Percutaneous endoscopic gastrostomy (PEG) with T-fasteners obviates the need for emergent replacement after early tube dislodgement

Timratana, Poochong; El‐Hayek, Kevin; Shimizu, Hiroki; Kroh, Matthew; Chand, Bipan

doi:10.1007/s00464-012-2348-7

Cited by 29 publications

(15 citation statements)

References 30 publications

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“…[46] However, some brands of T-fasteners have non-resorbable sutures that need to be removed and sometimes the anchors are not easily removed. Unfortunately, the authors did not separately report on using T-fasteners during PEG.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic versus percutaneous endoscopic gastrostomy placement in children: Results of a systematic review and meta-analysis

et al. 2017

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BACKGROUND:Percutaneous endoscopic gastrostomy (PEG) and laparoscopic-assisted gastrostomy (LAG) are widely used in the paediatric population. The aim of this study was to determine which one of the two procedures is the most effective and safe method.METHODS:This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses statement. Primary outcomes were success rate, efficacy of feeding, quality of life, gastroesophageal reflux and post-operative complications.RESULTS:Five retrospective studies, comparing 550 PEG to 483 LAG placements in children, were identified after screening 2347 articles. The completion rate was similar for both procedures. PEG was associated with significantly more adjacent bowel injuries (P = 0.047), early tube dislodgements (P = 0.02) and complications that require reintervention under general anaesthesia (P < 0.001). Minor complications were equally frequent after both procedures.CONCLUSIONS:Because of the lack of well-designed studies, we have to be cautious in making definitive conclusions comparing PEG to LAG. To decide which type of gastrostomy placement is best practice in paediatric patients, randomised controlled trials comparing PEG to LAG are highly warranted.

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Section: Discussionmentioning

confidence: 99%

“…Gastrostomy placement techniques, especially PEG, have changed over the years. [465051] However, the main concept of each procedure (e.g., endoscopic versus laparoscopic view) remained similar.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic versus percutaneous endoscopic gastrostomy placement in children: Results of a systematic review and meta-analysis

et al. 2017

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“…in 19862,3 and has since become routine practice. A t-fastener consists of a tiny metal bar attached to a thread or suture that can be advanced through a needle in order to secure the anterior gastric wall to the anterior abdominal wall.…”

Section: Introductionmentioning

confidence: 99%

T-Fastener Migration after Percutaneous Gastropexy for Transgastric Enteral Tube Insertion

Sydnor¹,

Schriber²,

Kim³

2014

Gut Liver

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Background/AimsTo determine the prevalence and time-course of t-fastener migration after gastropexy deployment.MethodsWe reviewed our procedural database for all percutaneous gastrostomy and gastrojejunostomy tube insertions performed over a 14-month period using a widely accepted t-fastener kit for gastropexy (Kimberly-Clark). Of 201 patients, 71 (41 males, 30 females; mean age, 56 years) underwent subsequent abdominal computed tomography (CT) imaging. The location and associated findings of each t-fastener were retrospectively recorded for each CT scan performed after the tube insertion.ResultsA total of 153 t-fasteners were deployed during 71 procedures with subsequent CT follow-up. In the short term (within 4 weeks after deployment), 5.1% of the t-fasteners had detached and were no longer present; 59.5% were intraluminal or within the gastric wall; and 35.5% were within the anterior abdominal wall musculature or subcutaneous. In the long term (>3 months), 48.6% of the t-fasteners had detached and were no longer present, 25.0% were intraluminal or within the gastric wall, and 26.4% were within the anterior abdominal wall musculature or subcutaneous. No t-fastener-related complications, such as abscesses, fluid collections, or fistulae, were identified.ConclusionsFollowing gastropexy for percutaneous transgastric feeding tube placement, t-fastener migration into the abdominal wall frequently occurred soon after the tube insertion. Therefore, recent t-fastener deployment does not guarantee an intact gastropexy.

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“…(A T-fastener is a nylon suture attached to a T-shaped metal bar.) 6 Spillage into the intraperitoneal cavity increases the risk of peritonitis and sepsis, leading to a rapid decline in patient status. 6 Options for confirming gastrostomy tube position following tube replacement are given in Table 1.…”

mentioning

confidence: 99%

“…In the push and pull endoscopic methods, internal and external bolsters at the end of the tube are the only elements holding the stomach in position against the abdominal wall, with no permanent attachment occurring until the tract matures. 6,11 Unfortunately, tube dislodgment is a common complication. 7,8 Complications.…”

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confidence: 99%

Ce

O'Rear

Prahlow

2015

AJN, American Journal of Nursing

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Percutaneous endoscopic gastrostomy (PEG) with T-fasteners obviates the need for emergent replacement after early tube dislodgement

Abstract: Placement of T-fasteners in high-risk patients may decrease overall morbidity if early tube dislodgement occurs. The findings show the safety of non-emergent endoscopic replacement of PEGs in certain patients. Early tube dislodgement may be a marker of overall mortality.

Cited by 29 publications

References 30 publications

Laparoscopic versus percutaneous endoscopic gastrostomy placement in children: Results of a systematic review and meta-analysis

Laparoscopic versus percutaneous endoscopic gastrostomy placement in children: Results of a systematic review and meta-analysis

T-Fastener Migration after Percutaneous Gastropexy for Transgastric Enteral Tube Insertion

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