Aktuelle Ernährungsmedizin 2015; 40 - P4_3
DOI: 10.1055/s-0035-1550217

Percutaneous endoscopic gastrostomy (PEG) – alternatives in complicated patients

P Kohout 1, Z Antos 1, M Rozmahel 1, G Puskarova 1, M Cernik 1, D Cermakova 1, J Vejmelka 1, Z Benes 1
  • 1Department of Internal Medicine, Thomayer's Hospital, Prague, Czech Republic

Introduction: Percutaneous endoscopic gastrostomy (PEG) is safe and easy to perform method for patients with indication of enteral nutrition for more than 4 – 6 weeks. The gold standard is pull method by Gauderer-Ponsky (first introduced 1980). In aprox. 10% of the patients there is not possible to introduce PEG this way (contraindication, anatomical or technical complications, prevention of complications, losing diaphanoscopy) and the other methods are performed (push through – by Russell, transthoracal introduction, transnasal endoscopy, percutaneous endoscopic jejunostomy). The experience of one center are published.

Methods: 152 patients (from 1142) were contraindicated for introduction of PEG by the pull method (113 indicated from another hospitals). Ways of applications, rate of success and complications were counted.

Results: Since October 2002 to October 2014 there were 1158 PEGs (incl.PEJs) introduced in 1142 patients (average age 68,5 years (2 months – 98 years), 559 men, 583 women). In 66 patients with Head and neck tumours was introduced PEG by push through technique (Russell) because of stenosis, infiltrstion of mouth and risk of implantation metastases), in 8 patients by transnasal endoscopy. 51 patients after stomach resection was indicated to PEG, only 1 unsuccesful attempt, in 9 patients PEJs and in 2 transthoracal application. In 12 patients with stomach cancer (contraindicaiton of PEG) was jejunostomy (PEJ) succesfully introduced. In 23 patients with absence of diaphanoscopy (contraindication of PEG) were PEG or PEJ succesfully introduced in 22 patients using ultrasonography and X-ray assistence. Rate of complication was 5,6%, only 0,55% were severe complications, the most frequent were infections of stoma site.

Conclusion: PEG is safe and easy to perform method. In complicated situations and relative contraindications should be contacted experienced PEG center with minimally 50 introductions per year to increase the success rate and to decrease the rate of complications.

References:

[1] Gauderer, MWL., Ponsky, JL., Izant, RJ.Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J. Pediatr. Surg., 1980, 15, p. 872 – 876

[2] Kohout, P., Skládaný L.: Percutaneous endoscopis gastrostomy, Prague, Galén, 200