Risk factors for early and late procedure‐related adverse events in percutaneous endoscopic gastrostomy: A single center, retrospective study

Peveling‐Oberhag, Jan; Osman, I; Walter, Dirk; Filmann, Natalie; Stratmann, Katharina; Hausmann, Johannes; Knop, Viola; Waidmann, Oliver; Vermehren, Johannes; Herrmann, Eva; Zeuzem, Stefan; Friedrich‐Rust, Mireen; Blumenstein, Irina; Albert, Jörg G.

doi:10.1111/jgh.14407

Cited by 11 publications

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References 22 publications

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“…This study reports a complication rate of 22.2%. According to previous reports, the complication rate ranges between 13.2 and 50.1% 10,13,28,30,31 . The large variance between these results may be attributed to the following: the short follow‐up time of the patient in most of these studies, the difference in the number of patients in each study, or how major and minor complications were defined.…”

Section: Discussionmentioning

confidence: 97%

“…Several studies have been carried out that identified high levels of CRP, low levels of serum albumin, hypernatremia, advanced age, malnutrition, presence of comorbidities, advanced stages of cancer as risk factors associated with complications, and mortality. 10,11,13,[17][18][19][20][21][22][23][24][25][26][27][28][29][30] This study reports a complication rate of 22.2%. According to previous reports, the complication rate ranges between 13.2 and 50.1%.…”

Section: Discussionmentioning

confidence: 99%

“…According to previous reports, the complication rate ranges between 13.2 and 50.1%. 10,13,28,30,31 The large variance between these results may be attributed to the following: the short follow-up time of the patient in most of these studies, the difference in the number of patients in each study, or how major and minor complications were defined. By comparison, the rate of major complications was 3.9%, in which 11 (73.3%) of the major complications occurred during the first week, with major bleeding being the most frequent complication followed by sepsis and aspiration pneumonia, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Factors predicting major complications, mortality, and recovery in percutaneous endoscopic gastrostomy

et al. 2021

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Background and Aim: Percutaneous endoscopic gastrostomy (PEG) has been used in patients with dysphagia and inadequate food intake via an oral route. Despite being a procedure with a high success rate, complications and death have been reported. The aim was to identify the factors related to major complications and mortality, as well as PEG removal prognostic factors due to improvement of their general condition. Methods: Patient characteristics, comorbidities, laboratory data, concomitant medication, sedation, and indication for PEG placement were collected. Major complications, mortality, and PEG removal factors were assessed. Results: A total of 388 patients were enrolled. There were 15 (3.9%) cases of major complications, with major bleeding being the most frequent in 6 (1.5%) patients. Corticosteroids were the independent variable associated with major complications (odds ratio [OR] 5.85; 95% confidence interval [CI] 1.71-20; P = <0.01). Advanced cancer (hazard ratio [HR] 0.5; 95% CI 0.3-1; P = 0.05), albumin (HR 0.6; 95% CI 0.4-0.9; P = <0.01), and C-reactive protein (CRP) (HR 1.1; CI 1-1.2; P = 0.01) were considered risk factors for mortality. Previous pneumonia (HR 0.4; CI 0.2-0.9; P = 0.02) was a factor for permanent use of a PEG; however, oncological indication (HR 8.2; CI 3.2-21; P = <0.01) was factors for PEG withdrawal. Conclusions: Chronic corticosteroid users potentially present with major complications. Low albumin levels and elevated CRP were associated with death. Previous aspiration pneumonia was a factor associated with permanent use of PEG; however, patients with oncological indication were the most benefited.This data suggest that it is important to identify the risk factors associated with PEG complications and mortality, so that clinicians can better identify which patients will benefit from PEG placement, thus avoiding unnecessary morbidity and mortality.The aim of this study is to identify the factors related to major complications and mortality, as well as PEG removal prognostic factors in those patients due to improvement of their general condition. MethodsStudy design and data collection. The study included the medical charts of 400 consecutive patients who underwent PEG placement between January 2012 and December 2019 at Keio university hospital in Tokyo, Japan. This study was approved by the ethics committee of the same institution (Approval No. 20200268).

