Maida¹,

Sferrazza

Maida

et al. 2020

WJGE

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Endoscopic procedures hold a basal risk of bleeding that depends on the type of procedure and patients’ comorbidities. Moreover, they are often performed in patients taking antiplatelet and anticoagulants agents, increasing the potential risk of intraprocedural and delayed bleeding. Even if the interruption of antithrombotic therapies is undoubtful effective in reducing the risk of bleeding, the thromboembolic risk that follows their suspension should not be underestimated. Therefore, it is fundamental for each endoscopist to be aware of the bleeding risk for every procedure, in order to measure the risk-benefit ratio for each patient. Moreover, knowledge of the proper management of antithrombotic agents before endoscopy, as well as the adequate timing for their resumption is essential. This review aims to analyze current evidence from literature assessing, for each procedure, the basal risk of bleeding and the risk of bleeding in patients taking antithrombotic therapy, as well as to review the recommendation of American society for gastrointestinal endoscopy, European society of gastrointestinal endoscopy, British society of gastroenterology, Asian pacific association of gastroenterology and Asian pacific society for digestive endoscopy guidelines for the management of antithrombotic agents in urgent and elective endoscopic procedures.

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Complications and early mortality in percutaneous endoscopic gastrostomy placement in lombardy: A multicenter prospective cohort study

Cited by 39 publications

References 15 publications

Prediction of risk of adverse events related to percutaneous endoscopic gastrostomy: a retrospective study

Prediction of risk of adverse events related to percutaneous endoscopic gastrostomy: a retrospective study

Relationship of early acute complications and insertion site in push method percutaneous endoscopic gastrostomy

Management of antiplatelet or anticoagulant therapy in endoscopy: A review of literature

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