Percutaneous endoscopic gastrostomy and gastrojejunostomy: a critical reappraisal of patient selection, tube function and the feasibility of nutritional support during extended follow-up☆,☆☆
Section snippets
Patients
All patients referred for PEG had an anticipated need for enteral nutrition of at least 4 weeks. The indication to extend the PEG into a JETPEG consisted of a documented history of reflux esophagitis or previous aspiration, the presence of gastric paresis or pancreatitis, diminished gag, swallow and cough reflexes in obtunded patients, intermandibulomaxillary fixation in trauma patients or artificial ventilation. The procedure was explained to outpatients and all materials to be used were shown
RESULTS
From November 1988 to December 1995, 286 patients, 147 male and 139 female, were referred for PEG. Patients were suffering from neurologic diseases such as ALS and cerebrovascular accident, mental-motor retardation because of cerebral palsy and metabolic diseases, and tumors of the head and neck. Some patients were admitted to the ICU for ventilatory support. The youngest patient was 6 weeks old, the oldest 85 years of age (Table 1).
DISCUSSION
Short-term prospective studies have demonstrated the superiority of a PEG over nasogastric feeding tubes in patients with dysphagia due to chronic neurologic disease.14, 15, 16, 17 Our long-term follow-up study, covering 275 patient-years, corroborated the beneficial short-term data. A procedure-related death rate of 1.0%, unsuccessful positioning in 6% and a major complication rate of 8.4% were in agreement with data from other large series that reported short-term18, 19, 20, 21, 22 and
References (34)
- et al.
Tube dysfunction following percutaneous gastrostomy and jejunostomy
Gastrointest Endosc
(1990) - et al.
Poor results with percutaneous endoscopic jejunostomy
Gastrointest Endosc
(1990) Perform JETPEG, not PED
Gastrointest Endosc
(1990)- et al.
Percutaneous endoscopic gastrostomy in patients with amyotrophic lateral sclerosis and impaired pulmonary function
Gastrointest Endosc
(1994) - et al.
Gastrostomy without laparotomy: a percutaneous endoscopic technique
J Pediatr Surg
(1980) - et al.
Percutaneous gastrostomy, a new simplified and cost-effective technique
Am J Surg
(1984) - et al.
Percutaneous endoscopic gastrostomy: indications, success, complications, and mortality in 314 consecutive patients
Gastroenterology
(1987) - et al.
Ethically justified, clinically comprehensive guidelines for percutaneous endoscopic gastrostromy tube placement
Lancet
(1997) - et al.
Predictors of outcome after percutaneous endoscopic gastrostomy: a community-based study
Mayo Clin Proc
(1992) - et al.
Percutaneous endoscopic gastrojejunostomy made easy: a new over-the-wire technique
Gastrointest Endosc
(1994)
Successful placement of percutaneous gastrojejunostomy using steerable glidewire: a modified controlled push technique
Gastrointest Endosc
Percutaneous endoscopic gastrostomy: an overview for 1996
Endoscopy
Percutaneous endoscopic gastrostomy: state of the art 1998
Endoscopy
Percutaneous endoscopic jejunostomy: long-term follow-up of 23 patients
Gastrointest Endosc
Limitations of percutaneous endoscopic jejunostomy
JPEN
Percutaneous endoscopic gastrojejunostomy: a dual center safety and efficacy trial
JPEN
Percutaneous endoscopic gastrostomy placement using the pull-through or push-through technique: is the second pass of the endoscope necessary?
Endoscopy
Cited by (94)
Rapid repair of percutaneous endoscopic gastrostomy tubes using three-dimensional printing: A case series
2023, Annals of 3D Printed MedicineLongitudinal complications associated with PEG: Rate and severity of 30-day and 1-year complications experienced by patients after primary PEG insertion
2021, Clinical Nutrition ESPENCitation Excerpt :Previous studies have tended to focus on the major complications related to or occurring at the time of physical insertion of the device, with only a minority reviewing longer-term complications. The rates of peristomal site infection are reported to range from 2.3% to 27.9% [4–9], tube leakage to range from 0.0% to 6.8% [4–6,8,9], dislodgement to be 12.8% [10] and minor bleeds to range from 1.4% to 9.7% [6–8] at 30-days. In addition, the 30-day mortality has been reported to be between 1.8 and 5.0% [6,11,12].
Multicenter cohort study of patients with buried bumper syndrome treated endoscopically with a novel, dedicated device
2021, Gastrointestinal EndoscopyGastrointestinal Complications of Neuromuscular Disorders
2021, Neuromuscular Disorders: Treatment and ManagementEndoscopic Enteral Access
2020, Surgical Clinics of North AmericaCitation Excerpt :This allows for postpyloric feeding while simultaneously decompressing the stomach for patients with significant gastroesophageal reflux, gastroparesis, history of inability to tolerate gastric feeds, recurrent aspiration events, or malignant gastric outlet obstruction not amenable to resection. However, this method has a high failure rate of up to 84% because the catheter frequently becomes malpositioned into the stomach.39–43 The JET catheter is also thin and easily clogged or kinked.
Estimating Adverse Events after Gastrostomy Tube Placement
2016, Academic PediatricsCitation Excerpt :Most studies have been case series of fewer than 300 patients where it is difficult to reliably quantify rare events such as mortality. One larger study that actively followed all patients studied to 30 days quantified the mortality rate at 6.7%.20 Other studies have varying follow-up periods (from in-hospital to convenience follow-up samples) demonstrate the presence of mortality, approximately 0.4% to 1%, yet the reliability of the estimates is unclear due to bias from small sample size and censoring.21–24
- ☆
Reprint requests: E. M. H. Mathus-Vliegen, MD, PhD, Department of Gastroenterology and Hepatology, C2-207, Academic Medical Center, Postbox 22660, 1100 DD Amsterdam, The Netherlands.
- ☆☆
0016-5107/99/$8.00 + 0 37/1/101475