Risk of Bleeding After Percutaneous Endoscopic Gastrostomy (PEG)

Singh, Diksha; Laya, Alexandra; Vaidya, Omkar U.; Ahmed, Syed; Bonham, Aaron J.; Clarkston, Wendell K.

doi:10.1007/s10620-011-1965-7

Cited by 40 publications

(16 citation statements)

References 48 publications

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“…Because of sharp-edged bump was passed out through esophagus by endoscopic method, anatomical variation might be the most important factor to increase mechanical complications. Recent other studies showed that aspirin and other antiplatelet agent use did not contribute to increase the bleeding during PEG placement (20, 21). Our study also showed that PEG tube replacement related-peristomal bleeding was rare (1.3%, 2/154), even with use of aspirin or antiplatelet agents despite of the methodological differences (PEG replacement vs PEG placement).…”

Section: Discussionmentioning

confidence: 97%

Comparison of Complications between Endoscopic and Percutaneous Replacement of Percutaneous Endoscopic Gastrostomy Tubes

et al. 2013

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When replacing percutaneous endoscopic gastrostomy (PEG) tubes, an internal bolster may be retrieved either percutaneously or endoscopically. The aim of this study was to compare the complications of percutaneous and endoscopic method during PEG tube replacement. The medical records of 330 patients who received PEG tube replacement were retrospectively analyzed. According to the removal method of internal bolster, we categorized as endoscopic group and percutaneous group. Demographic data, procedure-related complications and risk factors were investigated. There were 176 cases (53.3%) in endoscopic group and 154 cases (46.7%) in percutaneous group. The overall immediate complication rate during PEG tube replacement was 4.8%. Bleeding from the stoma (1.3%) occurred in percutaneous group, whereas esophageal mucosal laceration (7.4%) and microperforation (0.6%) occurred in endoscopic group. The immediate complication rate was significantly lower in the percutaneous method (OR, 6.57; 95% CI, 1.47-29.38, P=0.014). In multivariate analysis, old age was a significant risk factor of esophageal laceration and microperforation during PEG tube replacement (OR, 3.83; 95% CI, 1.04-14.07, P=0.043). The percutaneous method may be more safe and feasible for replacing PEG tubes than the endoscopic method in old patients.

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Section: Discussionmentioning

confidence: 97%

Comparison of Complications between Endoscopic and Percutaneous Replacement of Percutaneous Endoscopic Gastrostomy Tubes

et al. 2013

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“…Singh et al [5] retrospectively evaluated 1541 PEG patients and found postoperative bleeding in 51 cases (31%). According to these authors' definition, patients requiring 5 U or more blood transfusion, endovascular treatment, or surgical treatment were 'severe' cases -of which only one was noted, with hemostasis achieved by injecting epinephrine into the PEG site under endoscopy.…”

Section: Discussionmentioning

confidence: 99%

Pseudoaneurysm developed after percutaneous endoscopic gastrostomy

Shigoka

Maetani

Saito

2013

European Journal of Gastroenterology &Amp; Hepatology

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Percutaneous endoscopic gastrostomy (PEG) is widely performed. However, despite its widespread use, complications often follow and some of them are life-threatening. We report on two patients who developed pseudoaneurysm after PEG and how the bleeding was stemmed by transcatheter arterial embolization. Case 1 is an 84-year-old man. PEG by the pull method using One Step Button 24 Fr was performed. Blood-laced vomiting, followed by hemorrhagic shock was observed on day 21. Pseudoaneurysm less than 10 mm in diameter was observed in the gastroepiploic artery by urgent percutaneous abdominal angiography. A microcatheter was advanced selectively and the affected area was embolized by metallic coils and n-butyl cyanoacrylate. Case 2 is an 89-year-old man. PEG by the pull method using One Step Button 24 Fr was performed. On day 28, bleeding from the gastrostomy portion occurred and the patient went into shock. On urgent percutaneous abdominal angiography, pseudoaneurysm ∼5 mm in diameter was detected in the left gastric artery. A microcatheter was advanced selectively and the affected area was embolized by metallic coils and n-butyl cyanoacrylate. In the present two cases, gastrostomies were created in the anterior wall of the mid body portion as suitable for PEG position, but the bleedings occurred because of pseudoaneurysm formation accompanied by damage to the gastroepiploic or the left gastric artery. Those who perform PEG on a regular basis should be aware of the possibility of pseudoaneurysm as a serious adverse event.

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“…However, nonsteroidal anti‐inflammatory drugs (NSAIDs) may be continued if necessary 87 . With regard to PEG, many studies have demonstrated no increased risk of procedure‐related bleeding with aspirin and clopidogrel 81 , 82 , 88 – 91 . Even low molecular weight heparin (LMWH) does not appear to increase peri‐PEG bleeding risk 89 .…”

Section: Minor Complicationsmentioning

confidence: 99%

Long‐Term Nutrition

et al. 2016

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Long-term nutrition support requires long-term enteral access. To ensure the success of long-term enteral access, many factors need to be taken into consideration. This article represents a guide to placing and maintaining access in patients requiring long-term nutrition and addresses many of the common questions regarding long-term enteral access, such as indications, types of access, feeding after access placed, and recognition and treatment of potential complications. This guide will help the clinician establish and maintain access to maximize nutrition in patients requiring long-term nutrition.

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Risk of Bleeding After Percutaneous Endoscopic Gastrostomy (PEG)

Cited by 40 publications

References 48 publications

Comparison of Complications between Endoscopic and Percutaneous Replacement of Percutaneous Endoscopic Gastrostomy Tubes

Comparison of Complications between Endoscopic and Percutaneous Replacement of Percutaneous Endoscopic Gastrostomy Tubes

Pseudoaneurysm developed after percutaneous endoscopic gastrostomy

Long‐Term Nutrition

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