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Factors predicting major complications, mortality, and recovery in percutaneous endoscopic gastrostomy

et al. 2021

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“…The significance of the correct handling arises from the fact that in a real examination, a blunt puncture could constitute a risk to patient safety, for example bleeding. The risk of bleeding amounts to less than 0.01–0.9% in these examinations [29, 31].…”

Section: Discussionmentioning

confidence: 99%

Development and Pilot Validation of an Instrument Assessing Sensorimotor Skills for Percutaneous Gastral Puncture

et al. 2020

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Introduction: The acquisition of sensorimotor skills, so-called “technical skills”, plays an essential part in the professional and continuing educational training of medical and nursing staff. Facilities turn to simulator training to promote the safe and accurate performance of endoscopic examinations. Thus, this study aimed to develop and pilot-test a corresponding assessment instrument to monitor necessary sensorimotor or “technical” skills of the examiner for a safe percutaneous endoscopic gastrostomy (AS-PEG). Materials and Methods: Instrument development and pilot validation involved four stages: identification of potential items and initial draft of the AS-PEG; expert panel with 11 experts (content validity index [CVI] calculated); empirical validation using a quasi-experimental intervention on simulators; revision of the pilot AS-PEG taking expert assessment, and empirical testing into consideration. Results: The initial instrument yielded 13 categories and 44 items describing the PEG procedure. Experts rated 30 out of 44 items (68%) extremely or very important for the safety of the puncture of the stomach. Initial item-CVIs ranged from 0.00 to 1.00; scale-CVI was 0.61. Twenty-four trainees (7 physicians, 17 nurses) participated in the pilot simulation study. On average, 8:25 min were required for PEG placement (min–max 5:59–13:38 min, SD = 1:43). The revised AS-PEG version was reduced to 14 items with a range of the item CVI from 0.8 to 1.0, and a scale-CVI of 0.90. Conclusion: The AS-PEG instrument facilitates the evaluation of sensorimotor skills during percutaneous gastric puncture procedures within the context of PEG placement, across professions and without relating to the number of procedures previously performed. The instrument is economical and shows satisfying content validity.

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“…Overall, enteral nutrition via PEG tube has been shown to be safe and effective in patients with HNC . Although PEG insertion is considered a routine procedure, it is not without risk of immediate or delayed complications . Approximately, 8%‐30% of patients suffer from complications during or after PEG insertion .…”

Section: Introductionmentioning

confidence: 99%

Prophylactic percutaneous endoscopic gastrostomy in patients with head and neck cancer: Influence on nutritional status, utilisation rate and complications

et al. 2019

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractBackground: Patients with head and neck cancer (HNC) are at high risk for malnutrition because of tumour localisation and therapy. Prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement is common practice to prevent malnutrition.Objective: To investigate the benefits of prophylactic PEG tube placement for HNC patients in terms of the influence on patients' nutritional status, utilisation rate, complications and to identify the predictors of PEG tube utilisation. Methods:All consecutive HNC patients who underwent prophylactic PEG tube insertion between 1 January 2011 and 31 December 2012 prior to therapy were enrolled. The PEG tube utilisation rate, complications, the patients' nutritional status and tumour therapy were evaluated with the help of electronic patient charts and telephone interviews.Results: A total of 181 patients (48 female, median 67.5 years) were included. The PEG utilisation rate in the entire cohort was 91.7%. One hundred and forty-nine patients (82.3%) used the PEG tube for total enteral nutrition, 17 patients (9.4%) for supplemental nutrition and 15 patients (8.3%) made no use of the PEG tube. Peristomal wound infections were the most common complications (40.3%) in this study. A high Nutritional Risk Screening (NRS) score prior to tube insertion was found to be independently associated with PEG utilisation. No significant weight changes were observed across the three patient subgroups. Conclusions:The overall PEG tube utilisation rate was high in this study. However, given the high rate of infections, diligent patient selection is crucial in order to determine which patients benefit most from prophylactic PEG tube insertion. Entire cohort N = 161 Amount of total positive findings, N (%) 70 (43.48) Diagnosis during EGD Gastritis, N(%) 24 (34.29) Gastric erythema, N (%) 19 (27.14) Reflux oesophagitis, N (%) 4 (5.71) Gastric ulcus, N (%) 6 (8.57) Duodenal ulcus, N (%) 3 (4.29) Malignant duodenal tumour, N (%) 1 (1.43) Hiatal hernia, N (%) 6 (8.57) Erosive oesophagitis, N (%) 4 (5.71) Glycogen acanthosis N (%) 3 (4.29)

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Risk factors for early and late procedure‐related adverse events in percutaneous endoscopic gastrostomy: A single center, retrospective study

Cited by 11 publications

References 22 publications

Factors predicting major complications, mortality, and recovery in percutaneous endoscopic gastrostomy

Factors predicting major complications, mortality, and recovery in percutaneous endoscopic gastrostomy

Development and Pilot Validation of an Instrument Assessing Sensorimotor Skills for Percutaneous Gastral Puncture

Prophylactic percutaneous endoscopic gastrostomy in patients with head and neck cancer: Influence on nutritional status, utilisation rate and complications

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