Z Gastroenterol 2010; 48 - P033
DOI: 10.1055/s-0030-1263477

Evaluation of complications after PEG-placement without prophylactic antibiotics

T Kratt 1, D Stüker 1, K Angelova 1, M Küper 1, M von Feilitzsch 1, T Meile 1, I Werling 1, T Nesch 1, K Schröppel 2, KE Grund 1, A Königsrainer 1
  • 1Universitätsklinikum Tübingen, Allgemeine, Viszeral- und Transplantations-Chirurgie, Tübingen, Germany
  • 2Institut für Mikrobiologie der Universität Tübingen, Tübingen, Germany

Aims: Though many PEG studies are available, they show inconsistent results concerning early and late complications with a range of 3–70%.

Methods: Retrospective single center study of 2052 patients with PEG placement in pull-through-technique between 1990 and 2005. No routinely given prophylactic antibiotics in all cases. Evaluation of early (up to 30 days after PEG) and late complications (more than 30 days after PEG). Mean follow-up 5 months (0.5 to 55 months).

Results: 2038 adult patients (range 18–94 years. Indications: Malignant diseases: 56% (259 patients with prophylactic PEG placement and 882 PEG placements after radiochemotherapy), neurological diseases: 34%, other indications: 10.1%. Early complications in 14.8%: peristomal infection 11.6%, accidental puncture of nearby organs 0.15%, peritonitis 0.5%, abdominal wall abscess 0.1%, metachroneous bleedings 2.3%, PEG-related mortality 0.15% (3 cases). Late complications in 13.6%: peristomal infection 4.6%, abdominal wall abscess 0.05%, peristomal hypergranulations 1.7%, buried-bumper-syndrome 2.0%, tube occlusion/PEG damage 5.3%. Evaluation of all early and late PEG infections (KÜLLING classification): Grade I: 81.4% (local therapy sufficient), grade II: 15.3% (local therapy and systemic antibiosis), grade III: 3.3% (surgical intervention necessary).

Significant differences (p<0.05) regarding the risk of infections: 1. Local infection rate subject to the underlying disease (at risk: patient with malignancies) and 2. PEG placement in patients with malignancies before or after radiochemotherapy (at risk: patients with prophylactic PEG placement).

No significant differences were found concerning patients with intensive care stay vs. regular in-patient stay, age and sex of patient, clinical experience of the endoscopist.

Conclusion: Peristomal infections represent the main problem after PEG placement. Most of them were sufficiently treated by local therapy, only in few cases surgical intervention was necessary (3.3%). Surprisingly patients suffering from cancer with prophylactic PEG placement developed significantly more infectious complications than all other groups. Therefore we recommend a restricted indication of prophylactic PEG placement and a periinterventional antibiosis respectively.